Vaccine Info

FluMist Quadrivalent Influenza Vaccine

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Last reviewed
December 17, 2022
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FluMist® Quadrivalent Influenza Description For 2022

AstraZeneca's FluMist® (Fluenz® Tetra) Quadrivalent Intranasal vaccine is a live quadrivalent vaccine containing four vaccine virus strains. Like other live vaccines, FluMist Quadrivalent contains a weakened live virus. FluMist Quadrivalent triggers an immune response in the nose, where people usually catch the flu, says the U.S. Centers for Disease Control and Prevention (CDC). FluMist works in three ways in your nose, cells, and bloodstream to help provide flu protection within 14 days. It then triggers people's immune systems to build defenses (called antibodies).

For the 2022-2023 flu season, the U.S. CDC-authorized Quadrivalent (four-component) egg-based vaccines are recommended to contain:  A/Victoria/2570/2019 (H1N1)pdm09-like virus, A/Cambodia/e0826360/2020 (H3N2)-like a virus, B/Washington/02/2019 (B/Victoria lineage)-like virus, and B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

In a study published by the AAP journal Pediatrics on March 25, 2022, LAIV4 was not associated with an increased frequency of asthma exacerbations, an increase in asthma-related symptoms, or a decrease in peak expiratory flow rate compared with IIV4 among children aged 5 to 17 years with asthma.

FluMist Quadrivalent is the only U.S. Food and Drug Administration (FDA)-approved flu vaccine to use a needle-free nasal spray administrative technique, FluMist was initially approved by the FDA in 2003. ATC code: J07BB03; CAS Number: 1704512-59-3; and the FDA issued BL 125020/2852 on July 27, 2022.

Delaware-based AstraZeneca (AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialization of prescription medicines. Click here to find a FluMist Quadrivalent location in the USA.

Fluenz® Tetra in England

Live attenuated influenza vaccine (LAIV) has been used in the United Kingdom (U.K.) since 2013 to protect children against infection with influenza. The vaccine is the preferred product for children in flu 'at-risk' groups aged from two to 17 years and is part of the routine children's program delivered in schools and general practices. The U.K. says if it's their first time being vaccinated against the flu, children under nine years old with long-term health conditions will usually be offered a 2nd dose of the flu vaccine four weeks after the 1st dose. 

On December 16, 2022, the U.K. Health Security Agency confirmed Fluenz Tetra offers protections for scarlet fever and group A strep infections in children.

FluMist Quadrivalent Indication

The LAIV vaccine is not recommended for people with some chronic health conditions because this vaccine's safety and effectiveness in people with those conditions have not been established. In addition, children under two years old have an increased risk of wheezing (difficulty with breathing) after getting FluMist Quadrivalent.

The nasal spray flu vaccine is approved for healthy non-pregnant individuals, two through 49 years old. However, the U.S. CDC says that people with certain medical conditions should not receive the nasal spray flu vaccine. For example, you should not get FluMist Quadrivalent if you have a severe allergy to eggs or any inactive ingredient in the vaccine, have ever had a life-threatening reaction to influenza vaccinations, or are 2 through 17 years old and take aspirin or medicines containing aspirin—children or adolescents should not be given aspirin for four weeks after getting FluMist Quadrivalent unless your healthcare provider tells you otherwise.

Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with the nasal spray flu vaccine. However, the nasal spray flu vaccine should not be given to pregnant women. Postpartum women can receive a flu shot or the nasal spray flu vaccine. In addition, breastfeeding mothers younger than 50 years can get the nasal spray flu vaccine as long as they do not have a contraindication to getting that vaccine.

On September 15, 2022, the CDC sponsored a Clinician Outreach and Communication Activity (COCA) call to discuss the 2022- 2023 recommendations for pediatrics for this influenza season.

FluMist Quadrivalent Side Effects

FluMist Quadrivalent is contraindicated in persons who have had a severe allergic reaction (e.g., anaphylaxis) to any vaccine component, including egg protein, or after a previous dose of any influenza vaccine, and in children and adolescents receiving concomitant aspirin or aspirin-containing therapy. In clinical trials, the risks of hospitalization and wheezing were increased in children <24 months of age who received trivalent FluMist.

