How to choose the flu vaccine? Which is more suitable for you?
Since March 2021, the influenza activity in southern and northern provinces has been higher than that in the same period in 2020, and since September, the level of influenza activity in southern provinces has shown an obvious upward trend. The risk of overlapping epidemic of COVID-19 epidemic and influenza and other respiratory infectious diseases still exists this winter and next spring. Recently, it coincided with a large-scale cooling in China, and the flu vaccine quickly "warmed up". However, how to choose a flu vaccine that suits you?
I. Types of domestic influenza vaccines
At present, there are trivalent inactivated influenza vaccine (IIV3), tetravalent inactivated influenza vaccine (IIV4) and trivalent live attenuated vaccine (LAIV3) approved for marketing in China.
Among them, trivalent influenza vaccine is suitable for children and adults over 6 months, which can prevent influenza caused by two influenza A viruses (H1N1, H3N2) and one influenza B virus (Victoria).
Four-valent influenza vaccine has more protection against one type of influenza B virus (Yamagata) than three-valent influenza vaccine, but the current four-valent influenza vaccine in China needs to be over 3 years old to be vaccinated.
Second, the way of influenza vaccine administration
At present, there are two ways to administer influenza vaccine in China, one is traditional injection and the other is nasal spray.
Among them, the nasal spray method is unique to the nasal spray influenza vaccine, which was only listed in China in August 2020, but it is not the first in China. It has existed abroad for a long time (the United States and the European Union approved the use of nasal spray influenza vaccine in 2003 and 2012, and both of them are tetravalent), but the market share has not been high. This vaccination method can effectively avoid puncture and "needle fainting" caused by injection, but as for whether it can really make children not afraid of getting flu vaccine, it seems that it is not. Although it doesn’t seem to hurt, the nasal mucosa is also very sensitive, and the way of "nasal spray" is not necessarily more comfortable than intramuscular injection. It is difficult for children to ensure the accuracy of vaccination dose, and the technical operation requirements for vaccinators are relatively high.
Third, the safety of influenza vaccine
Influenza-like vaccines are all split or subunit, that is, inactivated vaccines. After years of practice, the safety of all kinds of inactivated vaccines is relatively high. Its contraindications are limited to allergies to vaccine ingredients, and there is no restriction on egg allergies. Even during pregnancy and some elderly people with basic diseases are recommended to be vaccinated.
Then let’s take a look at the new nasal spray influenza vaccine: this vaccine simulates the process of natural influenza infection. After the vaccine is atomized, it enters the body through the nasal cavity, and the first barrier is mucosal immunity, and then cellular immunity and humoral immunity are generated by activating lymphocytes. However, this means that the nasal spray vaccine must be an attenuated live vaccine. From the point of view of safety, attenuated live vaccine may expel vaccine virus strains after inoculation, and occasionally it is reported that the live virus discharged from the vaccinator is transmitted to the uninoculated. Therefore, it is not recommended to vaccinate children with severe immunocompromised patients with nasal spray influenza vaccine.
Relatively speaking, the live attenuated vaccine has more contraindications (rhinitis, asthma, immune problems, etc.), and the range of people who can be vaccinated is narrower. The vaccination age range of this vaccine is 3-17 years old, which directly avoids children under 3 years old and the elderly who may have basic diseases. Pregnancy is also a contraindication. Even people who have used anti-influenza drugs such as oseltamivir and zanamivir (or traditional Chinese medicine with antiviral components) 48 hours before vaccination are not recommended to be vaccinated with this nasal spray vaccine.
Some foreign researchers have summarized the cases of influenza still diagnosed after receiving nasal spray vaccine or attenuated live vaccine or inactivated vaccine for injection. Among 17,173 patients aged 2-17, 4,579 received inactivated vaccine by injection, 1,979 received nasal spray vaccine or live attenuated vaccine, and 10,615 were not vaccinated. It was found that the effectiveness of inactivated vaccine for injection against influenza A (H1N1) was 67%, and the effectiveness of nasal spray vaccine or attenuated live vaccine was 20%. Compared with the recipients of inactivated vaccine by injection, the probability of infection with influenza A (H1N1) is significantly higher among those vaccinated with nasal spray vaccine or live attenuated vaccine.
Fourth, the effectiveness of influenza vaccine
As far as the effectiveness of protection scope is concerned, the tetravalent influenza vaccine containing four influenza virus strains (two types A and two types B) is better than the trivalent influenza vaccine containing three influenza virus strains (two types A and one type B).
Based on five studies from 2013 to 2016, the effect of nasal spray vaccine or live attenuated vaccine on influenza A (H1N1) is lower than that of inactivated vaccine by injection in all children’s age groups. Therefore, the American ACIP (Advisory Committee on Immunization Practice) did not recommend nasal spray influenza vaccine in 2016-2017 and 2017-2018.
A meta-study published online in Pediatrics in January 2019, entitled "Live Attenuated and In Activated Influenza Vaccination Effectiveness", recorded the reasons (and reviewed Meta) why AAP and CDC did not recommend nasal influenza vaccine in 2016-17 and 2017-18.
Please see the figure below for a detailed comparison list.
(Click to view larger image)
Finally, to sum up:Under the age of 3, there is no choice but to get trivalent flu vaccine. Above 3 years old, tetravalent vaccine is definitely the first choice in terms of protection effect. However, the price of trivalent vaccine is half cheaper than that of tetravalent vaccine (50 yuan VS110 yuan). If the money is not bad, then choose tetravalent vaccine. As for the nasal spray vaccine, if you are over 3 years old and under 17 years old, you happen to be "dizzy" or have extreme fear of injection, then it is much better to vaccinate the nasal spray vaccine than to do nothing.
References:
1.Chung JR, Flannery B, Ambrose CS, Bégué RE, Caspard H, DeMarcus L, Fowlkes AL, Kersellius G, Steffens A, Fry AM; Influenza Clinical Investigation for Children Study Team; Influenza Incidence Surveillance Project; US Influenza Vaccine Effectiveness Network. Live Attenuated and Inactivated Influenza Vaccine Effectiveness. Pediatrics. 2019 Feb; 143(2):e20182094. doi: 10.1542/peds.2018-2094. Epub 2019 Jan 7. PMID: 30617239; PMCID: PMC6361354.
2. Yang Penghui, Yang Lufang. Study on immune defense mechanism of respiratory mucosal infection of influenza virus. International Journal of Immunology, 2006,72(5):294-298.
3. Technical Guide for Influenza Vaccination in China (2020-2021)
4.https://www.cdc.gov/flu/prevent/nasalspray.htm
5 Changchun 100 grams of biological nasal spray attenuated trivalent influenza vaccine instructions