The intranasal flu vaccine known as FluMist will not be available at Department of Defense (DoD) facilities or covered by TRICARE during the 2016-17 influenza season. The Centers for Disease Control and Prevention (CDC) recommended against using FluMist this year, due to several studies showing it is not effective in preventing influenza among certain age groups.

This season, the DoD’s entire supply of flu vaccine will be injectable. It is recommended for everyone, ages six months and older. The DoD expects to have enough supply of injectable vaccine at military treatment facilities (MTFs) for all age groups.

“We do not expect a flu vaccine shortage for the 2016-17 season,” said Army Col. Margaret Yacovone, Chief, DHA Immunization Healthcare Branch. “The DoD has contracted for 3.6 million doses of injectable flu vaccine, which is expected to fulfill our immunization needs.”

The DoD follows the recommendations of the CDC Advisory Committee on Immunization Practices, which recommended in July not to use the live, intranasal vaccine. This was based on studies that showed FluMist’s wasn’t very effective against H1N1, a common strain of the flu which caused the 2009 pandemic. The live, intranasal vaccine was found to be ineffective against H1N1 during the 2013-14 and 2015-16 seasons in children ages 2 to 17.

“Because the CDC didn’t recommend it this year, FluMist will not be available in MTFs and will not count toward our military member’s readiness requirements, and won’t be covered by TRICARE,” Yacovone said. “If CDC changes its recommendation in the future, it may again be available in the DoD.”

In the past, FluMist was either comparable to, or better than, injectable vaccines in certain younger populations. However, in recent years, that advantage was not evident. The CDC says the reason for the recent poor performance is not yet known.

“The CDC recommendation focused solely on how effective the vaccine’s was at preventing the flu,” Yacovone said. “The vaccine’s safety has not been called into question.”

Vaccine effectiveness refers to the ability of a vaccine to prevent actual cases of disease in real-world settings. How effective the flu vaccine is can vary widely from year-to-year, depending on the “match” between the circulating flu viruses and the viruses used to produce the vaccine. The vaccine can also vary in effectiveness based on the age and overall health of the person getting immunized.

Another recent report suggested that older people, or those with other serious medical conditions, should wait until later in the fall to get the flu vaccine, so the protection doesn’t wear off before flu season ends.

However, the CDC recommends that people get the flu vaccine as soon as it becomes available. While delaying immunization could have some benefit, waiting could result in missed opportunities to immunize. In other words, it’s better to get immunized early than not at all.

In DoD, “we expect to achieve our goal of 90 percent of the total force immunized by 15 December,” Yacovone said.

FluMist is currently the only non-injection-based flu vaccine. Concern and anxiety about injections are common. The CDC recommends the following steps to ease the pain associated with the injection process:

• Breastfeeding, swaddling or use of sweet-tasting solutions for infants up to 12 months old.
• Changes to injection technique (aspiration or slower injection).
• Injecting the most painful vaccine last (if administering multiple vaccines simultaneously).
• Stimulating the skin near the injection site prior to and during the vaccination.
• Distraction.
• Topical anesthetic.
• Simultaneous administration of vaccines at separate injection sites.

For more information about DoD coverage of the flu vaccine, visit the IHB flu resource page.