By Teresa Conrick
In June of this year, something odd happened at the annual CDC’s Advisory Committee on Immunization Practices (ACIP). They voted that the nasal flu vaccine or more precisely, that the "live attenuated influenza vaccine (LAIV)" should not be used during the 2016-2017 flu season. Here's a brief history of LAIV:
- June 17, 2003 - FDA approves nasal spray flu vaccine invented at U-M
- FluMist is a cold-adapted, live-attenuated, trivalent influenza virus vaccine.
- A trivalent vaccine, like the flu shot, it includes three different strains of vaccine.
In 2009, H1N1 was all the rage:
- The 2009 H1N1 nasal spray vaccine is being made in the same way as the seasonal nasal spray vaccine, but instead of containing three weakened live flu viruses, it only contains weakened 2009 H1N1 virus.
Then, in 2012, a new formula and here is the FDA approval: "February 29, 2012 Approval Letter - FluMist® Quadrivalent"
- We have approved your request to supplement your biologics license application for Influenza Vaccine Live, Intranasal, to include a quadrivalent formulation containing two influenza A subtype viruses and two type B viruses.
- FluMist Quadrivalent is a vaccine indicated for active immunization for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine. FluMist Quadrivalent is approved for use in persons 2 through 49 years of age.
Well that may have been a big mistake. "Concerns or controversial issues" were to come but not by the FDA nor the CDC:
June 2014 - CDC Gives Preference to LAIV:
- The preferential recommendation for using the nasal-spray vaccine (also known as live attenuated influenza vaccine, or LAIV) in young children was made in June 2014, the CDC noted.
- It was based on evidence gathered over several flu seasons that it offered better protection than inactivated flu vaccine (IIV, or injected vaccine) did. LAIV, made by MedImmune, is sold as FluMist.
Thursday, February 26, 2015:
- Today the Advisory Committee on Immunization Practices (ACIP) voted on its annual influenza vaccine recommendations for 2015-2016....ACIP did not renew the 2014-2015 preference for using the nasal spray flu vaccine (i.e., LAIV) instead of the flu shot (i.e., IIV) in healthy children 2 through 8 years of age..
- The decision not to renew the preferential recommendation was made based on new data from more recent seasons which have not confirmed superior effectiveness of LAIV observed in earlier studies. ACIP recommends that children 6 months and older get an annual influenza vaccine with no preference stated for either the nasal spray vaccine or the flu shot.
Which brings us to present day and yet another change -- DO NOT USE the nasal flu vaccine -- says CDC, who has now changed its tune:
CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017....or to put it another way on that same page - The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. There is no preference for one vaccine over another among the recommended, approved injectable influenza vaccines.
That seems to have a kind of important yet mysterious tone.
What made me wonder about all of this was back in 2014, I had been looking at some vaccines that seemed to show a pattern of changing the Microbiome -- and not in a good way. The live attenuated influenza vaccine ie, FluMist, was one of them:
Live Attenuated Influenza Vaccine Enhances Colonization of Streptococcus pneumoniae and Staphylococcus aureus in Mice (February, 2014)
...Community interactions at mucosal surfaces between viruses, like influenza virus, and respiratory bacterial pathogens are important contributors toward pathogenesis of bacterial disease. What has not been considered is the natural extension of these interactions to live attenuated immunizations, and in particular, live attenuated influenza vaccines (LAIVs). Using a mouse-adapted LAIV against influenza A (H3N2) virus carrying the same mutations as the human FluMist vaccine, we find that LAIV vaccination reverses normal bacterial clearance from the nasopharynx and significantly increases bacterial carriage densities of the clinically important bacterial pathogens Streptococcus pneumoniae (serotypes 19F and 7F) and Staphylococcus aureus (strains Newman and Wright) within the upper respiratory tract of mice. Vaccination with LAIV also resulted in 2- to 5-fold increases in mean durations of bacterial carriage. Furthermore, we show that the increases in carriage density and duration were nearly identical in all aspects to changes in bacterial colonizing dynamics following infection with wild-type (WT) influenza virus. Importantly, LAIV, unlike WT influenza viruses, had no effect on severe bacterial disease or mortality within the lower respiratory tract. Our findings are, to the best of our knowledge, the first to demonstrate that vaccination with a live attenuated viral vaccine can directly modulate colonizing dynamics of important and unrelated human bacterial pathogens, and does so in a manner highly analogous to that seen following wild-type virus infection....