FluMist Quadrivalent is generally well-tolerated; however, if you or your loved one has an adverse reaction to the vaccine, that information should be reported to VAERS.

VAERS is a U.S. passive reporting system, meaning it relies on individuals to send in reports of their experiences with a vaccine. However, anyone can submit information to VAERS, including parents and patients. Furthermore, healthcare providers are required by law to report to VAERS.

FluMist Quadrivalent and COVID-19 Vaccines

The US CDC previously issued interim clinical considerations stating that 'COVID-19 vaccines and other vaccines, including influenza vaccines, can be administered without regard to timing. And the annual influenza vaccination is recommended for all persons aged six months and older who do not have contraindications. However, 'Providers should be aware of the potential for increased reactogenicity with coadministration and should consult the CDC for updated guidance as more information becomes available. If coadministered, COVID-19 vaccines and vaccines that might be more likely to cause a local reaction (e.g., aIIV4 or HD-IIV4) should be administered in different limbs, if possible.'

'No data are currently available concerning coadministration of currently Authorized COVID-19 vaccines and influenza vaccines,' stated Lisa Grohskopf, M.D., MPH, CDC's ACIP vaccine committee presentation (slide #14) on June 24, 2021.

FluMist Quadrivalent Dosage

FluMist Quadrivalent is a vaccine sprayed into the nose by a healthcare professional. One spray of FluMist in each nostril can help protect eligible children and adults ages 2-49. People 9 years of age and older need one dose of FluMist Quadrivalent each year. Children 2 through 8 years old may need two doses of FluMist Quadrivalent, depending on their history of previous influenza vaccination. Your healthcare provider will decide if your child needs to come back for a second dose.

'You can breathe normally while you get FluMist Quadrivalent. It's okay if you sneeze, blow your nose, feel dripping down your nose or throat, or swallow after receiving FluMist Quadrivalent. You still get enough FluMist Quadrivalent to help protect you against the flu,' says AstraZeneca.

FluMist Quadrivalent News For 2020 - 2022

November 10, 2022 - AstraZeneca confirmed Flumist vaccine revenues reached about 59 million year-to-date.

September 23, 2022 - AstraZeneca announces FLUMIST® QUADRIVALENT doses are available in the U.S. for the 2022-2023 influenza season. "Educating communities about flu safety measures and encouraging yearly flu vaccination remains an important part of reducing serious and contagious health threats," said Liz Bodin, Vice President, U.S. Respiratory & Immunology, AstraZeneca.

March 25, 2022 - The results from a limited (151 children) clinical trial published by the AAP suggest within 42 days of vaccination, 10.8% of children who received the intranasal LAIV4 experienced an asthma exacerbation compared with 14.7% of those who received the intramuscular IIV4; risk difference -0.0390, 90% CI -0.1453 to 0.0674).

August 31, 2021 - AstraZeneca announced that FLUMIST® QUADRIVALENT vaccine doses are available in the U.S. for the 2021-2022 influenza season. FLUMIST QUADRIVALENT is the only U.S. FDA-Approved nasal-spray flu vaccine.

August 26, 2021 - The U.S. FDA confirmed (3) FluMist Quadrivalent lots from MedImmune, LLC, were released. 

June 1, 2021 - Global Nasal Spray Vaccine Market 2020 Development Analysis – AstraZeneca FluMist, Cipla, BCHT

February 11, 2021 - AstraZeneca plc published financial results, which stated Flumist Total Revenue, entirely comprising Product Sales, increased by 161% in the year (153% at CER) to $295 m, reflecting the greater use of influenza vaccines as health authorities in northern-hemisphere countries expanded seasonal-vaccination programs beyond typical levels during the ongoing COVID-19 pandemic. In the U.S., sales increased by 254% in the year to $70m and, in Europe, by 135% (126% at CER) to $219m.

November 25, 2020 -  Israel ordered AstraZeneca's FluMist vaccines for its citizens.

August 13, 2020 - AstraZeneca Ships FLUMIST® QUADRIVALENT Vaccine in the U.S. for the 2020-2021 Flu Season. AstraZeneca has increased production of FluMist QUADRIVALENT doses in the U.S. by over 25% more than previously planned, a majority of which are expected to be available by the end of September.

FluMist Quadrivalent Clinical Trials

Astra Zeneca's FluMist has been studied in several clinical trials.