Should I Get the Flu Shot?

Lauren Goldbeck, Alex Pew, Arista Jhanjee, and Kousha Mohseni, MS, Cancer Prevention & Treatment Fund

It’s that time of year again — time to get your flu shot! Everyone 6 months or older who have no restrictive health conditions is encouraged by the Centers for Disease Control and Prevention (CDC) to get the vaccine every year.1

Flu season usually starts as early as October and can last all the way until May. The flu usually peaks between December and March. The CDC recommends getting vaccinated by the end of October. Even if you don’t get your vaccine by then, it’s good to get vaccinated anytime during the flu season.

Check if your office, school, or local government is giving free flu vaccines first. If not, don’t worry!  Most (if not all) pharmacies and doctors’ offices have the vaccine available and it is free (no co-pay at all) under nearly every insurance plan. Just call first to make sure the vaccine is available.

Thanks to the Affordable Care Act (Obamacare), health insurance companies have to provide free preventive services like the flu shot.2 However, insurance companies can require you to go to certain places to get the shot. You should check with your insurance company first before getting your shot.

What’s New for 2018-2019?

As parents are getting their kids ready for flu season, they need to decide whether their children (or they themselves) should get a flu shot or a flu vaccine that comes in the form of a nasal spray. This spray, known as FluMist, sprays a live virus up your nose via mist and is an alternative for those who don’t like the idea of a flu shot. The CDC did not recommend FluMist for the 2016-2017 and 2017-2018 seasons because they rated the spray as ineffective during those years. However, flu vaccines are revised every year, and the CDC expects that FluMist will be somewhat effective in 2018-2019 for healthy 2 to 49-year-old non-pregnant patients.1

Even though FluMist is less likely to make a child cry than a shot, experts question whether it is a good idea because it is unlikely to be as effective as a flu shot. The American Academy of Pediatrics (AAP) strongly advises parents to choose the traditional flu shot for the 2018-2019 flu season when possible.3 The AAP points out that while the nasal spray is better than nothing, the effectiveness of FluMist has not yet been determined.4

Since the CDC and AAP realize the importance of vaccinating young children to protect from the flu and serious complications that the flu can cause, both are advocating for the same goal. As long as children are protected with a form of the Flu vaccine, a child’s risk of influenza is greatly reduced.  However, experts agree that the best way to protect oneself against different types of flu viruses is with the traditional flu shot. We agree that while the FluMist is better than nothing, you should choose a flu shot whenever possible for you and your children.

How Effective Is the Flu Vaccine in 2018-2019?

The most common flu viruses change every year. Since the new seasonal vaccine requires about 6 months to make, scientists change the flu vaccine every year. Vaccines are made with either three or four viral strains. This year’s vaccine differs from last year’s vaccine by a single strain.  Scientists change the flu vaccine every year to try to make it as effective as possible against the new flu strains that are most common that year, but that can be difficult to predict.5

For this flu season, current evidence shows that the vaccine will reduce your risk of getting the flu by 40 to 60%.6 Although it’s far from perfect, it’s definitely worth getting.7

If I Have Cancer or Am a Cancer Survivor, Should I Get the Flu Shot?

Yes, getting a flu shot is recommended for people with cancer and cancer survivors. It is also important for family members and close friends to get the shot as well. People with cancer or a history of cancer can get more severe flu symptoms that can result in hospitalization and serious conditions if they get the flu. In some cases, patients with certain cancers like leukemia, lymphoma, and myeloma as well as patients who have recently been treated with chemotherapy should preemptively take medication to treat the flu if friends and family around them show signs of the virus.8

The most important thing to know is that people with cancer should get the flu shot and not the nasal sprays like FluMist. This is because the shot uses dead or “inactivated” virus while the nasal sprays use live virus. Make sure to ask your physician any questions you have.8

Can the Flu Shot Give Me the Flu?

No, the flu shot can’t give you the flu. The flu shot is made of proteins that come from dead viruses, so you can’t get infected. However, the flu shot can cause soreness, redness, or swelling around the injection site. It can also cause a low-grade fever or body aches.9

Things to Remember for Young Children

  • Children aged 6 months to 8 years who have never received a flu vaccine should get two doses of the vaccine. The two doses should be separated by at least 4 weeks.
  • Children aged 6 months to 8 years who have previously received 2 or more vaccine doses only need one dose this year.
  • Because FluMist contains a live flu virus, healthy children should only start using the spray at age 2, and only if they are unable to get the shot instead.1

If I’m Over 65, Is There Anything Different for Me?