It is rather alarming that in 2014, a study shows that vaccination with a live attenuated viral vaccine can cause VERY important changes in the quantity of pathogenic bacteria (Streptococcus pneumoniae and Staphylococcus aureus). The researchers also point out -- our findings suggest a role for laboratory models of multispecies interactions with vaccine strains to inform future vaccine monitoring and evaluation programs aimed at identifying thus far entirely unrealized “unconventional” effects, both beneficial and detrimental, of live attenuated viral vaccines and cross-species microbial dynamics.
SO important and the value of this research cannot be denied. Then another study, similar and with the same profound results came out, Live Attenuated Influenza Virus Increases Pneumococcal Translocation and Persistence Within the Middle Ear, 2014 Dec 11:
Within 12 hours after LAIV inoculation, mice demonstrated an increased incidence of MEC (bacterial middle ear colonization)...The duration of MEC was measured for each episode per mouse, as defined above, and mean durations were calculated for each group. The duration was significantly increased across all vaccinated groups, regardless of pneumococcal strain.....
And still another study demonstrates the same - The administration of intranasal live attenuated influenza vaccine induces changes in the nasal microbiota and nasal epithelium gene expression profiles, December 15, 2015
To examine how viral infections and host antiviral immune responses alter the upper respiratory microbiota, we analyzed nasal bacterial composition by 16S ribosomal RNA (rRNA) gene sequencing in healthy adults at baseline and at 1 to 2 weeks and 4 to 6 weeks following instillation of live attenuated influenza vaccine or intranasal sterile saline....We found that live attenuated influenza vaccination led to significant changes in microbial community structure, diversity, and core taxonomic membership as well as increases in the relative abundances of Staphylococcus and Bacteroides genera....
This study is not about administering a live virus vaccine to the nose but tells us how that increased S. pneumoniae bacteria can spread from person to person.
Here, we show that increasing the bacterial load in the nasal cavity of colonized individuals as well as inducing an inflammatory response in naive “contact cases” facilitates the spread of pneumococci.
And that is a worry. Is it enough to have the live attenuated influenza vaccine, once the darling of CDC, chopped off the preferred list and now chopped off completely this year with maybe not the whole story from them? With CDC not always being transparent, it is a possibility.
Another big concern is that there are increasing numbers of older folks who have been exposed to S. pneumoniae via this vaccine. We also have increasing numbers of children being diagnosed with PANDAS, PANS, and Autism. There are connections here that warrant more investigations. This vaccine can not only effect the individuals who received it but also those who are exposed to them. From one of the above studies:
In the context of LAIV, one could envision a situation whereby a vaccinated individual with elevated bacterial carriage titers may not himself or herself be susceptible to bacterial disease but instead may act as a reservoir for increased transmission. Such a scenario might be particularly important, for example, between young children and grandparents or other elder individuals already having increased susceptibility to pneumococcal disease.(12) Additionally, although LAIV is not recommended for immunocompromised individuals, an unintended LAIV effect of increased bacterial transmission might have an important impact on bacterial disease in immunocompromised contacts.
And from one of many parents:
Both girls had first ever Flu Mist in Dec (5 yrs ago). Both were diagnosed w/ strep and PANDAS within 2-3 mos.
Now I should end here but I do need to mention that the live attenuated influenza vaccine is now used in England as reported brilliantly by our own John Stone. I see no changes happening there and one would truly wonder how that's possible but also how and why a PANDEMIC version of the live attenuated influenza vaccine is being discussed POSITIVELY with all of this research known of the dangers?
Teresa Conrick is Contributing Editor to Age of Autism.CDC