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Advocate staff photo by BILL FEIG -- Fifth grader LaTayna Williams, left, grimaces for a moment while receives the flu mist up the nose from Kameron Keller, right, nursing student at BR General. EBR schools launched their annual flu vaccination campaign at Claiborne Elementary School Thursday with students receiving shots or nasal spray. EBR shoots to immunize 5,000 to 8,000 or more kids each year to create what is known as herd immunity that limits the severity of a flu outbreak.

Even as Louisiana is in the middle of a busy flu season, a promising avenue to limit the spread of the virus, school-based vaccination drives, is on indefinite hold thanks to a decision 18 months ago by federal health officials to cease supporting nasal spray vaccinations that had become ineffective.

East Baton Rouge Parish schools led the way in 2008 when it began annual mass vaccinations of thousands of schoolchildren throughout the parish against the seasonal flu. Following Baton Rouge’s lead, smaller school-based vaccination drives were launched in New Orleans, Shreveport, Alexandria and Monroe.

But that all came to a halt in 2016. 

“It was all sort of in its infancy when we were stymied,” recalled Dr. Frank Welch, medical director of Louisiana’s immunization program.

What happened was the federal Centers for Disease Control and Prevention, following the advice of an expert panel, abruptly withdrew its support in June of that year for the use of the nasal spray known as FluMist because studies showed it no longer worked.

“That was a complete surprise,” Welch said.

FluMist, produced by Maryland-based MedImmune, had become the clear favorite among children and the go-to method of vaccination in schools.

“For most children, getting a shot is harder than getting a little mist blown up their nose,” Welch said.

In earlier studies, FluMist had shown that it was an effective alternative to traditional flu shots. More recent studies have shown that the latest iterations of FluMist performed no better than taking a placebo. Why FluMist ceased working is an ongoing medical mystery that MedImmune and other researchers have yet to solve.

In Baton Rouge, the annual flu vaccination drive was led by Health Centers In Schools. The nonprofit group runs several school-based health centers as well as oversees school nurses for the parish school system.

“I really like the inhaled vaccine because it was so easy,” said Sue Catchings, executive director of Health Centers in Schools.

By 2015, the drives were immunizing between 5,000 to 6,000 children a year in Baton Rouge. Catchings was working to increase those numbers substantially to reach what public health professionals call “herd immunity.” That’s a tipping point where enough people are protected against an ailment to provide indirect protection for an entire population, in this case, a school.

The federal Vaccine for Children program, which Welch oversees in Louisiana, provides free vaccines to low-income children. In Baton Rouge, Our Lady of the Lake Regional Medical Center has in the past supplied additional vaccines for children who did not meet those income requirements.

The hospital acquired Health Centers in School in 2012.

After FluMist fell out of favor, Catchings said conducting a mass vaccination drive using only traditional shots was a non-starter for her. Shots not only mean “facing a whole group of kids who are crying,” it’s also very disruptive, especially in elementary schools, she said.

Colette Barrett, vice president of admissions for Our Lady of the Lake, echoed Catchings.

“It was so much easier when you had FluMist because you could give FluMist and not disrupt the learning environment,” Barrett said. “That doesn’t happen when you give a shot.”

Flu activity in Louisiana, as well as across the country, increased dramatically over the month of December. The CDC’s latest weekly flu report, released Friday and covering the last week in December, lists Louisiana as one of the 22 busiest states in the country for the flu. And the virus is widespread in 46 states, up from 36 the week before, according to the CDC.

While FluMist is on hiatus, Health Centers in School is continuing with a more traditional approach to combat the current flu season. School nurses are still giving traditional flu shots on demand. Service levels are greatest at Baton Rouge schools with health centers. Mobile health units, so-called “blue buses,” visit schools throughout the parish to offer health services, including flu shots. And school nurses make a special effort to vaccinate children with chronic conditions such as asthma and diabetes, Barrett said.

“They are easy targets for a flu bug,” she explained.

Nationally, vaccination rates among children were unchanged during the 2016-17 flu season compared to the year before when FluMIst was still widely used. Welch said Louisiana’s number tracked the rest of the nation. But he said he believes that the elimination of FluMist halted improvement in the state’s flu immunization rates, though he can’t prove it.

”I believe if FluMist were available last year, we would have seen those (vaccination) rates rise, and instead we have held steady,” Welch said.

Barrett said the rate of vaccination in Baton Rouge schools undoubtedly declined some since FluMist fell out of favor but she didn’t know offhand how much.

Other organizations that do school-based vaccination drives have reported declines. For instance, the nonprofit Maryland Partnership for Prevention reported that it vaccinated half as many children with traditional flu shots last year compared with when FluMist were available, according to a recent story in The Baltimore Sun.

Local health professionals say that things won’t change until FluMist returns in a new and improved form.

“We had hoped it would only be gone one year, and then it was gone a second year,” Welch said. “I am sincerely hopeful that in the next year or two year it will come back.”

Barrett promised that the mass vaccination program in Baton Rouge public schools will pick right up where it left off when and if FluMist returns.

“We will jump and down and scream and be so excited to be able to incorporate that into our process,” she said.

Follow Charles Lussier on Twitter, @Charles_Lussier.