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Public Health Vaccine Coordinator said "no risk of transmission" for flu mist

post #1 of 15
Thread Starter 

My sons' school gave out flu mist at school today.  I am keeping them home all week, partially out of protest, but also because my middle son has multiple contraindications (primary immune deficiency, IgM deficiency, pulmonary defects)  The school did this last year, but I thought (stupidly) it was a one-time thing in response to the pandemic.  Nope, they did it again. 


I sent an email to the Director of Special Services expressing my concern that by misting hundreds of kids at school, they are putting my son, and children like him, at risk.  If they feel like they must offer flu shots at the school, the vaccine does not shed and does not put anyone but the vaccine recipient at risk.  


The Director forwarded my email to the Public Health Vaccine Coordinator.  The coordinator responded that there is "zero risk to those not actually receiving the mist" and that my son would be perfectly safe to attend school.  She said that she herself is immune compromised but she administers the mists all day.  


I have pulled up the manufacturer's insert and read through it again, and they are very clear that there is definitely a risk of transmission, although low.  There are no studies related to flu mist and my son's particular deficiency (there are some with AIDS patients, however, which appear to show it is relatively safe to receive the mist, although AIDS patients are still contraindicated "unless benefits greatly outweigh the risks")  So I have my "proof" that the vaccine coordinator is flat out wrong.


So what do I do now?  It was too late to do anything this year, except keep my kids home.  But I *really* don't want this to be a yearly thing, as the boys get older, it will matter more that they're out of school for a week, AND I really do think this is just a dumb idea.  I want to send something to the school board highlighting the risks of misting the entire school...thoughts?  

post #2 of 15

Can people receiving the nasal-spray flu vaccine LAIV (FluMist®) pass the vaccine viruses to others?

In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely. The current estimated risk of getting infected with vaccine virus after close contact with a person vaccinated with the nasal-spray flu vaccine is low (0.6%-2.4%). Because the viruses are weakened, infection is unlikely to result in influenza illness symptoms since the vaccine viruses have not been shown to mutate into typical or naturally occurring influenza viruses.

Can contacts of people with weakened immune systems get the nasal-spray flu vaccine LAIV (FluMist®)?

People who are in contact with others with severely weakened immune systems when they are being cared for in a protective environment (for example, people with hematopoietic stem cell transplants), should not get LAIV (FluMist®). People who have contact with others with lesser degrees of immunnosuppression (for example, people with diabetes, people with asthma taking corticosteroids, or people infected with HIV) can get LAIV (FluMist®).




That's from the CDC- the thing about transmission from the flu vaccine is that it HAS NOT been shown to cause influenza. This is a common mistake people make (think that "shedding" in this case = influenza). The attenuated virus has been shown to cause mild illness in others less than 2.5% of the time (and most studies show less than 1% of the time) but the big things to remember about these studies and this vaccine:


-the 2.4% number was from a daycare study where there was one case of transmission from a vaccinated to an unvaccinated child. This did not result in actual influenza but the virus was present in the other child.

-there has never been a reported case of the LAIV vaccine causing illness in an immunocompromised child; the risk is all (as of 2010 manufacture date info given) theoretical.



So, I would present the information, especially the CDC info, but I would not expect them to stop because I assume they will come back at you with the theoretical nature of the argument in addition to the exact phrasing of who should and should not receive the vaccine.




ETA: if this is a public school and you wanted to really go for it, you could argue the mandatory schooling laws, right to a public education, and then say your child's rights are being violated by not being given a safe environment to attend (ie, the vaccine takes away his right to public education)

post #3 of 15
Thread Starter 

Yep, I've read all of that.  I talked to my son's Hemotology/Oncology/Immunology dr who said that although this is what the CDC states, this would apply more towards my son encountering random people in public.  When you have and entire school potentially shedding the same virus, it does increase the chances of my son getting sick.  And even though it might not be "true" influenza that he gets sick with, it doesn't matter, he's still sick.  And at this time of year, when he's already susceptible to cough/cold/flu especially RSV (has had two lab-confirmed RSV illnesses, despite receiving Synagis his first winter) the last thing he needs is exposure to ANY other illness. 


