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Nasal vaccine against flu gets green light in Canada

For the first time in Canada, being vaccinated against the flu won't necessarily require the prick of a needle.

Health Canada has granted approval for a nasal vaccine designed to protect against seasonal flu, the first vaccine administered through the nose that's been authorized for use in this country.

The vaccine, called FluMist and marketed in Canada by AstraZeneca Canada Inc., protects by using a live but severely weakened or attenuated form of the virus to bolster an immune response.

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Now it will be up to provinces to decide whether they want to purchase the new vaccine for use in the coming flu season.

Marc Zarenda, scientific director for oncology and infection in the medical affairs department of AstraZeneca Canada, said the company has already notified the provinces of the vaccine's approval and plans to speak to officials about its availability.

"We'll have to see what the uptake is like," he said.

Arlene King, Ontario's chief medical officer of health, said FluMist has many potential benefits, but that no decision is being made in the immediate future.

"I think increasing the suite of influenza vaccines that we have in Canada is an important development," Dr. King said. "We will consider this product at the appropriate point in time."

The vaccine has a shelf life of 18 weeks and needs to be refrigerated at 2 to 8 C until use, the company said.

One major potential benefit of using the nasal vaccine is that it may better protect young people from contracting the flu. Research has shown it seems to be more effective in children age 2 to 17 than the traditional injectable flu vaccine. That could help reduce overall infection rates and boost herd immunity, said Mark Loeb, an infectious diseases expert and professor of pathology and molecular medicine at Hamilton's McMaster University.

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Public health experts also say the nasal vaccine is attractive because many children or their families may avoid immunization because of a fear of needles.

"It's a lot easier to administer," said Ian Gemmill, medical officer of health for Kingston, Frontenac, and Lennox and Addington Public Health and associate professor of community health and epidemiology and family medicine at Queen's University. "You can do an influenza clinic considerably more efficiently."

But the nasal vaccine also has risks. It's not approved for use in children younger than 2 or adults over age 59. Mr. Zarenda said that clinical data don't support use of the vaccine in children younger than 2 and that studies show it has limited effectiveness in those over 59.

However, warnings published on the FluMist website operated by MedImmune, a subsidiary of AstraZeneca, state the vaccine is linked to a higher incidence of wheezing and hospitalization among children younger than 2. It also warns against giving the vaccine to anyone with asthma or children younger than 5 who have a history of wheezing.

FluMist, which was introduced to the U.S. market in 2003, was originally not recommended for any children younger than 5, but a U.S. advisory committee moved the age down to 2 in 2007.

The nasal vaccine can also be more expensive than injectable vaccines. The New York Times reported last July the wholesale FluMist price in that country had dropped to $18.95 (U.S.) from a high of $50, but that's still more expensive than traditional vaccines, which are usually available for under $10 (Canadian).

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"The cost of vaccines is always a factor," Dr. King said, adding price is one of the many elements provinces will consider when looking at the new vaccine.

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