What Is the FluMist Flu Vaccine?

Nasal spray vaccine offers an alternative to shots

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FluMist Quadrivalent is a nasal spray flu vaccine that can be used as an alternative to the flu shot in some people. It may be a good option for adults or adolescents who are averse to injections or when there is a shortage of the traditional flu vaccine.

FluMist Nasal Spray Flu Vaccine
Joe Raedle / Getty Images News / Getty Images

As opposed to injectable flu vaccines, which are made with inactivated (killed) viruses, FluMist is a live attenuated vaccine made with weakened live viruses. Because of this, it is be avoided in people with compromised immune systems.

Studies have suggested that FluMist delivers a similar level of protection from flu as traditional flu shots.


FluMist Quadrivalent is approved by the U.S. Food and Drug Administration (FDA) for use in healthy, non-pregnant people between the ages of 2 and 49.

The vaccine is called quadrivalent because it is designed to protect against four different flu viruses, including two influenza A viruses and two influenza B viruses. The specific variants chosen for each annual flu vaccine are based on surveillance from over 100 national influenza centers in over 100 countries.

FluMist was first approved for use in 2003. However, it was found to be less effective than flu shots in children during the 2012-2013 and 2013-2014 flu seasons, leading the CDC to temporarily dropped its recommendation for the 2016-2017 and 2017-2018 seasons.

After the FluMist was reformulated in 2018, the CDC added it back to the line-up of recommended vaccines for the 2018-2019 flu season and those thereafter.

Before Taking

FluMist is an effective vaccine choice for some but not everyone. The vaccine is contraindicated for use in people who have had a prior severe allergic reaction to FluMist or any of the components of the vaccine, including egg protein.

FluMist should also not be given to the following groups:

  • Children under 2 years
  • Adults 50 and older
  • Children 2 to 4 years who have asthma or experienced wheezing within the past 12 months
  • Children 2 to 17 years who are taking aspirin or any salicylate-containing medication
  • People with weakened immune systems
  • People without a spleen or who have a non-functioning spleen
  • Pregnant women
  • People with an active cerebrospinal fluid leak into the mouth, nose, or ear, or from other places in the skull
  • People with cochlear implants
  • People who have recently taken flu antiviral drugs (who may need to delay vaccination for 2 to 5 days)

FluMist should also be used with caution in:

Other Flu Vaccines

FluMist is the only live attenuated flu vaccine and the only nasal spray flu vaccine. There are other quadrivalent flu vaccines delivered by injection and available under the brand names:

  • Afluria Quadrivalent
  • Fluarix Quadrivalent
  • Flublok Quadrivalent
  • Flucelvax Quadrivalent
  • FluLaval Quadrivalent
  • Fluzone Quadrivalent


FluMist is a fine, dry powder delivered in a syringe-like sprayer. Each sprayer contains 0.2 milliliters (mL) of the vaccine, enough for a 0.1-mL dose in each nostril.

The recommended dosage varies by age and flu vaccination history and may include one or two doses of the vaccine.

Age Status Dose Schedule
2 to 8 years Not previously vaccinated Two doses Separate doses by at least one month
2 to 8 years Previously vaccinated One dose n/a
9 to 49 years n/a One dose n/a

How to Administer

FluMist is administered by a healthcare professional. One spray is given into each nostril with a brisk compression of the suppressor. You can breathe normally during the administration and do not have to sniff.

It is okay if you sneeze or blow your nose after receiving a dose of FluMist. There will still be enough of the vaccine in your nostrils to trigger a protective immune defense.

Side Effects

Side effects are common with all drugs and vaccines, and FluMist is no exception. Most are mild and transient and will usually resolve within a day. On very rare occasions, severe side effects may occur.


According to pre-market clinical trials, FluMist was reported to cause the following side effects in 4% or more of users:

  • Runny nose
  • Nasal congestion
  • Headache
  • Lethargy/tiredness
  • Decrease appetite
  • Muscle aches
  • Fever, usually mild

Most side effects were low-grade and resolved on their own without treatment.


Younger children are at an increased risk of wheezing after receiving FluMist. Although the majority of cases in premarket studies involved children under 2 years, the risk of wheezing remained elevated up until the age of 5. Some cases required hospitalization.

Allergic reactions to FluMist, while possible, are extremely rare. Those who may experience a reaction (including a severe whole-body allergy known as anaphylaxis) are people with a severe egg allergy.

Even so, vaccine-induced anaphylaxis is rare. In the United States, only 33 cases of anaphylaxis were reported out of over 25 million doses of childhood vaccines delivered from 2009 to 2011, according to a 2016 review of the Journal of Allergy and Clinical Immunology.

If you have a severe egg allergy, two FDA-approved flu vaccines not derived from chicken eggs are safe for use:

  • Flublok Quadrivalent (approved for adults 18 and older)
  • Flucelvax Quadrivalent (approved for people 4 and older)

Warnings and Interactions

FluMist is avoided in children up to the age of 17 who take aspirin. This is because aspirin is linked to a potentially severe condition, called Reye's syndrome, in children recovering from viral infections. There are concerns that exposure to FluMist, a live virus vaccine, may trigger Reye's syndrome in these children.

Aspirin should be avoided for four weeks following vaccination with FluMist in anyone under the age of 18.

FluMist should not also be taken with antiviral drugs used to treat flu symptoms. There are four such drugs currently approved by the FDA:

Flu antivirals should not be used 48 hours before and two weeks after FluMist vaccination as doing so may undermine the effectiveness of the vaccine.

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