I know the risk is low, but I also think it's wholly unnecessary.  He is already at risk just attending public school, we've chosen to accept that risk because of how much he gains (not just education, but also he gets speech, occupational, and physical therapy at school in addition to the private therapies we have him in outside of school) but it annoys me that additional risk is being introduced when there is a safer alternative (either the shot, or not offering any type of vaccines at school to begin with). 


I'm going to wait until after the holidays I think and then I'll approach the school board.   

post #4 of 15

You might be surprised at how low the uptake numbers are with in school vaccination. My daughter's class has 19 kids in it, only 2 opted to get the flu vaccine and my daughter was the only one who got the mist. In the PreK, only 3 kids got the vaccines, and, again, only one was mist. I know this because I volunteered during that hour and part of that was sorting the kids into lines. I left halfway through the 1st grade, and even there there were only a couple kids. Most of the work and time was spent on the paperwork, filing, and going to rooms to bring down the few kids at the right times.


That could  just be our school, but since flu vaccination uptake is only like 30% in the general population(or much lower), I can't imagine it differs all that much in schools. Its convenient for some of us and definitely gives the opportunity to many who might not have it elsewhere, so maybe the uptake is a bit higher than general pop...but it can't be too high I wouldn't think...



(I did a quick google scholar search and the highest number of compliance in a school-based vaccination clinic study I could find was 56%- most were below 50%)

post #5 of 15
Thread Starter 

You might be right, last year it was pretty high, but it was H1N1 being given at the school, not seasonal flu.  I'll be curious to see how many choose to get it this year. 

post #6 of 15
Originally Posted by carriebft View Post

You might be surprised at how low the uptake numbers are with in school vaccination. My daughter's class has 19 kids in it, only 2 opted to get the flu vaccine and my daughter was the only one who got the mist. In the PreK, only 3 kids got the vaccines, and, again, only one was mist. I know this because I volunteered during that hour and part of that was sorting the kids into lines. I left halfway through the 1st grade, and even there there were only a couple kids. Most of the work and time was spent on the paperwork, filing, and going to rooms to bring down the few kids at the right times.



Anecdotal evidence

post #7 of 15

Followed by me saying it was anecdotal ("could just be our school") and my best attempt to see what ACTUAL evidence there was out there (google scholar search on school vaccination clinics.)


unless maybe you wanted me to post the scholar results? I could do that...*shrug*

post #8 of 15

I really feel for you on this because I would be worried too.  The thing I'm thinking though is that you are going to be encountering people all winter long who have been given flu mist, and you're not going to know who has had it and who hasn't.  You're also going to be encountering lots of people who have the actual flu.  A lot of the kids who are getting the flu mist at school would probably otherwise be getting it at their doctor's office which would have more or less the same results. 


More importantly, the more kids who get the vaccine, the less likely it is that your son is going to be exposed to kids who actually have the flu later on, and I would think, the less likely he is going to end up getting it.  If you feel like you need to keep him home to keep him safe for the week, I would, but I wouldn't fight the school about it.  We don't vaccinate, but the way I see it, the more people who do, the safer my son actually is (yes, selfish, but true.). 

post #9 of 15

Please, do not miss my point.


Non-vaccinators are constantly accused of using anecdotal evidence to make a point and ignoring any of the applicable science.  


But when a vaccine advocate uses anecdotal evidence, well, ... shrug, "I could have ... "


Please be fair.  

post #10 of 15

exactly how did I "ignore the evidence" by looking for the evidence and reporting back what I found? I did not miss your point. I think you missed mine.


I provided evidence. If you want the actual links...here ya go...


http://pediatrics.aappublications.org/cgi/content/abstract/116/6/e868 (40%)


http://pediatrics.aappublications.org/cgi/content/full/peds.2006-2603v1 (45 % overall, 56% elementary- the largest percentage I could find)


http://pediatrics.aappublications.org/cgi/content/abstract/122/1/e260 (44%)


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-4STTJX4-2&_user=10&_coverDate=08%2F12%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1553124276&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8dc8efc6588c983d28e0b3c301aa0067&searchtype=a (41%)


http://www.nejm.org/doi/full/10.1056/NEJMoa055414?hits=10&andorexactfulltext=and&FIRSTINDEX=150&FIRSTINDEX=150&SEARCHID=1&searchid=1&COLLECTION_NUM=8&resourcetype=HWCIT&resourcetype=HWCIT&andorexacttitleabs=and (47%)


there's plenty more...


