The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends against live attenuated influenza vaccine (LAIV4) in children 2-4 years of age with asthma because of the risk of asthma exacerbation. What about older children? Are there data that suggest LAIV4 is inferior to inactivated influenza vaccine (IIV4) in older children with asthma or that the live vaccine could complicate their asthma? While some smaller retrospective studies have been performed to answer these questions, Sokolow et al (10.1542/peds.2021-055432) share with us the results of a randomized clinical trial of 151 children ages 5-17 with asthma in an article we are early releasing this month in Pediatrics.
The authors conducted the study in three geographic sites over two influenza seasons, from 2018 through 2019, randomizing patients with asthma to receive either LAIV4 or inactivated IIV4. They followed these subjects for 42 days after vaccination. The primary outcome was asthma exacerbation. Most notably, the authors found the LAIV4 vaccine non-inferior to the IIV4 vaccine even when they adjusted for severity of asthma. They also found no difference in the frequency of asthma exacerbations experienced within 14 days of vaccination and no differences in asthma-related symptoms. There were also no differences in peak expiratory flow rate or asthma-related healthcare utilization at 14 and 42 days. Side effects were generally similar with some increased myalgia and sore throat which in the IIV4 group.
These findings may make you more apt to consider using the LAIV4 vaccine in situations when IIV4 supplies may be limited, when schools want to give the LAIV4 vaccine as a mass vaccination, or if your patient with asthma is needle phobic. Are you convinced enough to give your patients with asthma the LAIV4 or will you still rely on the IIV4? Link to this study and see if it can convince you that use of the LAIV4 may be an alternative to consider for patients with asthma who are 5 years of age or older.