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Healthy living: the other flu fighter

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With flu shots unavailable for millions, many people have shrugged off another form of flu vaccine approved for healthy children 5 and older and adults through age 49.

New lots of the nasal spray FluMist, made with live but weakened flu virus, are in shipment this week and will begin hitting pharmacies and doctors' offices soon.

After vaccine manufacturer Chiron announced in October that it could not meet its flu vaccination orders, MedImmune, which manufactures FluMist, increased production from 1.1 million doses to 3.1 million doses.

FluMist isn't flying out of the refrigerators it must be stored in, however. Several doses of FluMist are sitting unused in freezers in pharmacies throughout the metro area, calls on Friday showed.

Given the lack of traditional vaccine available in shot form, doctors and other health care professionals suggest that people ask their physicians whether the vaccine is a good choice for them. They note that it may be particularly helpful for certain groups of people, such as those who travel frequently and parents of healthy infants and toddlers but stress that it is only for healthy people from 5 to 49.

"It's not for people in high risk groups, and that's a drawback, but it works well in the group who can take it," said Tony Sarrantonio, a pharmacist and manager of Concord-Carlton's Pharmacy. "I've had a lot of repeat customers from last year who are happy with it. "

FluMist, first marketed in 2003 to the enthusiasm met by the Edsel or New Coke, does have some drawbacks. It costs more than a flu shot --- $40 to $50, depending on who is giving the dose, compared with the flu shot's $12 to $20. Children 14 and younger must have a prescription, which means a visit to the doctor and another fee, driving up the cost.

Because it is made with live but weakened virus, those vaccinated can show mild symptoms of the flu. It is therefore never advised for people with underlying medical conditions such as asthma, a suppressed immune system or even those living in a household with someone whose immune system is vulnerable. Health care workers also are advised not to take FluMist because they can shed the virus and infect people.

For doctors, it can be a hassle simply because it must be kept frozen until administered.

Many metro doctors and pharmacists who have administered it, however, said they have seen few side effects. In the right circumstances, doctors said it is a safe and effective way to prevent getting the flu.

Sarrantonio said customers in his pharmacy have been particularly pleased that manufacturer MedImmune dropped the price this year.

A dose last year ran as high as $100 if administered in a doctor's office, and many physicians chose not to even carry it because of the high cost. Its availability is apparently unpredictable across the metro area. Many pediatricians said they did not even order it, and some pharmacies chose not to stock it.

After having to destroy 80 percent of the 4 million to 5 million doses manufactured last year, MedImmune cut production this flu season to 1.1 million doses, said company spokeswoman Jamie Lacey. It also dropped the wholesale price from $46 to $16.

After the British government refused to let Chiron distribute its flu vaccine because of contamination in its Liverpool factory, MedImmune went back to its bulk supply and ramped up production of FluMist, Lacey said. The company produced 2 million more doses. About one-third to one-half of those doses are in shipment, Lacey said.

But it's still a gamble for MedImmune. This year, many people are confused about whether to take the nasal spray, said Dr. Harry Keyserling, professor of pediatrics and infectious diseases at Emory School of Medicine. That may be due in part to a mixed public health message.

"People have been told they are low risk and to be a good citizen and to not worry," Keyserling said.

That may be true for healthy people between 5 and 49, but the spray flu vaccine can prevent other flu losses, such as time off from work and school, and feeling horrible for three to five days.

For these reasons, the spray is an option that eligible people may want to consider, some experts said.

"It's up to the patient," said Keyserling, who noted that no Emory health care workers were vaccinated with the nasal spray because of its propensity to cause symptoms. "They need to check first with their health care providers to see if they have it."

In Georgia, kids 14 and younger must receive their dose from a doctor, but those from 14 to 49 can receive FluMist from a pharmacist. Before they can receive the dose, however, patients must complete a short screening form provided by the Centers for Disease Control. If they answer no to all questions, they can get FluMist.

Parents who decide FluMist might be an option for their children should first consult with their pediatrician, Keyserling said, especially since not all pediatricians even stock FluMist. > On the Internet:

Copyright 2004 The Atlanta Journal-Constitution


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