Nasal vaccine snuffs the flu Medicine sprayed up children's noses is effective, painless

May 14, 1998|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Spraying a flu vaccine up children's noses, physicians have hit upon something every parent will appreciate: no needle stick, almost no flu and fewer ear infections.

The findings, published yesterday in the New England Journal of Medicine, are the culmination of three decades of trying to find easier ways to give children shots.

Scientists found that squirting the flu vaccine up children's noses, like a nasal spray, provided 93 percent protection against the influenza virus.

It also proved to have 98 percent protection against a common complication, ear infections.

"This is a real advance. This will make getting the vaccine much more acceptable to the people who should be getting it," said Dr. Elizabeth Barnett, an assistant professor of pediatrics at Boston Medical Center, who evaluated the study in an editorial.

The implications are significant, because children are usually the first to get influenza viruses and then spread them.

About 25 percent to 50 percent of youngsters get the flu each winter, with a sore throat, bad cough and fevers. In the aged and those with chronic illnesses, it can kill.

"I have dreaded it as each winter rolls around. One would show a sign of a runny nose, and I would say, 'Oh, dear God, don't let this be bad,' " said Kathleen Mader, 37, a Harford County woman who has four children, including 3-year-old triplets.

"They don't have to be too old before they start asking, 'Are we getting a shot?' "

Three of her children took part in the study, which involved about 1,600 children ages 1 through 6 in 10 sites around the country, including the University of Maryland Medical Center.

Only 1 percent of children who received the nasal vaccine developed influenza, compared with 18 percent of children who got a placebo. Also, the incidence of ear infection with fever from any cause was 30 percent lower in the group who got the medicine.

Fewer ear infections mean fewer antibiotics, which will help reduce the overuse of those medicines, said Dr. James C. King, an associate professor of pediatrics who is working on the trial at Maryland. He said that during the winter, at any given time, about half of the children in day care are on antibiotics.

In the United States, the flu vaccine is recommended for those 65 or older and those under 65 who are at high risk, such as people, including children, with chronic illnesses.

But most who could benefit from the shots don't get them. In those age 65 and older, flu shot levels reached 58 percent in 1995. In people under 65 at high risk, the level topped out at about 30 percent. In children, doctors believe that perhaps a quarter get shots.

Why? People hate needles, and the flu shot must be given every year to protect against changing virus strains. Every year, more than 20,000 Americans, mostly over the age of 65, die from flu, and more than $4.6 billion is spent on influenza-related medical costs.

King said that side effects from the nasal vaccine are limited to a mild cold or stuffy nose. That's because the vaccine is made of live but weakened strains of the influenza virus, geared to cause a reaction that will kill any flu virus at its main entry point, the nose.

Yesterday, doctors recommended that people at risk, such as health care workers and children in day care centers, get the vaccine first. It is unclear whether the general population should also get the vaccine.

Tyler Szarko, 7, one of the children in the study, said the nasal spray experience was strange.

"It felt kind of tickly, and it sometimes makes you sort of sneeze," the Catonsville boy said. "It feels better than a shot."

The vaccine's manufacturer, Aviron, is betting on that. The company is expected to submit an application to the U.S. Food and Drug Administration this year to market the vaccine.

Officials at the National Institute for Allergy and Infectious Diseases, which funded the study, said the nasal vaccine is also being studied in adults and the elderly, and that it might be on the market for the 1999 flu season.

Experts say it is a promising technology for delivering other vaccines.

But at least one longtime pediatrician, Dr. Crossan O'Donovan, past president of the Maryland chapter of the American Academy of Pediatrics, predicted children may still pull away.

"My guess is, if you take a 3-year-old and say, 'I have this thing, and I'm going to blow this juice up your nose,' they're going to look at you like you have three heads, and then they're going to go right through the roof."

Pub Date: 5/14/98

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