Which Flu Vaccine Should I Get?

Megan N. Brown, PharmD, RPh
Megan N. Brown, PharmD, RPh is a public health pharmacist with fellowship training in drug information and health communications.
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Did you know that the flu shot is just one of many ways to get vaccinated against the flu? Here, we’ll walk you through this year’s 13 flu vaccine options so you can choose the one that best suits your body and lifestyle!

Although no prevention method will guarantee you won’t get sick, getting a flu vaccine is the best way to protect yourself and your loved ones from the nasty virus.

 

Why do I need a flu vaccine?

Because influenza (flu) viruses pass easily from person to person, they can cause many people to get sick. Even in best-case scenarios, getting the flu can be uncomfortable and inconvenient. You may have days or weeks of typical symptoms like fever, chills, muscle aches, cough, congestion and headaches.

Sometimes, severe cases of flu can lead to possibly life-threatening complications like pneumonia, inflammation of the heart or brain, and organ failure. Some people have to be hospitalized and may even die from flu complications.

Children under two years of age, adults above 64 years of age, people with chronic diseases, and others with weak immune systems have the highest risk of developing complications. Some strains of the flu can cause even young-to-middle-aged, healthy adults to be hospitalized or die.

That’s why the CDC recommends that everyone six months of age or older get a flu vaccine every year.

 

How do the yearly flu vaccines work?

There are many different types of flu viruses, and—at least for now—there’s no way to protect yourself against all of them. So, scientists use data to make their best predictions about which three to four flu strains will be the most common in the upcoming flu season. That year’s flu vaccines work by targeting those strains. The effectiveness of the flu vaccine largely depends on how accurate the scientists’ predictions are.

You may have heard that last year’s flu vaccines—for the 2017-2018 flu season—were less effective than expected. (The CDC reported over 80,000 deaths in the US last year from flu.) For this season, the CDC states that “flu vaccines have been updated to better match circulating viruses”.

 

When should I get vaccinated?

The flu vaccine takes about two weeks to become effective, so you should get vaccinated as soon as flu vaccines become available each fall! This year, the CDC recommends that you get the vaccine before the end of October.

Flu vaccines contain antigens, or elements of flu viruses, that teach your body how to mount an immune response if a live flu virus ever invaded your system. This learning process takes about two weeks after vaccination.

 

What are the different types of flu vaccines?

Flu vaccines fall into many different categories. Here’s a rundown of how they’re administered, what’s in them, and what their potential side effects are.


Different routes of administration

Intramuscular (IM) injection

The IM flu vaccine is the traditional “flu shot” that’s usually injected into the muscle of your upper arm. Of all the flu vaccine options, the IM injection is probably the most convenient. It’s available almost everywhere that offers vaccinations, and most insurance plans cover it. It’s also usually very effective.

With the IM flu vaccine, it’s normal to have a stiff or sore arm up to a few days after vaccination. Other common side effects include fever, muscle pain, a general feeling of sickness. These side effects are easy to mistake for the flu, but are typically much milder than actual flu symptoms.

If you can’t tolerate needles, you don’t have to miss out on the protection that vaccines offer. Other flu vaccine options are available for you. (Keep reading to learn more!)

Nasal spray

The nasal spray, FluMist Quadrivalent, is a live, attenuated (weakened) influenza vaccine (LAIV) that has fallen in and out of favor over the years. The CDC generally lets the public know whether to use the nasal spray in a given flu season since it may work better in some years than others.  

A nasal spray is a convenient option for people who don’t like needles, especially young children. For the 2018-2019 flu season, the CDC recommends FluMist for people two to 49 years old who aren’t pregnant. However, there are some groups of people who should NOT get the nasal spray flu vaccine:

Side effects of the FluMist flu vaccine include runny nose, wheezing, headache, muscle aches, sore throat, and fever, but they are usually much milder than actual flu symptoms.

