Nasal spray flu vaccine still not covered by Ontario government

Flu season is around the corner, and for those reluctant to get jabbed in the arm with a needle, there is another option — a nasal spray.

However, for Ontarians, FluMist is still not covered by the Ontario Health Insurance Plan — one of the few areas of the country where the spray isn't covered under public health plans — despite the fact it was approved for use in Canada in 2010.

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Unlike vaccinations, which contained killed viruses, the flu spray contains a trio of living, albeit weakened, flu viruses.

There's increasing evidence that FluMist isn't just for those who hate needles, or an option only in case of potential shortfalls in the supply of the more traditional flu vaccine.

Studies indicate the spray is more effective in preventing influenza for healthy children two to 17 years old.

"It is more effective, it prevents the flu better than does the flu shot in that particular age group," pediatrician Dr. Dina Kulik told CBC News.

That assertion is backed by expert groups on both sides of the border.

The National Advisory Committee on Immunization, which advises the Public Health Agency of Canada, recommended the spray — deemed a live attenuated influenza vaccine (LAIV) — for healthy children ages two to 17 as far back as 2011.

"Three randomized comparison studies conducted in over 12,000 children from six months to 18 years of age consistently demonstrated statistically significant superior efficacy of LAIV relative to an injectable, trivalent inactivated influenza vaccine," the agency said in its report.

In the U.S., the spray has been approved since 2003. The expert group that advises the U.S. Centers for Disease Control and Prevention (CDC) recommended in July this year, following several months of analysis by a working group that compared the two vaccines, that children two to eight receive the spray instead of the vaccination.

3 provinces yet to provide coverage

CBC News has learned that the spray is covered under the public health plans of all provinces and territories except Ontario, Nova Scotia, and New Brunswick.

FluMist has been offered in addition to the flu shot in some school systems like Guelph, Ottawa and Peterborough — meaning families don't have to pay for it. But for children in school districts that don't offer the spray, marketed by AstraZeneca, which has its headquarters in Mississauga, Ont., it requires a prescription and a cost of $25-30 per dosage.

There's also no indication if or when Ontario may cover the nasal spray provincewide.

Ontario’s chief medical officer of health told the Globe and Mail in 2010 when it was introduced to market that the product would be considered "at the appropriate point in time."

A Ministry of Health spokesperson told CBC News this week that, "The ministry is currently reviewing new flu vaccines including FluMist," adding that factors being assessed include "scientific evidence, cost effectiveness [and] impact on the health system."

Public Health Ontario, in a study where five schools received the mist, found it better protected kids.

"Hopefully we can inform the policymakers so that they can make a more educated decision on which vaccines can be funded," said Jeff Kwong, a scientist with the agency.

The spray isn't recommended for everyone, especially those with severe asthma or active wheezing, and, under most circumstances, pregnant women.

As for adults, studies have been inconclusive as to whether it's more effective than a flu shot. The CDC communicates a more conservative age ceiling of 49 years of age for use, 10 years less than in Canada.

The dosage of 0.1 millilitre per nostril is only needed once per flu season, although two doses within four weeks are recommended for children between two and eight years old who have never received a flu vaccine before.

Side-effects can include:

• Runny or stuffy nose.
• Headaches.
• Muscle aches.