Flu: What's New, What's Not New

September 27, 2016

What is not new is that everyone 6 months and older should get a flu vaccination every year. This recommendation has not changed. What is new: 1) Only injectable vaccines will be available this year. No nasal preparations will be used. 2) The vaccine components have been updated to better match circulating viruses.

3) There are new vaccine preparations. 4) The egg allergy recommendation has changed. (See below.)  

It used to be easy to get a flu shot. You would ask and you would get! Now there are many different preparations. While this may seem to complicate things, it has resulted from research striving to improve the vaccine and tailor it to the needs of certain groups of people.  The vaccine you get will depend on availability and your age as well as certain allergies. Below is a description of the preparations, both new and old, that will be available this season. Feel free to read them or skip to the new egg allergy recommendation and rest assured that your health care provider or flu clinic that you attend will know what you should get, based on availability. If you desire a specific preparation, you may need to “shop around” to find it.

There are many forms and preparations of flu vaccinations:

Standard dose of trivalent (contains protection against three strains) or quadrivalent (contains protection against four strains) are inactivated vaccines given by injection into the muscle or by a short needle under the skin (called intradermal.) Trade names include: Fluarix, Flulaval, Fluzone,  Fluzone Intradermal, Afluria, and Fluvirin.

High dose for people are 65 and older: This preparation (Fluzone high dose) has four times the amount of antigen (inactivated virus) as the standard dose. This was developed because as people age, their immune response (that which fights germs) is not as strong as it was when people are younger.

Adjuvanted Inactivated Influenza vaccine: This is a new vaccine preparation. It contains an adjuvant, MF59, which is an emulsion of squalene oil. (Squalene is a naturally occurring substance found in humans, plants and animals.) This vaccine is only for persons age 65 and older. Studies have shown that the addition of an adjuvant can create a stronger immune response in older persons. It is marketed under the trade name Fluad.

Cell-culture vaccines: Most flu vaccines use chicken eggs to grow the preparation. Instead of using chicken eggs to produce the vaccine, this method of preparation uses cells from mammals (Madin –Darby Canine Kidney or MDCK). This technology is potentially more flexible than egg-based technology and does not rely on the availability of hen eggs. It can be used in persons 4 year and older. It is marketed under the trade name Flucelvax. 

Recombinant vaccines: This preparation does not require the use of flu viruses or chicken eggs. It is marketed as Flublok and is for persons age 18 and over. This vaccine is suitable for persons with egg allergies.

Speaking of egg allergies, the Centers for Disease Control (CDC) reports that the recommendations for people with egg allergies have been updated for this season. Specifically, they recommend:

  • People who have experienced only hives after exposer to an egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, lightheadedness or recurrent emesis (vomiting) or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.

            Many people have concern over the preservative, thimerosal, which is used in multi-dose vials preparations of the flu vaccine. (Single dose vaccines do not use it.) Thimerosal is a mercury-derivative that has been used as a preservative for over 50 years. Research has shown that there is no association between thimerosal and autism, despite what you may have heard. Flu manufacturers can make the single-dose vaccine preparation without using thimerosal. This action was not due to safety concerns, but rather as a response to the public’s desires.

      You may hear controversy about the effectiveness of flu shots. While there is some truth to this (it is not a 100% effective or provide a guarantee), it is currently the best tool we have to protect against the flu and its complications. In fact, the more people who get a flu shot, the greater the immunity in a community. It is easy to get (available at pharmacies, health care provider offices, big box stores and at community sites.) It is inexpensive and covered by most health insurances. Its track record for safety is excellent.   While you may prefer one form over another (provided you meet the criteria) you should not wait to get a flu shot if the form you prefer is not available. What seems to happen every year is that people wait until flu begins to peak and find out that vaccine is no longer available. CDC recommends everyone should get their flu shot by October but also notes that they can be given into January.

District residents (Bethany, Hamden, North Haven and Woodbridge) can contact Quinnipiack Valley Health District (QVHD) by phone at 203 248-4528 or email dculligan@qvhd.org  if you have questions about flu vaccines. Note: QVHD does not administer flu vaccinations at this time.  You can also visit www.cdc.gov for detailed information on any of these preparations.