This Year’s Flu Vaccines: What To Know, And Why Not To Punt

An ad for vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

An ad for flu vaccines outside a Brookline, Mass., pharmacy on Sept. 20, 2013. (Carey Goldberg/WBUR)

It feels premature, off-seasonally odd, a bit like all the Halloween candy already on store shelves in August.

Flu is a cold-weather plague, yet the pharmacy signs advertising flu vaccines are already out on the sidewalks now, beneath the benevolent sun of perfect 70-degree days and leaves just beginning to tinge their edges with red and yellow.

But flu vaccine experts say that it’s really not too early to get vaccinated, and there’s a bit more to know this year as you roll up your sleeve. There are new and myriad options in flu vaccines, including:

• A “quadrivalent” vaccine that protects against four strains of flu virus rather than the usual three.

• New egg-free flu vaccines for people with egg allergies.

• High-dose “super” vaccines for older people.

• Short-needle vaccines (I’m not sure if I got one of these last year, but I was pleasantly shocked at how tiny the needle was and how little it hurt.) For shot-haters, nasal vaccines remain available for many as well.

Health authorities emphasize that flu vaccine “shopping” shouldn’t get in the way of just getting it done. Flu is no joke, killing an average of 24,000 Americans a year, including dozens of children.  USA Today offers a nice rundown of the options here, and the CDC’s flu vaccine page is here. I also spoke with Dr. Michael Jhung, a flu vaccine expert at the CDC’s National Center for Immunizations and Respiratory Diseases. Our conversation, edited, is below, but first, my own personal favorite flu-vaccine tip: A 90-minute bout of exercise soon after a flu shot could help jump-start your antibody production, according to a recent study that suggests it might even double your antibodies

CG:  First of all, I’m seeing these ads for flu vaccines in pharmacies already now in September, and it seems ridiculously early; flu season doesn’t even peak until January, and also, doesn’t the vaccine wear off after a while? So I’m thinking, maybe I’ll get it, but not now . . . How would you respond to that?

MJ: That’s a great question. I think a lot of people entertain the idea of getting an influenza vaccine, but then they put it off and they say, ‘Well, the season hasn’t started, I have plenty of time.’ But the fact of the matter is, the best time to get an influenza vaccine is before the season starts, not during the season.

And influenza seasons are very unpredictable from year to year. Typically, they do peak in January or February, and they start a few months prior to peaking, but last year, we saw a season that started a month earlier than it typically starts. So we don’t know when the season’s going to start, that’s why we’re encouraging folks to go out and get vaccinated as soon as they can.

And what about the wearing-off thing?

The influenza vaccine does provide excellent protection against influenza. That protection does wane over the course of a year, and that’s one of the reasons why we recommend folks get vaccinated every year. But the protection that it offers should last throughout one entire influenza season, even if someone gets vaccinated in early October.

Or even September?

Or even September.

What if I were to say ‘Well, I already got one last year, and I know that the vaccines come out every year because they change the strains of the virus that are in them, but there has to be a big overlap in viruses from year to year. So do I really need to get another one?’

That’s a very interesting question. There is some overlap from year-to-year in the virus strains that are in the vaccine, but it’s really important to recognize that the vaccine will only protect you against the influenza viruses that it contains. So, if you got influenza last year, and you think that protects you against influenza this year, that may not be true. You could very well be exposed to a different influenza this year, and be protected by this year’s vaccine if the vaccine contains that virus in it to provide that protection.

Even during the flu season, if you’re one of those people who puts off vaccination and you happen to get the flu early in the season, you can still get the flu, just a different virus later in the season. So we’d still recommend folks get vaccinated, even if they think they’ve had the flu this year.

So how about this? This year is just too confusing! There’s that nasal vaccine, there’s this new quadrivalent vaccine, there’s some kind of super-vaccine for old people, so there are too many choices, and what if my clinic doesn’t have the exact vaccine that I should get?

There are a lot of choices out there, as far as the influenza vaccine goes. Let me just make it very simple: get vaccinated, and get vaccinated early.

Okay….

We don’t have a recommendation as far as what vaccine you should get. As long as you get vaccinated, you’re going to be protected. And I’d say that the number of options out there really is a nice opportunity for folks to get vaccinated if they otherwise might not get vaccinated.

