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Flu Myths: Dispelling the Myths Associated With Live Attenuated Influenza Vaccine

  • Pritish K. Tosh
    Affiliations
    Vaccine Research Group, Mayo Clinic, Rochester, MN

    Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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  • Thomas G. Boyce
    Affiliations
    Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN
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  • Author Footnotes
    1 Dr Poland is the chair of a data safety monitoring committee for a novel influenza vaccine being developed by Merck Research Laboratories. He is an investigator for an influenza clinical trial funded by Protein Sciences and has offered consulting advice on influenza vaccines to GlaxoSmithKline, Novartis, CSL Ltd, Novavax, Dynavax, and PowderMed. Dr Boyce is on the Speaker's Bureau for Sanofi-Pasteur and MedImmune.
    Gregory A. Poland
    Correspondence
    Individual reprints of this article are not available. Address correspondence to Gregory A. Poland, MD, Vaccine Research Group, Mayo Clinic, 200 First St SW, Rochester, MN 55905
    Footnotes
    1 Dr Poland is the chair of a data safety monitoring committee for a novel influenza vaccine being developed by Merck Research Laboratories. He is an investigator for an influenza clinical trial funded by Protein Sciences and has offered consulting advice on influenza vaccines to GlaxoSmithKline, Novartis, CSL Ltd, Novavax, Dynavax, and PowderMed. Dr Boyce is on the Speaker's Bureau for Sanofi-Pasteur and MedImmune.
    Affiliations
    Vaccine Research Group, Mayo Clinic, Rochester, MN
    Search for articles by this author
  • Author Footnotes
    1 Dr Poland is the chair of a data safety monitoring committee for a novel influenza vaccine being developed by Merck Research Laboratories. He is an investigator for an influenza clinical trial funded by Protein Sciences and has offered consulting advice on influenza vaccines to GlaxoSmithKline, Novartis, CSL Ltd, Novavax, Dynavax, and PowderMed. Dr Boyce is on the Speaker's Bureau for Sanofi-Pasteur and MedImmune.
      Live attenuated influenza vaccine (LAIV), commercially available since 2003, has not gained widespread acceptance among prescribers. This underuse can be traced to several misperceptions and fears regarding LAIV. This review examines both the facts (safety, immunogenicity, and effectiveness) and the most pervasive myths about LAIV. Live attenuated influenza vaccine is a safe, highly immunogenic, and effective vaccine. It is well tolerated; only mild and transient upper respiratory infection symptoms occur with LAIV vs placebo, even in higher-risk patients with asthma or the early stages of human immunodeficiency virus. It is immunogenic, especially in induction of mucosal immunity. In certain populations, LAIV is as effective as, and in some cases more effective than, inactivated influenza in preventing influenza infection. It appears to be more effective in preventing influenza infection than trivalent inactivated influenza vaccine when the vaccine virus strain does not closely match that of the circulating wild-type virus. Many myths and misperceptions about the vaccine exist, foremost among them the myth of genetic reversion. Independent mutation in 4 gene segments would be required for reversion of the vaccine strain of influenza virus to a wild type, an unlikely and as yet unobserved event. Although shedding of vaccine virus is common, transmission of vaccine virus has been documented only in a single person, who remained asymptomatic. In the age groups for which it is indicated, LAIV is a safe and effective vaccine to prevent influenza infection.
      ACIP ( Advisory Committee on Immunization Practices), HAI ( hemagglutination inhibition assay), HIV ( human immunodeficiency virus), LAIV ( live attenuated influenza vaccine), TIV ( trivalent inactivated influenza vaccine)
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