Flu Vaccine Q & A
Updated November 2018
A few changes this year. Last season, I noticed more patients wanting the quadrivalent (quad) over the trivalent flu shot compared to previous years. This year I’m seeing very few trivalent vaccines even available; most vaccines are quad.
For the past 2 seasons, nasal spray (FluMist, live attenuated) was removed as a recommended option, but this year it is again on CDC’s recommended list. Also, several flu shots have adjusted ages to include a younger population, e.g. Afluria Quad is now for children 5 years and older (previously 18 years and older). Regardless of the changes, the CDC still recommends the appropriate flu shot for anyone 6 months and over, with no preference towards any particular vaccine. This table from CDC provides an excellent summary for this season’s vaccines: https://www.cdc.gov/flu/protect/vaccine/vaccines.htm
The strains covered this year are the A/H1N1, A/H3N2, B/Victoria, and additional in the quad, B/Yamagata. However, the B/Victoria component has been changed and A/H3N2 has been updated.
While not a vaccine, I found this noteworthy: since October 24, 2018 a new drug Xofluza® (baloxavir marboxil) has been added to the treatment of acute uncomplicated flu in persons 12 and older who have had flu symptoms for less than 48 hours. Xofluza joins other drugs like Tamiflu® (oseltamivir) and Relenza® (zanamivir). Follow the CDC for more information on Xofluza as it becomes available.
Remember, even if you have a runny nose but not really feeling sick, you can get your flu shot. If you have an illness or condition that you think is serious enough to go to the doctor, then hold off getting it.
Stay warm, active and healthy!
Originally posted October 2015
It’s been beyond crazy at the pharmacy now that flu shot season is in full swing. But it’s really great to see the number of people who are taking the step to prevent getting and spreading the flu. There’s always a Q & A time before you get your shot and I’ve noticed that lots of people have similar questions and I thought it would be helpful to share some of them.
Q1. There’s more than one flu shot? What are the options?
There are 2 main categories of flu shots: 1. live attenuated or inactivated and 2. how many strains the vaccine covers.
Live attenuated vs Inactivated
Live attenuated vaccines contain a weakened form of the disease-causing pathogen but do not cause the actual disease. Presently, there’s only one live attenuated influenza vaccine (LAIV) – FluMist – which is given in the nose. Inactivated flu vaccines contain killed viral strains. The inactivated vaccine may contain 3 strains (trivalent/TIV) or 4 strains (quadrivalent/QIV).
Comparing the live and inactivated types, live vaccines produce a stronger immune response because of its similarity to the natural virus. It also has the advantage, for people who hate needles, of being inhaled. An important note is that you cannot have a compromised immune system (either because of a medical condition or use of immunocompromising medications) and get the LAIV. Inactivated flu shots may not elicit as strong of an immune response but they’ve been manufactured for a long time and provide great coverage for the flu season.
Trivalent vs Quadrivalent
The A strains of the flu virus are the A/H1N1 and A/H3N2; the B strains are the Victoria B-lineage strain and the Yamagata B-lineage strain. Trivalent vaccines covers both A strains plus 1 B strain, while the quadrivalent covers both A and B strains. This season (2015 – 2016) the trivalent vaccine contains the A strains and the B-Yamagata strain.
Currently, the CDC doesn’t recommend a particular flu shot – so it’s patient’s preference once you meet the requirements e.g. age. The QIV does cost a bit more than the TIV. However, studies within the past 5 years suggest that while the QIV may have higher upfront costs, long term costs may be lower since the QIV may provide better protection for the flu. [1,2]
Q2. If you get the flu shot early, will it wear off by spring?
Research does show that your protection against the flu, after you get your vaccine, decreases over the months . Historical data show that peak times for the flu are December and February and sometimes a spike in May. In balancing those 2 bits of information, you might feel conflicted as to the ‘perfect time’ to get immunized. While there are flu trends, there are also outliers e.g. one year you might have an early flu outbreak – say September. Also remember that it takes about 2 weeks for your body to make sufficient antibodies against the flu. So it’s a good idea to get your flu shot as soon as it’s available, usually end of July/early August. Try as hard as you can to get it by early October. But if you just didn’t have the time, get it whenever you can. Late flu protection is better than none!
Q3. Can I get the flu shot at the same time as other immunizations?
Live attenuated and inactivated vaccines provide immunization using a different process. Because live vaccines require more cellular ‘work’, timing with other vaccines is more important.