There’s an option for folks who don’t like needles, they can get a nasal spray. There’s now an option for folks who really have had bad allergic reactions to egg proteins and egg-containing items in the past. There’s a completely egg-free option that those folks could elect. And as you said, there’s an option for older people, the high-dose option, that may be a great fit for them, because they need a little bit more protection due to their natural protective immunity waning a little bit as they age

But as a good comparison shopper, doesn’t it make sense for me to try to get a quadrivalent vaccine, with four strains in it, instead of just three? Shouldn’t I look around for that?

You know, we really want you to get vaccinated as soon as possible. So, the recommendation we have is: go to your healthcare provider. If they have quadrivalent, and you’re interested in that, go ahead and get it. If they don’t, if they just have a trivalent shot, that’s good protection too, and we’d recommend that you’d get the vaccine on that first visit. The quadrivalent, four-strain vaccine is intended to provide a broader protection; it protects against an additional influenza B. But the trivalent offers great protection as well. It includes protection against one influenza B and two influenza As. And if that’s all that your provider has when you’re going in to get vaccinated, we would recommend that you take that vaccine when you’re there.

There have been studies that came out recently that seem to imply that the effectiveness of the flu vaccine can be somewhat underwhelming. In fact, the CDC’s own weekly Morbidity and Mortality report seemed to say that last year’s vaccine was only 56% effective against the virus for people who were over 6 months old, and virtually ineffective for people over 65. So, that sounds kind of ‘eh.’ Should I really go ahead and get it anyway?

First of all, I need to say that regardless of the vaccine effectiveness numbers, the vaccine is still the best way to prevent you from getting the, getting influenza.

Better than hand-washing, better than being careful about contact — it’s the best?

Absolutely. So even though the numbers aren’t as high as we’d like them, it’s still the best way to protect yourself from influenza. And I think we need to take a close look at the vaccine effectiveness numbers to make sure that folks understand what they mean. If the effectiveness number is, let’s just say, 50% for example, it doesn’t mean that if you take the vaccine, you have a 50/50 chance of getting the flu that year, because then the argument wouldn’t really hold any water. If you have an equal chance of getting the flu whether or not you get the vaccine, it doesn’t make a whole lot of sense.

What it does mean, though, is, if you take two people, and you give one person the vaccine and the other person says ‘I don’t need the vaccine, I don’t want to get it,’ the person who’s vaccinated has a 50% less chance of getting the flu and having to go to the doctor for their influenza, and that’s a pretty big reduction in risk.

What if I say, ‘Oh, I don’t need the vaccine, I never get the flu”?

Well, we hear a lot of people say that they never get the flu, so they don’t need the vaccine. And I don’t want to force anybody to get a vaccine if they don’t elect that. But we also need to recognize the protection that getting a vaccine will provide others. Particularly those who are at high risk of bad outcomes from flu: this group includes folks with underlying medical conditions like asthma, or heart disease, people over 65, and people under 5 years of age.

If you think you’re not going to get the flu or you’re okay getting the flu because you’re a young, healthy person, but you live with somebody who’s a young child, or maybe has an underlying medical condition, you can help protect them from influenza by getting vaccinated so you can’t pass it on to people who are at increased risk of being hospitalized or dying from flu. So that’s one very good reason to get vaccinated, even if you don’t think that flu will harm you too much.

Is it possible to transmit flu without having symptoms yourself?

It’s very unlikely. We know that you can transmit influenza before you start to show symptoms, though, so on the first day or so of being infected, you may not have a fever or cough or sore throat, but you’re still infectious, and you can still pass it on to someone else before you know you have the flu.

Last one: I hear people say, ‘Oh, I’m not getting the flu vaccine. I got it one time and then I got the flu, and I think the vaccine gave it to me.’

That’s a great question, and it’s one we hear every year. And I think there’s a couple ways to answer that question. I’ll start by saying, the flu vaccine cannot give you the flu. The vaccine includes either a killed version of the virus, or a component that’s been altered in a way such that it’s not infectious. Some of the new vaccines have just a small component of the virus, one single protein, and not the virus at all, so they cannot be infectious. There’s one vaccine formulation that’s brand new this year, that’s a purified protein vaccine, and it contains a small part of the influenza virus, just a protein essentially, and that helps provide immunity from influenza. So, it’s non-infectious. It cannot give you influenza, and in fact, none of the vaccines can give you influenza.