so, in short my post was:

-bringing up that she could be surprised that less than she thought would be vaccinated since she was worried that all the students would be shedding the same virus (I was- why I was surprised)

-pointing out that it could just be my experience and my logic on why I assume there would not be much over 30%/general population numbers

-searching myself through studies and finding that, no, I was not wrong or far off....less than 50% respond to these programs even when they are being used for a study (and probably have a lot more leg work done to get people vaccinated for that reason)


I think you boiled it down a bit far to say it was nothing but anecdotal evidence. You also made it seem like I was hiding that fact, that is was my experience. I did not. I clearly stated this could have just been MY experience.







To me, relying on anecdotal evidence is when someone says something like "vaccines cause autism. My child was diagnosed with autism after receiving the MMR vaccine." or  whatever. It's using your own experiences as THE evidence. I said my experience might be similar to what she finds. Then I looked to see if there were studies on it that might confirm my experience and I found that, in school based vaccination programs, even when they are being used for a study, less than 50% typically comply.

Edited by carriebft - 11/23/10 at 10:51am
post #11 of 15



you  may want to take a look at some of those school based vaccination studies. A couple of them have sections with physicians who are concerned about the implications of using the live vaccine at a school.

post #12 of 15

I would submit both the CDC information & an official letter from your physician to the school board. And although the risk is theoretical, you are a mom & of course will worry & shoulder the responsibility of making the best decision possible for your child. I support you keeping your kid(s) out of school for whatever time period your physician deems reasonable, and also submitting this info to the teacher & school board/administration/nurse.


Keep in mind that these vaccination programs are done in part to protect kids like yours (ie. the most vulnerable). I would acknowledge this somewhere in the letter, for they really are not the enemy, but I would also state that the way it is done poses a risk to the severely immunocompromised. The thing is that you want the other kids to be protected from the flu so that they don't transmit it to your child, and the only way to do this (via mass immunization campaign) may necessitate your child stay out of school for a week or so. I don't see any other way around it.

post #13 of 15



op - I agree with your concern.  with flu circulating naturally, you may have a concentration of the circulating strain in the school, but flumisting the entire school guarantees there will be strains circulating.   in my state, per the state health department, they do not recommend the mist in school settings because of this risk.  This was printed on the letters that went home to school kids last year during H1N1 school clinics.  All the clinics waited for and used the shots.
post #14 of 15

Is this NY state? I don't see that info on the department website and they are holding mist clinics in schools as well (and old google news searches say they did last year, too- such as Williamsville schools in western NY, Buffalo schools also in erie county and Willsboro Schools in upstate). Or was this another state? I would love to read that info and maybe there would be some helpful information to present for the OP.


My sister (her and her husband both work in NY public schools) had a convo about this last night and she expressed concern about transmission from mist; it would be interesting if indeed NYS doesn't recommend their use in schools. she basically had the same question as the OP.

post #15 of 15
Thread Starter 

THank you all for generating such good discussion!  


You're right, a high vaccination rate theoretically benefits my son, I do understand and appreciate that vaccines are created specifically for people like him.  I do believe in herd immunity with some vaccines, and I know that he is lucky to live in a time when less infectious diseases are circulating.  That said however, I would never expect anyone to put their child in any sort of risk to protect my child.  My child's health risks are MY burden to bear, and mine alone.  Also...rates of genetic defects are increasing, and who's to say what causes that.  Connor is the first in our family to have this chromosome abnormality, he did not inherit it, something "caused" it.  Who knows what...but how's that for circular logic...vaccines are created to help protect children like Connor, yet children like Connor could perhaps be born because of environmental exposures that may be IN vaccines...see that circle?  Ugh.  




I have not contacted the school yet.   But I will be gathering up the various quotes from "official" sources (the manufacturer, the CDC, the AAP, etc) and will present it to the school board.  My hope is to generate good discussion among them so they see that no decision is without possible consequences.  If I have to keep my kids home for a week every year, then so be it.  I take risks by sending him to school, I choose to mitigate those risks from time to time as necessary.  But I don't want to sit silent about this.  There is a risk to the school offering the mist, they need to understand it better.  

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