We sometimes hear that folks are going to skip their yearly flu vaccine because they don’t believe in flu shots, they never get sick, or they think that flu shots don’t work or are dangerous.
Some nurses and doctors are refusing to get a flu shot and have to wear masks at work.
Flu vaccines are safe and have many benefits, even if they aren’t any where near 100% effective.
So are there any legitimate reasons to skip a flu shot?
Of course.
In fact, three very good reasons to skip a flu shot include:
being younger than 6 months of age
having a severe allergic reaction (e.g., anaphylaxis) after a previous dose of flu vaccine or to any component of the flu vaccine
and, uh…
Actually, although folks might have many of bad excuses, there are only two good reasons to skip a flu shot…
So, infants who aren’t old enough to be vaccinated yet, and anyone who has had a life-threatening reaction to a previous dose.
Additional precautions, but not true contraindications, do including having had Guillain-Barré syndrome <6 weeks after a previous dose of influenza vaccine and having a moderate or severe acute illness with or without fever when you are planning to get vaccinated.
Even if you have had a severe reaction to eggs, you can still get a flu shot. Just get it get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office), so that you can be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
Are you skipping the flu shot because you never get sick? How lucky do you feel this year? Don’t continue to gamble that you won’t get the flu. Increase your chances of staying well by getting a flu shot, the best way to avoid the flu.
After decades with a single type of flu vaccine – the flu shot – there are now many different kinds of flu vaccines that many of us can choose from. And your choices are not just between the nasal spray flu vaccine vs a flu shot. There are also a lot of different kinds of flu shots available now.
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)
Having choices is nice.
It would be also be nice to have a little more guidance on what to do with these choices.
It is actually easy to start by asking which one you should get for your kids, as many of these flu vaccine options are only available for adults and seniors.
Flu Vaccine Options
Before you start thinking too long and hard about potential options, keep in mind that you might not have as many options as you think.
“Not all products are likely to be uniformly available in any practice setting or locality. Vaccination should not be delayed in order to obtain a specific product when an appropriate one is already available.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Doctors and clinics might not stock multiple brands or types of flu vaccines, so you might have to get whatever flu vaccine that they have available.
“Within these guidelines and approved indications, where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
And that’s okay. In most cases, there haven’t been head to head studies showing that one flu vaccine is better than another.
Flu Vaccine Options for Kids
Still, since these options might be available to you, it is good to know about them.
This year, younger kids, between the ages of 6 months and 3 years, can either get:
FluLaval Quadrilvalent
Fluarix Quadrivalent
Fluzone Quadrivalent Pediatric
While you are unlikely to notice a difference, both FluLaval and Fluarix are given at a 0.5ml dose containing 15 µg of HA per vaccine virus, while Fluzone is given at a 0.25ml dose containing 7.5 µg of HA per vaccine virus. Why the difference? “Safety and reactogenicity were similar between the two vaccines,” even at the different doses.
Basically, these are just different brands of the same type of flu shot.
There are even more options as your kids get older though, including Fluzone Quadrivalent (age three and above), Afluria Quadrivalent or Trivalent (age five and above), Flucelvax Quadrivalent (age four and above), FluLaval and Fluarix.
Of these, some folks wonder if Flucelvax, since it isn’t made in chicken eggs, might be more effective than the others. Remember, one of the things that are thought to make the flu vaccine less effective than most other vaccines is that they are made in eggs, leading to mutations. And there is actually some evidence that those flu vaccines that are not made in eggs might be more effective.
“And the University of Pittsburgh Medical Center is taking that a step further, saying it will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. That’s because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.”
Guidance on which flu vaccine to get: Shots for kids, maybe go egg-free
Again, remember that the CDC has made “no preferential recommendation” for one flu vaccine over another. Why not? We don’t have enough information to make that kind of recommendation.
Should parents only ask for Flucelvax? That would only work if they made enough doses for every kid to get vaccinated, which they didn’t. Should you hold out until you can find FluceIvax for your kids? No, since doing that might leave them unvaccinated once flu season hits.
What else should you know about your flu vaccine options? While over 80% of flu vaccines are now thimerosal free, most of these flu vaccines are still available in multi-dose vials with thimerosal.
Also thimerosal free, this year, Flumist is back as an option. It is available for healthy kids who are at least two years old. Although the AAP has issued a preference for flu shots this year, the ACIP says that kids can get either Flumist or a flu shot.
What about if your kids are allergic to eggs?
“Persons who report having had reactions to egg involving symptoms other than urticaria (hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status.”
Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season
Unless they had a severe allergic reaction to a previous flu vaccine, they can get any available flu vaccine, especially if the previous reaction was only hives or they are able to eat eggs.
What if you want a flu vaccine without aluminum? Take your pick. While it would be safe it was, aluminum is not an ingredient in flu vaccines.
Flu Vaccine Options for Adults
In addition to all of the flu vaccines available for older kids, adults have a few more options:
Afluria Quadrivalent or Trivalent can be given by jet injector to those between the ages of 18 and 64 years
Flublok Quadrivalent – a recombinant flu shot that can be given to those who are at least 18 years old
Fluzone High-Dose – a trivalent flu shot with a higher dose of flu virus antigens (4 times the amount of antigen as a regular flu shot) that is available for seniors who are at least 65 years old
Fluad – a trivalent flu shot with an adjuvant that is available for seniors who are at least 65 years old
Why get a flu vaccine with a jet injector instead of a standard needle? High-pressure jet injectors don’t use needles!