But I believe I’ve seen on the nasal vaccine, it does say that it has ‘live vaccine,” doesn’t it?

Yes, and the acronym is L.A.I.V. for “live attenuated influenza vaccine,” and the “attenuated” means it’s been changed in a way so it’s not infectious. However, we recommend that folks who have poor immune systems, folks who are maybe immuno-compromised, we recommend that they still get vaccinated, but not take any chances at all, and get a different formulation of the vaccine, one that’s killed instead of attenuated.

It is still possible to get influenza after you’ve been vaccinated. And there are several reasons for that. It’s also very possible to think that you have influenza after you’ve received the vaccine. So, what happens is, we know that it takes about two weeks after the vaccine to become fully protected. And if somebody waits a little bit, until the season has started, gets their vaccine, but then gets exposed to somebody who has the flu before two weeks passes, they could get infected because they didn’t give themselves enough time.

We also know there are lots of respiratory viruses that circulate in the fall and winter, and folks who get the vaccine and come down with a fever and cough may think that they have the flu when they really just have a cold.

And remember, whatever vaccine you get, we know it’s not 100% effective, and we know that it provides protection only against three or four viruses.

Out of how many?

Out of many that are circulating. And you could be exposed to a slightly different form, a different virus, than what’s in the vaccine. Or, you may be in a group of people who doesn’t respond as well to the vaccine, and you still may get influenza after you’ve been vaccinated. Even though that vaccine’s given you the best protection we can give at this point, you can still get the flu, even if you’ve been vaccinated. But you can’t get the flu from the vaccine.

Readers, any lingering questions? Would you like to share your own reasons for skipping the flu vaccine in the comments below? We’ll ask health authorities and vaccine experts for their responses.

Please follow our community rules when engaging in comment discussion on this site.
  • Gail Fiorini

    Never mind. I keep losing everything I type. Too sick to get question across.

  • Annie Smart

    I have only had 2 flu shots in my life. About 10 years ago and 2 days ago. Both times I have been ill with full out flu-like symptoms afterwards, ill enough to have to stay in bed for 2 days with shaking, goosebump skin, a temperature, a terrible headache, sinus and dizziness. I’m normally robust and I do not ‘ail’ easily. I’m writing this from my sickbed (day 2) totally fed up with how this side effect is played down by every web site I’ve found. One occurence and I might agree on coincidence but 2 for 2 is not me accidentally being exposed to an infected person around the day of the injection. It has to be the shot.

    I understand some people can breeze thru this but it’s not OK to underplay that some of us don’t handle this well. I haven’t felt this ill in years. I’m 61 and will never be getting another.

  • Kay Shallcross

    “High-dose “super” vaccines for older people.”

    As a PSA, the package insert for Fluzone flu vaccine (the one above) reveals that 23 seniors died during the drug trial. Do your research, then make what you feel is the best choice for YOU.

  • KM

    About the thimerosal… It may not be the little bit you get in this one flit shot. But. If you get a flu shot every year, eat lots of fish, and have mercury fillings, etc…, over time the mercury level in your body is going to accumulate and this has hazardous effects. Look into chelation.

    Further, if you get adequate sleep, eat the right foods, supplement with vitamin C (and note that if you are stressed, your adrenals will eat up all your vitamin C), keep your body in good alignment and know your body you most likely will not get sick (healthy people don’t get sick) or you most likely WILL know you are sick or are getting sick and can stay home and let it pass before passing it to someone else when you are still outwardly asymptomatic. Our bodies are incredibly smart and resilient if we give them the right assistance as needed. If we keep treating ourselves like helpless hosts then that’s what we will become. Look at where the antibiotic era has lead us… to the post-antibiotic era.

    From, a nursin student in Boston who is doing everything to NOT get the flu shot.

    • Nancy Razoux DeRocha

      As a Nurse you must get a flu vaccine it is required in order to be around pts. unless you have an allergy to eggs and or have had an adverse reaction to the flu vaccine. Really the amount of people that you are around do not want to catch your flu, peds,oncology,respiratory pts. need I say more yes I will who is your nsg instructor and what about the nurse manager if you don’t want the flu vaccine why are you in nsg try MRSA thats fun try being exposed to hep. after they have been discharged and you find out a week later all the things that Nurses are exposed to when they are not on precautions only to find out that what they have yes indeed is airborne and we didn’t have a mask on.