You can get the inactivated flu vaccine with another inactivated or live vaccine at the same time or on a different day with no time considerations. But for the live attenuated flu vaccine, it’s recommended that you either get the other live vaccine at the same time or wait 4 weeks between vaccinations.
Q4. Do I have to eat/not eat anything special after the flu shot
No, just your normal (hopefully healthy) diet.
Q5. Can I get the flu shot if I’m pregnant?
Yes! Pregnant women should be vaccinated. Pre-filled syringes (PFS) are preservative free so they do not contain thimerosal, which is a mercury-based preservative. Most women feel more comfortable with the preservative-free option; however, in the event that the PFS are not available, the multi-dose vaccine (containing thimerosal) can still be given since studies have shown that they are safe since the mercury content is very low.
For more info on pregnancy and thimerosal, visit CDC Pregnancy & Flu
Q6. Do I need to make an appointment at the pharmacy to get a flu shot?
Nope, just walk right in. The only thing to be aware of is peak hours at your local pharmacy – usually lunch time and after work – then you might have a bit of a wait. Also be aware of when your pharmacy closes. Many pharmacists stop giving vaccines about 30 minutes before closing, simply because it takes times to get everything prepared.
Q7. It the flu shot covered by insurance?
There are a few ways your flu shot may be covered:
Most insurance plans cover flu shots that you get at the pharmacy, although there are a few plans that require you to go to the doctor instead
The flu shot is covered under Medicare part B and, in most states, Medicaid for adults and children
Enrolled veterans are covered
Using flu shot vouchers – visit Familywize for more info
Ask your employer – some companies offer vouchers to get a free flu shot
If it seems strange that there are so many ways that the flu shot is covered, think of it this way: it’s far more expensive for a person to get the flu than to get a flu shot. Getting the flu leads to loss of work days for employers, having to say at home for working parents with sick children, and an increase in health care burden and expenditures when the flu leads to secondary complications.
Q8. What if I have allergies like peanuts or latex?
Peanut and latex allergies are not contraindications to getting the flu shot. Additionally, there are latex-free syringes if you are very sensitive. A good precaution if you’re concerned but still want to get a flu shot is to wait in the pharmacy for 30 minutes after your injection to make sure you feel okay.
If you have a mild egg allergy (e.g. hives), Flucelvax or Flublok is an alternative for you . These vaccines are manufactured without using eggs. Flucelvax is approved for persons 4 and over, while Flublok is for persons 18 and over. Both vaccines are quadrivalent. Call your pharmacy beforehand to see if they have it in stock. If you have a severe egg allergy, visit your doctor to talk about your options.
Q9. Do I really have to wait 15 minutes after getting the flu shot before I leave?
Pharmacists should always give you an administration form to complete before giving any vaccine. If you have never had a severe reaction with a previous vaccination, then you can indicate this on your form or convey this to your pharmacist – either way, it is not necessary to wait the 15 minutes.
However, if you have had a previous reaction or if it is your 1st time getting a vaccine (children included), you should still wait the recommended time.
Q10. Do you have to get a bandage after a flu shot?
That might seem like a silly question but you’d be surprised at the number of people who ask! Some are concerned that the site of injection may get infected. The answer is no, unless you have bleeding. Since the area is cleansed with alcohol and the injection site so small, the risk of getting an infection is very low. But if you do feel like you’ll scratch the area because of irritation or you just want one, then by all means get a bandage.
Kieninger D,Sheldon E, Lin WY, Yu CJ, et al. Immunogenicity, reactogenicity and safety of an inactivated quadrivalent influenza vaccine candidate versus inactivated trivalent influenza vaccine: a phase III, randomized trial in adults aged ≥18 years. BMC Infect Dis. 2013 Jul 24;13:343. doi: 10.1186/1471-2334-13-343.
Beran J,Peeters M, Dewé W, et al. Immunogenicity and safety of quadrivalent versus trivalent inactivated influenza vaccine: a randomized, controlled trial in adults. BMC Infect Dis. 2013 May 20;13:224. doi: 10.1186/1471-2334-13-224.
Center for Disease Control. Recommendations for the Use of Influenza Vaccines, 2018–19 Influenza Season. Accessed on Nov 3, 2018 from https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_w
Immunization Action Coalition. Influenza Vaccination of People with a History of Egg Allergy. Accessed on Sept 26, 2015 from http://www.immunize.org/catg.d/p3094.pdf