Demonstrating the capacity of the National Advisory Committee on Immunization for timely responses to post-market vaccine monitoring signals: Canada’s experience with the live-attenuated influenza vaccine

• Main Authors: Linlu Zhao, Kelsey Young, Althea House, Rob Stirling, Matthew Tunis
• Format: Article
• Language: English
• Published: Public Health Agency of Canada 2021-05-01
• Series: Canada Communicable Disease Report
• Subjects: influenza; laiv; nasal spray; post-market surveillance; vaccine effectiveness
• Online Access: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2021-47/issue-5-6-may-june-2021/national-advisory-committee-immunization-recommendations-post-market-vaccine-live-attenuated-influenza-vaccine.html

Over the last several years, the recommended use of the live-attenuated influenza vaccine (LAIV) for children has evolved in the United States (US) in response to evidence of a potential decrease in LAIV effectiveness based on post-market monitoring. These issues were not observed in Canada or elsewhere; consequently, recommendations from Canada’s National Advisory Committee on Immunization (NACI) and the US Advisory Committee on Immunization Practices (ACIP) on whether to use LAIV differed for two influenza seasons (2016–2017 and 2017–2018). This retrospective describes how NACI arrived at its recommendations in response to post-market signals of reduced LAIV performance from the US in 2013–2014 and again in 2015–2016. NACI’s experience with LAIV marks the first time in Canada where a preferential recommendation on the use of an influenza vaccine in a routine immunization program was reversed. This experience highlights the importance of ongoing post-market monitoring of vaccines, international collaboration and careful consideration of local context to inform vaccine recommendations. NACI’s capacity for timely responses to post-market vaccine performance signals will facilitate responsiveness to similar post-market monitoring signals from the coronavirus disease 2019 (COVID-19) vaccines.