Like FluceIvax, Flublok is not made in chicken eggs. The recombinant hemagglutinin(HA) proteins are made in insect cell lines. Does Flublok work better than egg based flu vaccines? That’s the theory, but again, there is no preference for one of these vaccines over another.
Seniors have even more choices.
Should they get Fluzone High-Dose, Fluad, or one of the other flu vaccines? Both have been shown to be more effective than standard flu vaccines in seniors, but they have not been compared against each other.
“In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.”
CDC on People 65 Years and Older & Influenza
But neither Fluzone High-Dose nor Fluad are quadrivalent, so only protect against three flu virus strains.
Is there a quadrivalent flu shot for older adults that might work better than standard flu shots?
Yes. FluceIvax and Flublok are non-egg based quadrivalent flu shots that might be more effective than standard flu vaccines.
So are you more confused now that you know you have so many options? Just remember that for most people, the mistake isn’t about choosing the right flu vaccine, it is about not getting vaccinated.
What to Know About Your Flu Vaccine Options
While it might seem like you have a lot more options in a flu vaccine this year and that some might be more effective than others, keep in mind that availability will likely greatly limit these “options.”
And the best flu vaccine is the one that you actually get, as it will be the one that reduces your risk of getting the flu. Missing your chance to get vaccinated and protected because you are waiting for a specific brand or type of flu vaccine isn’t going to help keep the flu away.
Are you looking for more information about the ingredients in the vaccines your kids are about to get?
Have you tried one of those vaccine ingredient calculators?
Should You Use a Vaccine Ingredient Calculator?
As you do your research and look at the risks and benefits of your vaccine decision, you should know that those vaccine ingredient calculators that claim to help reduce toxins aren’t really helping you make an informed decision.
Calculate which vaccine-preventable diseases your child will be protected from when he gets vaccinated.
They are a propaganda tool that simply works to increase fear about vaccines by making you think that you need to do a vaccine lot search, compare vaccine brands, or work to reduce exposures to specific ingredients.
Why would you need to do a lot search? There are no hot lots of vaccines that you need to avoid.
Why would you need to compare vaccines based on their brands? Vaccines are safe. Vaccine ingredients are safe. Although the ingredients might vary a bit based on the brand of vaccine, that isn’t going to impact how well a vaccine works or it’s side effects.
Depending on the brand, don’t some vaccines do contain more aluminum than others?
“The alternative suggests only one aluminum-containing vaccine at a time in the infant years (the right brands must be chosen). By spreading out the shots, you spread out the exposure so infants can process the aluminum without it reaching toxic levels.”
Bob Sears in The Vaccine Book
The FDA states that “the amount of aluminum in the recommended individual dose of a biological product shall not exceed” 0.85 to 1.25 milligrams.
Not surprisingly, no vaccine exceeds that approved amount of aluminum, no matter what brand you choose.
Why do anti-vaccine folks scare parents into thinking that their kids are getting exposed to potentially toxic levels of aluminum from vaccines?
“WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 [micro]g/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.”
FDA on Aluminum in large and small volume parenterals used in total parenteral nutrition.
The FDA and AAP and others began investigating and then warning folks about aluminum in 1986. They weren’t worried about aluminum in vaccines though. They were concerned that newborns and younger premature infants might be getting too much aluminum if they were getting a lot of IV products with aluminum, especially if they weren’t able to eat on their own and were dependent on total parental nutrition for long periods of time.
So these were high risk infants who were potentially getting high doses of aluminum each and every day for weeks or months at a time. And somehow anti-vaccine folks equated this with other infants who were getting vaccines every few months, at least they did once they started to move away from worrying about thimerosal.
What to Know About Using a Vaccines Ingredient Calculator
Vaccine ingredient calculators are a propaganda tool that anti-vaccine folks use to scare parents away from vaccinating and protecting their kids.
It is no secret that multi-dose vials of flu vaccine still contain the preservative thimerosal, and that most flu vaccines are now thimerosal free.
One anti-vaccine group did test and find thimerosal in a vaccine, but it was a flu vaccine that said it contained thimerosal. How much did they find? The amount that was supposed to be in the vaccine… If they were really reporting about some kind of conspiracy, you would have thought they would have tested one of the thimerosal free flu vaccines that are available.
What about the idea that “some information regarding additives and residuals is considered to be a trade secret and thus confidential?”
The chapter in the book Vaccines where that quote comes from also states that because of FDA regulations “the use of, and quantity of, additives and residuals should be disclosed on the vaccine label.”
Specifically, vaccines labels must include:
the preservative used and its concentration
known sensitizing substances
the type and calculated amounts of antibiotics added during manufacture
the source of the product when a factor in safe administration
the identity of each organism used in manufacture, and, where, applicable, the production medium and method of inactivation
So what are the trade secrets?
“It is important to recognize that FDA-approval of all new vaccines involves not only assessment of the antigens and final contents, but the entire process of synthesis. Each and every component introduced and used in the manufacture is scrutinized. While there are a wide array of excipients required to either manufacture, package or deliver effective immunity, each of these is part of this approval process.”
Vaccinophobia and Vaccine Controversies of the 21st Century
They are likely very specific details about the production process. In other words, how exactly they put all of the ingredients together to actually make the vaccine.
There is no secret about what’s in your child’s vaccines. No hidden ingredients either.
What about warnings over contaminates in vaccines?
When they rarely occur, contaminated vaccines are discovered and removed. Keep in mind that vaccines are very safe from contamination and the only issue with any recent incidents is that they are used by the anti-vaccine movement to further scare parents who are on the fence about vaccines.
What to Know About Hidden Ingredients in Vaccines
There are no secret or hidden ingredients in vaccines.
