The Medical Minute: Flu shot or not?

October 01, 2003

This flu season you can choose to get a shot or try to beat the flu by a nose -- whatever the method, it's still a good idea to get immunized.

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

Fall begins flu season. Even though influenza does not typically arrive on the east coast until December, now is the time to prepare. That usually means a shot, but this year something new will be available -- a nasal spray vaccine for the flu.

The FDA approved FluMist™ this year for prevention of the flu. Not a shot, it's a nasal spray -- half the vaccine is sprayed into one nostril and half into the other. Since the flu gets its start in our noses, it only stands to reason that the first line of defense ought to be the nose.

FluMist™ is different than traditional flu vaccine because it contains living flu viruses that have been treated so they cannot develop into the disease. The virus lives in the nose and throat of the vaccinated person for a while as the person's immune system develops resistance to it. The traditional shot has dead virus. Except for a sore arm where the shot is given, side effects to the traditional vaccine are mild and with repeat doses, typically become even less. FluMist™ side effects include fever, sore throat and runny nose, possibly because it mimics a real infection. As with the traditional vaccine, people who have a life-threatening allergy to eggs should avoid it.

Who should get flu vaccine and in particular, FluMist™? The simple answer is just about everyone should consider getting flu vaccine. For traditional flu vaccine, people over 50, even healthy ones, should get it because as many as one quarter of this age group have undiagnosed diseases that put them at risk of serious complication or death from the flu. Everyone over 65 should get it regardless of health conditions because the risk of flu complications is high among seniors.

Anyone over age 6 months with heart or lung disease, such as, asthma, cystic fibrosis or chronic bronchitis or other chronic illnesses as sickle cell anemia, kidney disease, and diabetes should get vaccinated. Anyone with weakened immune systems due to HIV/AIDS or those who have had organ transplants should also be immunized. People in nursing homes or long-term care facilities should be immunized because influenza can spread rapidly in these settings. Pregnant women after the first trimester are at risk from complications of the flu and should get flu vaccine. Children up to age 18 on long-term aspirin therapy should be immunized because influenza can cause Reye's syndrome in children taking aspirin. Even younger children in good health between 6 and 24 months have an increased risk for hospitalization from flu complications and should get flu vaccine.

In addition, if you live in the household of someone for whom influenza is dangerous, you should be immunized. Flu vaccine is not 100 percent effective so the more people immunized, the lower the likelihood that anyone at risk will actually come in contact with the virus.

Flu virus spreads before we realize we have it so medical personnel should be immunized to prevent getting the flu and then spreading it to their patients. Finally, anyone who wishes to reduce his or her risk of the flu should consider getting a flu shot.

So, if you hate shots, is FluMist™ for you? Currently it is recommended only for healthy people between 5 and 50 years of age. It was tested on people in that age range and found to be about as effective as the traditional shot. It may work on other ages, but it is only approved for ages 5-50 because there is no proof yet that it works in other age groups. It should NOT be given to people with asthma or other lung diseases or people with weakened immune systems because the weakened flu virus used in FluMist™ causes a temporary respiratory infection with and can worsen these conditions. It also causes fever, which could stress those with the kinds of problems flu vaccine is supposed to protect. Pregnant women should get the shot, not FluMist™.

It is anticipated that it will be more expensive than regular flu vaccine and may not be covered by insurance. Medicare and many other insurances cover traditional flu vaccine cost.

Administration of flu vaccine begins in October. It takes about two weeks for full response and immunity lasts about six months. Vaccine supplies are anticipated to be adequate for all who want it. If you have never had a flu shot before, expect to feel some achiness for a day or two -- acetaminophen or ibuprofen should help reduce these side effects. The split virus or subvirion version of the injectable vaccine is typically better tolerated. People who have had flu shots before usually do not get any side effects except slight soreness at the injection site.

Check with your doctor or look for mass immunization programs that are often run by businesses or community organizations to get your vaccine. For more information on the flu, visit http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm

(Media Contacts)

Last Updated March 20, 2009