  • Todd

    On Friday I got my flu shot (for seniors, as I am 66) for this year, and inside of 12 hours, I began having flu-like symptoms – Most notably ague and moderate diarrhea. This is the first time I have had a reaction to a flu shot. Of course I cannot prove cause and effect here, but I am rarely sick; maybe a cold every three or four years. I am not advocating that seniors skip their flu shots, but if you have a reaction, make sure to report the symptoms to your doctor. My doctor had just received his vaccine for seniors that day, and I am wondering if the batch is tainted.

    • John

      Diarrhea is not caused by the flu and is likely not related to the shot

  • TJtruthandjustice

    A study just out (linked below) shows that the effectiveness of the flu vaccine is statistically insignificant for its primary target population, people who are 65 and older. Yet Dr. Jhung tells us that the flu vaccine is “still the best way to prevent influenza,” better than hand washing. This makes absolutely no sense.

  • TJtruthandjustice

    Vaccination may make flu worse if exposed to a second strain

    Medical Xpress, August 30, 2013 —A new study in the U.S. has shown that pigs vaccinated against one strain of influenza were worse off if subsequently infected by a related strain of the virus.

    Microbiologist Dr. Hana Golding of the Center for Biologics Evaluation and Research at Bethesda in Maryland and colleagues at the National Animal Disease Center in Ames, Iowa and elsewhere, vaccinated “naive” piglets (those that had never been exposed to flu viruses) against the H1N2 influenza strain and later exposed them to the rare H1N1 virus, which is the virus responsible for the 2009 swine flu pandemic.

    When the piglets were vaccinated they produced a wide range of antibodies to block the H1N2 virus, but these “cross-reactive” antibodies not only failed to provide protection against the second virus, H1N1, but appeared to actually help the H1N1 virus infiltrate lung tissue and cause more severe symptoms and respiratory system complications such as pneumonia and lung damage. The unvaccinated controls suffered milder pneumonia and fewer other complications. This effect is called Vaccine-Associated Enhanced Respiratory Disease.

    The researchers found that the antibodies produced in response to H1N2 could not bind to a key region of the H1N1 virus and could therefore neither kill nor neutralize them and stop them binding to cells in the pigs’ lungs, and in fact helped the new virus to fuse to lung cells and multiply more readily, through a process the scientists dubbed “fusion enhancing.”

    http://medicalxpress.com/news/2013-08-vaccination-flu-worse-exposed-strain.html

    Flu vaccine barely worked in people 65 and older

    Elizabeth Weise, USA TODAY 8:48 p.m. EST February 21, 2013

    This season’s flu vaccine was almost completely ineffective in people 65 and older, which could explain why rates of hospitalization and death have been some of the highest ever recorded for that age group, according to early estimates released Thursday by the Centers for Disease Control and Prevention.

    For people under 65, getting vaccinated this season reduced the need to go to the doctor for the flu by one-half to two-thirds.

    For those 65 and older, though, it helped in just 9% of cases, a number too low to be statistically significant, according to a report in the CDC’s Weekly Morbidity and Mortality Report released Thursday. The study was based on a survey of 2,697 children and adults by the U.S. Influenza Vaccine Effectiveness Network from Dec. 3, 2012, through Jan. 19, 2013.

    http://www.usatoday.com/story/news/health/2013/02/21/flu-vaccine-doesnt-work-over-65/1934651/

    New flu vaccines offer extra protection – and more profits

    By Ben Hirschler, Thu Sep 19, 2013 10:32am EDT

    (Reuters) – Big drugmakers are seeking a boost from new four-in-one influenza vaccines that will be available for the first time this flu season.

    Offering more protection to patients, the new quadrivalent vaccines provide a route to premium pricing that could improve margins and profits in a highly competitive
    market.

    Sanofi, GlaxoSmithKline and AstraZeneca all have products ready to tap the new opportunity, while Novartis is lagging behind its rivals.

    Until now, seasonal flu vaccines have only protected against three strains of
    flu – two strains of influenza A, which usually causes more cases and more severe illness, and one of influenza B, which is less common but also circulates in multiple forms.

    The new vaccines include protection against a second strain of influenza B,
    which experts expect will prevent the vast majority of type B infections.

