The only option not worth considering? Not getting your flu vaccine.

Have you ever walked down the breakfast cereal aisle at the grocery store and been overwhelmed by your choices? While your options for flu vaccination aren’t quite as numerous, you do have many choices for the 2013-2014 flu season. But don’t let indecision keep you from getting vaccinated. Flu vaccination is the most effective way to avoid getting the flu. Today’s post explores your options and Dr. Paul Sax, Clinical Director of the HIV Program and Division of Infectious Disease at Brigham and Women’s Hospital, offers advice on choosing a vaccine for yourself and your family.

Trivalent Vaccines

Flu vaccines stimulate your immune system to create proteins called antibodies. Antibodies prepare your body to fight off illness in the event you’re exposed to the flu virus. In most cases, the vaccines stimulate your immune system to create antibodies by exposing you to a weakened form of the flu virus.

Typically most flu vaccines are trivalent, meaning they provide protection against three different flu viruses. The 2013-2014 trivalent flu vaccine protects against two type A flu strains and one type B flu strain. According to the Centers for Disease Control and Prevention (CDC), the following trivalent flu vaccines are available:

  • Standard dose trivalent shots in which the flu virus is grown or cultured in cells from chicken eggs or mammal cells. Egg-based vaccines are approved for people aged 6 months and older and vaccines cultured in animal cells are approved for people 18 years and older. People with severe allergies to eggs (a small proportion of the population) should avoid egg-based vaccines.
  • Egg-free standard dose trivalent shot, introduced this year, differs from other flu vaccines because it does not use the flu virus to stimulate the immune system. The egg-free vaccine is appropriate for people with severe egg allergies aged 18 through 49 years.
  • High-dose trivalent shot approved for people 65 and older.
  • Standard dose intradermal trivalent shot which is injected into the skin instead of the muscle. This vaccine uses a much smaller needle than the regular flu shot and is approved for people 18 through 64 years of age.

Quadrivalent Vaccines

These vaccines protect against four flu viruses – the viruses covered in the trivalent vaccine plus one additional type B flu strain. The following quadrivalent flu vaccines are available:

  • Standard dose quadrivalent shot which is approved for people aged 3 years and older. There also is one brand that is approved for children as young as 6 months.
  • Standard dose quadrivalent nasal spray, approved for people 2 through 49 years of age, who do not have underlying health conditions that put them at risk for flu-related complications – including women who are pregnant, people with asthma, or those on long-term aspirin therapy.

With all these choices, how do you decide which flu vaccine to get? Dr. Sax offers this advice:

Should I get a trivalent or quadrivalent vaccine?

Dr. Sax recommends getting the vaccine that is the most convenient. If you have a choice, he suggests the quadrivalent vaccine, which is widely available. He emphasizes that the most important thing is getting vaccinated. Either vaccine can provide the flu protection you need.

Are people over 65 years the only ones who should consider a high-dose vaccine?

In addition to people over 65 years of age, Dr. Sax suggests that the high-dose vaccine may offer added protection to people with weakened immune systems, such as those undergoing chemotherapy, receiving immune-suppressing drugs for diseases like rheumatoid arthritis or colitis, and people with HIV. The high-dose vaccine is not as widely available as standard-dose vaccines, so you may need to order it through your provider. If you’re unable to get the high-dose vaccine, or even if it’s too inconvenient to get it, Dr. Sax advises that the standard-dose vaccine is still an effective alternative.

Is there an advantage to getting the flu vaccine by injection versus nasal spray?

Nasal spray vaccines, says Dr. Sax, work very well and are a good alternative for people who don’t like needles. You’re less likely to get a sore arm with the nasal spray vaccine, though you may be more likely to experience some nasal stuffiness.

Why did so many people get ill from the flu last year?  Did flu vaccination really help? 

Dr. Sax notes that last year’s vaccine was closely matched to flu viruses circulating in the community. As usual, the vaccine wasn’t perfect – it’s estimated that the vaccine prevents  60-80 percent of cases. He suggests that the 2012-2013 flu season seemed severe because the 2011-2012 flu season was very mild in comparison.

Flu vaccination is the best way to prevent getting the flu, says Dr. Sax; he adds that every infectious disease specialist he knows gets vaccinated, as a way to protect themselves and to prevent spreading the disease. And remember, contrary to popular belief, you cannot get the flu from the flu vaccine. Flu season overlaps with the cough and cold season. If you get a cold shortly after you get a flu vaccine, it’s completely unrelated to the vaccine. (Unfortunately, the viruses that cause colds are completely different from the flu virus, so the flu vaccine offers no protection against colds.)

In summary, while there are more choices out there for flu vaccine than ever, it’s more important to get any of the available vaccines than to worry too much about getting the right one, as all will do a good job at protecting you from the flu.

The only option not worth considering? Failing to get your flu vaccine.

More information about the flu vaccine and where to get it:

– Jamie R.

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