Intradermal injection

The intradermal flu vaccine is not available for the 2018-2019 flu season. When it’s available, the intradermal flu vaccine (Fluzone Intradermal) has a needle that is 90% smaller than that of the IM flu shot. That’s much less intimidating for people who don’t like needles! It’s injected into the skin instead of the muscle, and protects against four flu strains. It can be used in people between 18 and 64 years old.

Compared to the IM shot, the intradermal flu shot might cause more redness, swelling and itching after vaccination. It also contains egg protein, so if you have a severe egg allergy, avoid this particular flu vaccine.


Different strengths

Standard-dose flu vaccines are typically effective enough for people younger than age 64. Most regular-dose, egg-based flu shots for the 2018-2019 flu season will be quadrivalent.

The high-dose flu vaccine (Fluzone High-Dose) contains four times the amount of antigen as IM flu vaccines do. It can be helpful for older adults whose immune systems are weaker because it allows the body to build up a stronger immune response. It may even lower their risk of being hospitalized due to flu complications. For this reason, Fluzone High-Dose is only recommended for people over age 64.

Note: Since Fluzone High-Dose contains egg protein, no one with a severe egg allergy should get the high-dose flu vaccine.


Different ingredients

Trivalent vs. quadrivalent flu vaccines

Trivalent flu vaccines offer protection against three flu strains. Quadrivalent flu vaccines offer protection against four flu strains. See the handy tables below to find out how many strains each vaccine option protects against.

Flu vaccine allergens

The exact makeup of a flu vaccine can change from year to year. Check with your doctor if you have allergies to flu vaccine ingredients like egg protein, antibiotics (like neomycin or polymyxin), latex or certain preservatives.

 

What are the available flu vaccine brands?

Here’s a summary of each flu vaccine available in the US. You can use a GoodRx coupon to save as much as 80% off the cash price.

Note: All the flu vaccines listed below are standard-dose vaccines except for the high-dose vaccine, Fluzone High-Dose.

Trivalent Flu Vaccines

Age range Brand Route of administration Allergens GoodRx price
≥ 4 years Fluvirin intramuscular Egg protein, neomycin, polymyxin, (latex)* $27
≥ 5 years Afluria intramuscular Egg protein, neomycin, polymyxin $27
≥ 18 years Flublok intramuscular None $29
≥ 65 years Fluad intramuscular Egg protein, neomycin, kanamycin, latex $29
≥ 65 years Fluzone High-Dose intramuscular Egg protein $49
* Some versions of Fluvirin may contain latex.

 

Quadrivalent Flu Vaccines

Age range Brand Route of administration Allergens Cash price
≥ 6 months FluLaval Quadrivalent intramuscular Egg protein $31
≥ 6 months Fluzone Quadrivalent intramuscular Egg protein $31
≥ 6 months Fluarix Quadrivalent intramuscular Egg protein $31
2-49 years FluMist Quadrivalent intranasal (nasal spray) Egg protein $27
≥ 4 years Flucelvax intramuscular Minimal egg protein $31
≥ 5 years Afluria Quadrivalent intramuscular Egg protein, neomycin, polymyxin $26
≥ 18 years Flublok Quadrivalent intramuscular None $52

 

Disclaimer: GoodRx prices are subject to change. We recommend checking GoodRx.com right before you get your flu vaccine to see the latest discounts.

 

Where can I get a flu vaccine?

Remember, there’s no way to guarantee you won’t get the flu, but getting a flu vaccine each year is the best way to protect yourself.

Fortunately, there are plenty of places where you can get a flu vaccine. In addition to your doctor’s office or local pharmacy, here are a few other places that offer flu vaccines:

VaccineFinder is a convenient (and free!) online tool you can use to locate flu vaccines in your area. Once you type in your zip code, you can even see what types of vaccines are available at different locations nearby (though we’d still recommend calling before you go to make sure the vaccine you want is in stock).

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