FluMist: Who is the nasal spray best for?

FluMist, the nasal flu vaccine spray, was approved in September by the U.S. Food and Drug Administration for at-home use starting in fall 2025. Currently, it can only be administered by a healthcare provider. Dr. Pedro Piedra, professor of molecular virology and microbiology and pediatrics at Baylor College of Medicine, details what FluMist is, its efficacy and how to decide if it is best for you. 

What is it?  

FluMist is a live, attenuated influenza vaccine containing a weakened flu virus for the three vaccine strains. It’s approved for children as young as 2 years and adults up to age 49.

“Instead of an injection, there is a live vaccine administered by spray into the nose to give a good immune response so that the nose and respiratory system is better prepared against influenza,” Piedra said. 

While Piedra says the FluMist spray is intended for otherwise healthy children and adults, it also is suitable for needle-shy people. 

“The immune response is good for both children and adults. Like all vaccines, there could be a local reaction for a small percentage of people – this could be a mild cold, a runny nose or soreness in the throat because the virus is alive and replicates in the nasal passage,” he said. 

Is FluMist effective?  

Piedra says that FluMist has levels of effectiveness comparable to the inactivated vaccine for the age range it is intended for. It is not for immunodeficient or immunocompromised people. Also, the nasal spray could cause wheezing after administration in children under 5 with a history of recurrent wheezing.

“Also, older children and adults with significant lung disease should speak with their physician to see if there is an alternative vaccine that will not predispose them to a potential wheezing episode,” Piedra said. “You can have a flu shot that will not impact the respiratory tree; the live vaccine spray might.”

If you have plans to get FluMist nasal spray, you should not take any antiviral medication against the flu for the ext two weeks. This is because the live attenuated or weakened flu virus will respond to the antivirals and shut off the replication so that you don’t have a vaccine response. 

Due to the live attenuated FluMist, children should not take aspirin or aspirin-containing products because of the potential for Reye’s syndrome, a condition impacting the liver or brain after the flu. Like other vaccines, FluMist should not be administered to anyone who has a severe allergic reaction to any component in the vaccine.

Is the at-home use of FluMist best for you?  

With FluMist available for at-home use next fall, you can have more control over when you want to receive the vaccine.

“You can dictate the timing of the vaccine without truly affecting much of your routine,” Piedra said. 
He also says to be aware if using FluMist in the home of someone who is immunodeficient. First, consult your physician to determine the best vaccine options to protect your family against influenza.