Editor’s Note: Dr. Carly Pierson (she/her) is a resident physician in pediatrics at the University of Virginia. She is in the Primary Care Track. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Influenza can cause serious illness and have severe complications. This past winter, I have seen children whose flu illness has resulted in debilitating disease, including pneumonia, brain, lung, and eye infections, and Guillian-Barré syndrome (a neurological disorder that causes paralysis). Often, these patients end up in the pediatric intensive care unit; some require invasive procedures and/or extensive rehabilitation.
Children with asthma are at especially high risk for severe influenza illness and complications, and this means that vaccinating this patient demographic is extremely important. Two types of influenza vaccinations that are available include the live attenuated influenza vaccine (LAIV), an intranasal formulation, and the inactivated influenza vaccine, a needle injection. The fact that LAIV is intranasal makes it more attractive for those with “needle phobia.” Because influenza vaccination rates have declined in recent years, offering the LAIV could be an enticing strategy to increase vaccination coverage, especially in high-risk populations, like those with asthma.
This is why Allyn Bandell, PharmD, from AstraZeneca, along with colleagues from the UK, Children’s Hospital of Philadelphia, Intermountain Health, and Vanderbilt, published the paper “Safety of LAIV Vaccination in Asthma or Wheeze: A Systematic Review and GRADE Assessment,” which is being early released this week in Pediatrics (10.1542/peds.2024-068459). Of note, several of the authors are employees of or received funding from AstraZeneca US, a manufacturer of LAIV.
Up to now, LAIV has been contraindicated for children ages 2–4 years who have a history of asthma or wheezing in the past 12 months and discouraged with a precaution for those older than 5 years with asthma. This is because early clinical trials showed an increased risk of wheezing and hospitalization for young children who received LAIV. This is why the authors conducted their systematic literature review—to look at more recent studies about the safety of LAIV for individuals aged 2–49 years with asthma or recurrent wheeze.
The authors evaluated data from 24 studies, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. They found little or no difference in patient-reported outcomes following LAIV versus inactivated influenza vaccine administration or no vaccine administration in individuals with asthma and/or recurrent wheeze.
This conclusion could potentially increase the flu vaccine options that are available to this at-risk population. In an accompanying commentary to the article, entitled, “LAIV Use for Children with Asthma or Recurrent Wheeze: Time to Move the Needle,” authors Annika Hofstetter, MD, PhD, from the University of Washington, Melissa Stockwell, MD, from Columbia University, and Kristina Bryant, MD, from the University of Louisville write that the Bandell study provides convincing evidence, espousing that it is time to “move the needle” and reconsider the use of LAIV for children with asthma or recurrent wheeze (10.1542/peds.2024-070120). The commentary authors also urge that, if this restriction is lifted, careful monitoring will be needed, particularly if self-administered and/or home LAIV is made available in the 2025–26 influenza season (it was recently approved by the US Food and Drug Administration).
To learn more about the safety and efficacy of LAIV administration in patients with asthma, check out this article.
