Talk:Live attenuated influenza vaccine

message: Is it me or does this page seem a lot like an advertisement? ArmyOfFluoride (talk) 09:00, 9 January 2009 (UTC)
replies: text: an ad with lots of pesky footnotes.  —Preceding unsigned comment added by 68.166.205.33 (talk) 22:03, 14 January 2009 (UTC)
thread_title: Suspect?

message: Please feel free to provide additional information to this comment, and to consider it for inclusion in the main article whenever it is ready.   
Recovery from live influenza virus infection is known to induce broad immunity against other influenza types.  Flumist is a live attenuated vaccine, and as such, arouses a broad immune response:  
:With the use of live attenuated vaccines, it is possible to stimulate mucosal and cell-mediated immunological responses of a similar kind to those elicited by natural influenza infection. 
Thus Flumist may confer immunity against influenza-A beyond that developed in response to IM shots since Flumist is actually a tiny proprietary flu tweaked each year to display the surface antigens of the season's three chosen vaccine viruses.  The base virus is live but weakened so as to cause no significant symptoms and be easily overcome by the immune system.  Flumist thus provides the body the opportunity to develop broad immunity by fighting off a live virus infection.  This immunity includes the formation of antibodies in the blood similar to those the body produces in response to needle vaccination (called humoral immunity).  Humoral immunity in those who receive either Flumist or a needle-injected vaccine helps many of them to nip a nascent flu infection in the bud, to recover quickly, and to have only mild symptoms or none at all.  Humoral immunity from shots lasts only a few months, so that shots are timed each year to be administered at the beginning of the flu season.  The immunity arising when Flumist arouses the immune system to repel an attack from an actual weakened virus bearing the surface antigens of the season's three chosen influenza candidates appears to be much longer lasting than the immunity produced by the body in response to needle administration of killed viruses.  Flumist immunity probably lasts at least a year and possibly multiple years.  
Studies indicate that in response to Flumist innoculation the body also develops mucosal immunity (so that flu viruses never enter the bloodstream), humoral immunity that may stop any viruses found in the blood, and cellular immunity, so that any cells nonetheless invaded by a flu seeking to enter and replicate itself recognize the invader and mount a vigorous defense.  The result is a three-part immunity -- mucosal, humoral, and cellular.  This three-pronged defense is potentially more robust, as well as longer-lasting, than the isolated humoral immunity developed in response to current needle injected dead vaccines.  
Broad mucosal immunity was noted in trials of an H5N1 nasal spray vaccine tested in Japan.  No pain as Japan develops nasal spray bird flu vaccine Wed Mar 12, EThttp://news.yahoo.com/s/afp/20080312/hl_afp/healthflujapanvaccine 
—Preceding unsigned comment added by 67.101.68.153 (talk) 21:23, 29 October 2007 (UTC)
thread_title: Flumist may yield more robust and longer-lasting immunity than older injected vaccines

message: "Seasonal Flu Vaccination May Offer Partial Immunity to H5N1" reports Eric Toner, M.D. summarizing research studies revealing the protective effect of seasonal flu vaccinaton against H5N1.  Dr. Toner reports for Clinitians' Biosecurity Network.  Dr.Toner's report is available at: http://www.upmc-cbn.org/report_archive/2007/02_February_2007/cbnreport_02212007.html    
At least two separate human studies to date indicate  that annual flu shots may be protective against H5N1. In one, scientists from St. Jude's, summarize findings in animals and humans and conclude that
"Overall, these findings raise the possibility that seasonal influenza vaccination may provide some protection against pandemic H5N1l."  
RESEARCH ARTICLE
Cross-Reactive Neuraminidase Antibodies Afford Partial Protection against H5N1 in Mice and Are Present in Unexposed Humans
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040059&ct=1&SESSID=1386b277eb2b6128495454737b76f5d2 
 
