A nationwide shortage of FluMist, the nasal spray flu fighter popular among needle-phobic youngsters, has left many Minnesota hospitals and flu clinics in short supply during this, the busiest time of the flu shot season.

So far, the Minnesota Department of Health has received just 42 percent of its pre-order of FluMist, said Kris Ehresmann, director of the department’s infectious disease, epidemiology, prevention and control division.

Some providers have completely run out, although others still have some in stock. That has left parents either scrambling to find doctors and pharmacies with ample supply of the nasal spray or else holding off on vaccinating their children until next month, when more FluMist is expected to arrive.

“It is an inconvenience,” said Diane Alexander, pharmacy director at Children’s Hospitals and Clinics of Minnesota, which has received 60 percent of its order. The shortage also has upped this flu season’s “ouch” factor. “We’ve had to tell kids they have to get a shot,” Alexander said.

Minnesota is experiencing “sporadic” flu activity. The flu season generally runs from October through May, with the peak time in January and February. Last year, the flu peaked earlier than normal, and children were hit especially hard. Ten Minnesota children died from flu-related complications.

“We had the highest number of [flu] cases we’ve seen statewide, and certainly at Children’s,” said Patsy Stinchfield, director of infection prevention and control for Children’s.

Public health officials advise that everyone older than 6 months be vaccinated for the flu but that the spray not be used until age 2. It takes two weeks after vaccination (either from the shot or the nasal spray) to build up resistance to the virus.

Among those affected by the shortage are underprivileged children who qualify for the federal program Vaccines for Children. The program, administered in Minnesota by the state Health Department, offers free vaccines to eligible children.

“We’ve seen very little FluMist in that program,” Alexander said. “Our clinics are totally out of the VFC supply, but they can get injections.”

Production delays

Just one company makes the nasal vaccine, supplying the world’s demand for the no-needle inoculation.

A statement from the manufacturer, AstraZeneca Pharmaceuticals, attributed the shortage to production challenges.

“This influenza season we have encountered some challenges with production of two of the four strains contained in our vaccine, which has impacted delivery timing,” the statement said. “We have shipped nearly 7 million doses through mid-November in the U.S. and will be shipping several million more through late November and into December to meet late-season demand throughout the remainder of the season.”

There was a two-month lag in the manufacturing process, in part because an added strain took longer to grow than expected, added Stinchfield, who is also a member of the Centers for Disease Control and Prevention advisory committee on immunization practices.

Complications from last year also contributed to the delay, she said. The nasal spray contains a weakened, live virus. Last year, part of the vaccine was very sensitive to heat and “was damaged in the distribution process, yielding that vaccine ineffective,” Stinchfield said. “Last year, we had zero effectiveness. They have since then fixed that.”

But it took time to get to the bottom of the problem and develop this year’s vaccine to address the heat sensitivity issue, she said.

The FluMist nasal spray was approved by the U.S. Food and Drug Administration in 2007 and can be administered to anyone ages 2 to 49. Other than avoiding a needle, there is no major difference between the shot and the nasal spray, although people with egg allergies or who have weakened immune systems also should steer clear of the spray.

At Children’s, the hope is that the shortage will be over in a few weeks. Officials say they treat every visit as an opportunity to vaccinate against the flu virus, but they know that demand for FluMist is high.

“Of our orders, we order more FluMist than we do anything else, because the kids prefer to get that and not get a shot,” Alexander said. “We thought we were set with our order. We now have to go back and figure out how many more shots we have to order.”