As we age, the flu can be more dangerous and vaccines are less effective because our immune systems are not as strong. You may have seen a “high-dose flu vaccine” advertised for people over the age of 65.  Should you consider it?

The high-dose vaccine has four times as many flu proteins than the usual flu shot, and so it is expected to be more effective. Studies comparing the high-dose and standard-dose vaccines found that those who received the high-dose version (IIV3-HD) were better protected against the flu during the 2012-2013 flu season.10,11 While studies show that the high-dose flu vaccine (Fluzone) might be more protective than the standard flu shot, the CDC is still reviewing data to see how effective Fluzone is in the 2018-2019 flu season.1 And, individuals receiving the high-dose version also had more of the common side-effects from the flu shot, like a low-grade fever and soreness. Since there is no clear evidence that the high-dose vaccine has benefits that outweigh the risks, the CDC doesn’t have a recommendation for getting one vaccine over the other. However, facilities that offer flu shots may administer the high-dose shot without asking patients what they prefer. If you are 65 or older and don’t want the high-dose shot, you should say so when requesting a shot.

What Should I Do If I Have an Egg Allergy?

Flu injection options are very similar for individuals with and without egg allergies.

  • If your only reaction to eating eggs is hives, you can receive any flu vaccine.
  • If you have a severe reaction to eggs, including nausea/vomiting, changes in blood pressure, respiratory issues, and/or any reaction requiring medication or emergency medical attention (ex. anaphylaxis shock)…
    • You can receive any flu vaccine.
    • You should receive the vaccine in a medical setting and under the supervision of a provider who is trained to address allergic reactions.12

Can I Still Get the Flu Even After Getting the Flu Shot?

 Yes, you can still get the flu after getting the flu shot. There are many strains of the flu that could possibly infect you, and the shot doesn’t protect you against all strains. And as we said, it works better on people with stronger immune systems. Even if you do get the flu, it might be less severe if you’ve had the vaccine.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2018–19 Influenza Season. MMWR Recomm Rep 2018;67(No. RR-3):1–20. DOI:http://dx.doi.org/10.15585/mmwr.rr6703a1. Accessed on September 21, 2018.
  2. Will the Affordable Care Act cover my flu shot? U.S. Department of Health and Human Service. Retrieved from https://www.hhs.gov/answers/affordable-care-act/will-the-aca-cover-my-flu-shot/index.html.  Accessed on September 21, 2018.
  3. American Academy of Pediatrics. American Academy of Pediatrics advises parents to choose the flu shot for 2018-2019 flu season. AAP.org. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Advises-Parents-to-Choose-the-Flu-Shot-For-2018-2019-Flu-Season.aspx. May 21, 2018. Accessed September 21, 2018.
  4. American Academy of Pediatrics. AAP issues flu vaccine recommendations for 2018-2019. AAP.org. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Issues-Flu-Vaccine-Recommendations-for-2018-2019.aspx. September 3, 2018. Accessed September 21, 2018.
  5. Selecting Viruses for the Seasonal Influenza Vaccine. (2018). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/about/season/vaccine-selection.htm. Accessed on September 21, 2018.
  6. Frequently Asked Flu Questions 2018-2019 Influenza Season (2018). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved fromhttps://www.cdc.gov/flu/about/season/flu-season-2018-2019.htm.  Accessed on September 21, 2018.
  7. Flannery B, Chung JR, Thaker SN, et al. Interim Estimates of 2016–17 Seasonal Influenza Vaccine Effectiveness — United States, February 2017. MMWR Morb Mortal Wkly Rep 2017;66:167–171. DOI: http://dx.doi.org/10.15585/mmwr.mm6606a3.  Accessed on September 8, 2017.
  8. Should People With Cancer Get a Flu Shot? (n.d.). Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/infections/should-i-get-a-flu-shot.html
  9. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. (2018). Retrieved from https://www.cdc.gov/flu/protect/keyfacts.htm. Accessed on September 21, 2018.
  10. Diaz Granadanos, C. A. et al. (2014). Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014 Aug 14;371(7):635-45. doi: 10.1056/NEJMoa1315727. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25119609. Accessed on September 21, 2018.
  11. Shay, D., Chillarige, Y., Kelman, J., et al. (2017). Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014. The Journal of Infectious Diseases; 215(4): 510-517. Retrieved from https://academic.oup.com/jid/article/3058746. Accessed on September 21, 2018.
  12. Flu Vaccine and People with Egg Allergies. (2017). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved fromhttps://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm.  Accessed on September 21, 2018.