These studies suggest that it is prudent for individuals to seek vaccination for themselves and their families, and for governments to promote wide vaccination to create a herd immunity effect to slow contagion until more specific vaccines can be developed.
Aside from developing a pandemic-specific vaccine (the benefits and risks of which are explored in the above CIDRAP note) it is possible that the long-lasting immune response to FluMist may be broad enough in scope to provide some protection, albeit unknown and probably weak, against an "bird flu" pandemic (e.g. an H5N1 influenza Type-A that has become human adapted) .  
First, inoculation with a live weakened influenza may serve to protect against a Type-A H5N1 "bird flu" influenza pandemic that breaks out the same year because fighting off any live Type-A influenza virus gives the immune system strong and long-lasting immunity against other Type-A influenza.  FluMist inoculation actually lets the inoculated person's immune system gain experience fighting off an actual flu with the surface antigens of the three flus selected for vaccination that year.  The immune system thus gains experience similar to that it would gain fighting off a three tiny weakened flus -- two Type-A flus and one Type-B flu.  There is good reason to hope that the resultant immunity would be broad -- it is almost unheard-of for a person with a functioning immune system to come down with any form of influenza a second time within a year of catching any other form.  Epidemiologists well recognize this effect, because as a result flu years tend to alternate with either an H3N2 strain or an H1N1 type influenza strain predominating, almost to the exclusion of the other.  This suggests that infection with one, (In recent years often H3N2), confers residual immunity to the other (recently H1N1), so that the one that breaks out first and reaches the susceptible population leaves that population (after fight off the first Type-A influenza to emerge) with an immunity broad enough to prevent the other strain from getting a start. This well-recognized effect directly affects vaccine formulation.  Because there is no certainty in advance whether the coming season will be an H2N3 season or an H1N1 season, each year's flu vaccinations, FluMist and needle delivery alike, include both an H2N3 and an H1N1 Type-A influenza (as well as one Type-B).  (The two Type-A strains are the H2N3 and H1N1 strains, respectively, that are deemed to be the most likely candidate for breaking out during the season ahead).  
Second, and related, FluMist inoculation results in a three-prong immune reaction resulting in enhanced immune function against all flus at the mucosal, blood (humoral) and cellular level. This immune reaction has been shown in some studies to be broad enough to give at least some protection against even influenza A strains different from the ones included in preparing that year's vaccination.  It is unknown whether this immunity might extends to an H5N1 strain, but there no reason to show that it would not.  While humoral immunity (blood antibodies) tends to be somewhat strain-specific, mucosal and cellular immunity may be much broader.  Additionally, young children are immuno-naive as to common flus, while adult immune systems have generally grown more sophisticated through prior exposure.  Recent studies have shown that in this immuno-naive group, FluMist was markedly more effective at reducing influenza infection.  A pandemic is a pandemic specifically because the entire population is immuno-naieve to the novel emergent strain, to which even adults have had no prior exposure.  If FluMist protects the immuno-naive through non-strain-specific immunity, it might logically provide some protection against an H5N1 strain.  As set out below, the blood of adults immunized against seasonal flu shows immune activity against H5N1, and animals nasally vaccinated against seasonal flu survived H5N1 challenge when unvaccinated animals did not.   
 
Both seasonal flu vaccines (including FluMist) include an H1N1 strain with its N1 antigen, and "bird flu" H5N1 also has an N1 antigen.  Italian scientists were curious whether the inclusion of an N1 antigen from each season's H1N1 might result in protection against the N1 antigen in an H5N1 strain. An experiment was done exposing the blood of vaccinated and unvaccinated humans to H5N1 (in a test tube) and the blood of vaccinated humans showed more immune response. "We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors."  http://www.cdc.gov/eid/content/14/1/121.htm
Volume 14, Number 1–January 2008
Research
Cross-subtype Immunity against Avian Influenza in Persons Recently Vaccinated for Influenza
Cristiana Gioia,* Concetta Castilletti,* Massimo Tempestilli,* Paola Piacentini,* Licia Bordi,* Roberta Chiappini,* Chiara Agrati,* Salvatore Squarcione,* Giuseppe Ippolito,* Vincenzo Puro,* Maria R. Capobianchi,* Comments to Author and Fabrizio Poccia*
*National Institute for Infectious Diseases "Lazzaro Spallanzani," Rome, Italy
http://www.cdc.gov/eid/content/14/1/121.htm 
    
