The invention of the nasal spray flu vaccine was a stroke of brilliance, if you ask the oodles of Americans who hate, loathe, and fear needles. When the nasal spray was nixed in 2016 by the Centers for Disease Control and Prevention (CDC), needle fearers had to brave their phobia and tolerate the standard flu shot for two years.

Good news, needle haters: The nasal spray flu vaccine is back.

Known formally as the live attenuated influenza vaccine, or LAIV, the nasal spray flu vaccine is made from a weakened flu virus that is sprayed into the nose, according to the CDC. Like the flu shot, the needle-free flu vaccine does *not* cause the flu.

The History of the Nasal Spray Flu Vaccine

FluMist, the trade name for LAIV, was created at the University of Michigan School of Public Health in Ann Arbor, MI, by a professor named Hunein “John” Maassab in the 1990s. It received FDA approval in June 2003, and was available for consumers the following flu season.

This nasal spray flu vaccine was a treasured option for kids and needle-adverse adults, but starting at the 2016-17 flu season, the CDC pulled the plug. Turns out, compared to those who got the flu shot, those who had received FluMist had not gotten as good of coverage against an aggressive form of H1N1 in earlier flu seasons. During the 2016-17 and 2017-18 flu seasons, the CDC recommended the flu shot only, which appeared to prevent the prominent flu strains more effectively.

How the Flu Vaccine Works

Although you just call it “the flu,” influenza can be caused by several strains of the flu virus. Terms like H1N1 (a.k.a. “swine flu”) or H5N1 (“avian flu”) refer to the strain of influenza A virus.

The H (hemagglutinin) and N (neuraminidase) are two proteins found on the surface of the virus, according to the CDC. There are 18 subtypes of hemagglutinin and 11 of neuraminidase. The strain names, then, refer to which subtype of hemagglutinin and neuraminidase make up the virus.

Which leads us to the flu vaccine. Each flu season (which tends to run from October to May) has one or more predominant strains of the flu virus. Experts can predict which strains will *most likely* wreak havoc that season, and the flu vaccine is formulated specifically to prevent against those strains. That’s why you need to get a new flu shot (or spray) each year.

How Effective Is the Nasal Spray Flu Vaccine Now?

Influenza strains are constantly shifting and can be difficult to combat, making the flu vaccine more effective some years, and less effective other years. It was a tricky form of H1N1 that lead to the downfall of the nasal spray flu vaccine in 2016.

However, early data has shown that the new nasal spray flu vaccine has improved effectiveness against the H1N1 strain, according to the CDC. In fact, the CDC has “no preference” for whether you choose the shot or spray, so the nasal spray appears to be on equal footing as the traditional flu shot.

Eligibility for the Nasal Spray Flu Vaccine

According to the CDC, the nasal spray flu vaccine is for non-pregnant individuals between the ages of 2 and 49. Pregnant women, children younger than 2, and adults older than 50 should continue getting the traditional flu shot.

People with certain medical conditions are also not eligible for the nasal spray and should opt for the flu shot, such as people with weakened immune systems or children with asthma.

Those at risk of developing serious complications if they get the flu—people with heart disease, lung disease, neurological conditions, or diabetes—should also talk to their doctor about the best vaccination option for them. Get the full list of high-risk individuals on the CDC website.

If you’re not sure, but you’re interested in getting the nasal spray flu vaccine this year, ask your doctor what they recommend.


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