    But extra protection comes at a price. French drugmaker Sanofi, whose Sanofi Pasteur unit is the world’s biggest supplier of flu vaccines, with sales of 884 million euros ($1.2 billion) in 2012, says it expects a premium of some 50 percent or more.

    http://www.reuters.com/article/2013/09/19/us-flu-vaccines-idUSBRE98I0M720130919

  • David in Tucson

    I get a flu shot every year, like clockwork, and have done so for at least 25 years, maybe 30. In fact, I got the one for this season just a couple of days ago (no reaction beyond the injection site being a bit sore for a day or so). Rarely, I have come down with the flu, despite a flu shot, but if I don’t get a flu shot, I WILL come down with flu. And I have come down with the flu as early as mid-October and as late as late March.

    I figure I owe it to myself to do what’s possible so that I can function well, and I owe it to others to not pass the flu along to them.

  • estengel

    I used to work at a medical center where flu shots are given out for several weeks free – easy to get, no cost, and lot of patients around – so why on earth not? Same with husband who still works in health care. Getting one involves a bit more effort now, but I’m over 65, so yes, definitely. Interestingly, of my 4 adult children, all in their 20′s-30′s, two will say they’re too expensive and insurance doesn’t cover (correct), another was one of those convinced she got flu from her flu shot but is now a parent of a 2-year old with a form of asthma so she may be more inclined to protect her child and herself, and one and his wife are both teachers and have a 7-month old, so will probably get the shots. All of course ignore the annual maternal reminder about flu shots but it’s in my job description.

  • lindam313

    Oh, the weird swelling was gone within 5 days or so and has never happened again (knock on wood here too)

  • lindam313

    In 1990 I took the flu vaccination at the request of my asthma/allergy doctor. I had no problem with the vaccination at all. The trouble began in Jan 1991 when my husband, who normally gets vaccinated did not and he contracted the flu – 101 fever, aches, chills, etc. I on the other hand, had all of the joints in my body swell, my skin tighten and itch for several days. I went to the dr who ran an ANA titer as well as a rheumatoid arthritis screen. The ANA came back slightly elevated and the rheumatoid test came back negative. He sent me to a rheumatologist several weeks later who learned that my rheumatoid test was now positive. Previously, I had never had the flu and I have never had the flu since despite being asthmatic – colds are more of a disaster for me in terms of endless coughing – the rheumatologist said that I had the “flu,” not to worry about the positive rheumatoid screen since out of 4 people, only one will ever display any symptoms and not to EVER get the flu shot again since I had somehow gone into overdrive or something and reacted very strangely to the shot months later when I came in contact with the flu. I have learned that this is not a common response, but drs have seen odd cases such as this. Is there anything different about the newer flu shots that may prevent this from happening? That said, I have not (knock on wood) had the flu ever, nor had I had any fever other than 99 since I was about 10 years old. I’m now 55 years old and never did get another flu shot due to fear of that happening again or WORSE. I’d love to receive a response to this from someone knowledgeable about flu vaccines, etc. Thanks.

    • Mark

      Linda, I’m a professional student in the medical field and can tell you that there will never be a black or white answer for your question: there’s no way to predict how your body will react after getting a flu shot, and there is even a chance that your reaction in 1991 was not related to the flu shot.

  • Anne

    I got a flu shot, and my choices were with or without preservative (mercury). Any thoughts here?

    • John C.

      Thimerosal (an organo-mercury preservative) has been used to preserve vaccines and other pharmaceuticals for many years. Flu vaccines are very difficult to sterilize (heat can inactivate the vaccine and sterilizing filtration can sometimes alter the vaccine because the viruses are large and aggregated in many cases). Therefore some type of preservative is commonly used to prevent any possibility of un-wanted infection. Some folks have health concerns about thimerosal. I am not going to get into whether those concerns are valid. Lets just say that folks have these concerns. The best thing to do is read the lable and ask your doctor. If the vaccine does not have thimerosal as an ingredient, it is likely to be preserved with something else like an antibiotic. If you are allergic to antibiotics, then the thimerosal containing vaccine might be a better choice.

      • zigadox

        Sir, the onus is on you. ” I am not going to get into whether those concerns are valid.” If you don’t explain yourself about this, then there is a possible hole in your argument!