Third in mice, a test found that mice immunized against the seasonal influenza developed substantial immunity against H5N1.  
Cross-protection against H5N1 influenza virus infection is afforded by intranasal inoculation with seasonal trivalent inactivated influenza vaccine.  
http://www.newscientist.com/channel/health/bird-flu/mg19626273.700-drug-brings-hope-for-a-universal-flu-vaccine.html  In this experiment, dead influenza A viruses from the H1N1 and H3N2 families in combination with Ampligen was administered nasally to mice. These are seasonal flu antigens, not pandemic H5N1 antigens.  When the researchers then infected the mice with H5N1, the unvaccinated mice all died, but half or more of the nasally vaccinated mice lived. Only nasal vaccination was effective; "Subcutaneous inoculation did not induce a cross-reactive IgA response and did not afford protection against H5N1 viral infection. "  Immune response developed from nasal administration of ordinary seasonal flu antigens with Ampligen was protective against H5N1. By extension, one could hope that FluMist's inclusion of seasonal antigens taken from each season's H1N1 and H3N2 might result in immunity broad enough (and long-lasting enough) to provide FluMist-vaccinated persons with at least some protection against an H5N1 strain. This animal study supports breadth of immunity, particularly perhaps that elicited by an N1 antigen, as a third possible mechanism by which seasonal FluMist inoculation might provide at least some protection against an H5N1 "bird flu" pandemic when one emerged, and without the long delay inherent in current vaccination schemes.  
Fourth, FluMist demonstrated broad protection against mismatched influenza A strains in at least two studies:
:In a two-year, multicenter, randomized, double-blind placebo-controlled trial (conducted between 1996-1998) in children 24 months-71 months of age, FluMist provided comparable protection in a year with matched strains (95 percent protection -- year two) and a year with mismatched strains (87 percent protection -- year two).  The mismatched strain that circulated during the studied season was A/Sydney (H3N2).  
:In a head-to-head study conducted during the 2004-2005 influenza season that included over 4,000 children between two and five years of age, when looking specifically at strains that were mismatched, there were 54.2 percent fewer cases of flu in children who received FluMist versus those that received the flu shot (Attack rate 3.2 percent vs 7.1 percent, respectively). The mismatched strains that circulated during the studied season were A/California-like (H3N2), B/Florida and B/Victoria lineage strains.  
This broad immunity may extend to H5N1, as the other studies above suggest.    —Preceding unsigned comment added by 69.3.11.152 (talk) 23:34, 28 February 2008 (UTC)
thread_title: Ordinary FluMist might provide some protection in an H5N1 pandemic

message: After noting Flumist is not approved for 
People 50 years of age and over"
the footnote mis-states the current approved ages, stating:
(ref) The vaccine continues to be recommended for healthy persons ages 5-49 years who are not pregnant. http://www.cdc.gov/flu/about/qa/nasalspray.htm (/ref)" 
In fact, the vaccine is now recommended for healthy persons two through 49 years of age, inclusive.  
The above factually inaccurate statement of the age range is also somewhat out-of-place and unnecessary in a section about whom the vaccine is not approved for. One appropriate step might be to simply remove the superfluous and inaccurate footnote.  
Might a person knowledgeable about the actually approved and recommended age range and a sense of stylistic concision attempt an appropriate edit?
—Preceding unsigned comment added by 69.3.11.152 (talk) 00:04, 29 February 2008 (UTC)
thread_title: Factual mis-statement about recommended age range

message: I understand that it can be adapted to present antigens from any circulating virus, and I understand that receiving the trivalent vaccine may boost your resilience to other subtypes; however, the first statement of the "Groups for whom..." section needs a qualifier to be true. We do not know what antigens pandemic influenza virus will contain. We also do not know that FluMist will be able to generate a vaccine for the pandemic virus. 
Currently reads:
Vaccination is a cost-effective counter-measure to the threat of seasonal or pandemic outbreaks of influenza.
I suggest:
Vaccination is a cost-effective counter-measure to the threat of seasonal outbreaks of influenza, and may also prove applicable in an influenza pandemic.
The exact wording is not important, but making an absolute statement like, "FluMist can save you from the pandemic flu" is fallacious.
Nackee (talk) 23:02, 3 March 2008 (UTC)
thread_title:  Fallacious to state that FluMist is a counter-measure for a flu pandemic 

message: Can someone take a picture of any nasal spray near someone's nose and upload it to commons.wikimedia.org?  That way we can use it as an image on this article.  Something similar to: http://www.umm.edu/features/images/NasalSpray.jpg   Daniel.Cardenas (talk) 05:24, 11 May 2008 (UTC)
thread_title:  Image Request

message: It is basically background information, and lacks the salience of the sections in front of which it has been placed.  Other than the HIV information in the final footnote (which belongs in the "from whom recommended" sections, the history section is a footnote.  It is out of place intruding itself before the article's currently-applicable information.  Perhaps it could be moved to a "history of flumist" article for those few interested in that topic.  —Preceding unsigned comment added by 68.166.205.33 (talk) 22:07, 14 January 2009 (UTC)
thread_title:  The history section should go at the end 

message: MedImmune's live attenuated influenza vaccine (LAIV) technology may be particularly well-suited for vaccinating against emerging influenza strains. LAIV is different from the injectable influenza vaccine ("flu shot") in that it is a gentle mist sprayed into the nose, where the influenza virus usually enters the body. It contains live vaccine virus strains that are weakened so as not to cause the flu, but prompt the body to mount an immune response after the first dose. Because it is live and stimulates a broad range of immune responses, LAIV may offer some cross-protection against circulating flu strains that are "drifted" - meaning they are very closely-related but not perfectly matched to the flu strains in the vaccine.  —Preceding unsigned comment added by 64.105.0.126 (talk) 00:18, 17 June 2009 (UTC)
thread_title:  live attenuated influenza vaccine (LAIV) may be well-suited for vaccinating against emerging influenza strains 

message: "Robert Roos * News Editor
Sep 29, 2009 (CIDRAP News) – While there is evidence that the live nasal-spray vaccine for seasonal influenza works better than injectable vaccine in children, the injectable vaccine was found to be more effective in a trial in close to 2,000 young adults, according to a recent report in the New England Journal of Medicine.
... "
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/sep2909flumist-jw.html  —Preceding unsigned comment added by 66.167.95.156 (talk) 20:44, 6 October 2009 (UTC)
thread_title:  Shot beats nasal spray in adult seasonal flu vaccine trial 

message: *People less than 6 months of age (before 2010, was 2 years of age  
Many other examples of need to update.  —Preceding unsigned comment added by Ocdncntx (talk • contribs) 17:38, 6 November 2010 (UTC)
thread_title:  out of date in 2010.  Recommendations for vaccine widened.  

message: How is the virus "attenuated"?  Is this simply a genetically engineered virus that is designed to have attributes of three other strains, and not cause disease? -- Beland (talk) 22:39, 9 August 2011 (UTC)
replies: text: Sorry for the late answer, just read your question now.  There are three phenotypes that were achieved in the parent strains: ca (cold adaptated), replicating well at 25 degrees Celsius; ts (temperature sensitive), restricting the replication at 37 degrees Celsius, and att (attenuated), not causing classical illness in the ferret model.  The parent strains that have these adaptations are incubated with wild type strains with the desired antigens, and this produces genetically reassorted cold adapted strains.  These reassortant strains have the ca, ts, and att gene segments from the parent strain, as well gene segments encoding the hemagglutinin and neuraminidase surface proteins from the wild-type virus selected for that year. See: http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4292B1-02.pdf --Synaptophysin (talk) 14:15, 27 August 2013 (UTC)
replies: text: Thanks, that was very helpful! I just added that material into the new section "Production". -- Beland (talk) 17:25, 5 May 2019 (UTC)
thread_title:  How is it produced? 

message: I think the article "FluMist" should be merged into "Live attenuated influenza vaccine". In practice, that would mean moving the content from the "LAIV" article into "FluMist", followed by renaming the latter. I suggest this renaming because the two articles pretty much overlap completely in scope. The reason why I think the single, merged article should be named "Live attenuated influenza vaccine" rather than "FluMist" is because the latter is a brand name, whereas the former is a more generic description. While brand names are appropriate article titles for vaccines (per MOS:MED), I think the generic name should be preferred in this case. A superficial glance of the scientific literature (via www.pubmed.gov) seems to indicate that the generic name is fairly well established. Gabbe (talk) 20:39, 22 December 2012 (UTC)
replies: text: Since there have been no objections poster here during the last week, I plan to go ahead with the merger. Gabbe (talk) 18:47, 29 December 2012 (UTC)
thread_title:  Merge discussion 

message: It would be very helpful if someone could post information about the release date for flumist, especially for this year (2015).  All arguments about the relative efficacy of the shot vs flumist go out the window if the shot is available well before flumist, as appears to be the case here in Hawaii in 2015.  (The supermarkets are giving out the shot, but no one and no web page seems to be able to tell me when flumist will even arrive.)
98.155.30.229 (talk) 09:42, 7 September 2015 (UTC)
thread_title:  Release date? 

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