With so many vaccine choices, there are more ways than ever to attack this deadly virus…

Getting a flu shot seems fairly straightforward. But these days, there may be more to it than simply rolling up your sleeve and getting a jab in the arm. There are multiple flu vaccines to choose from (including some that aren’t injected), but your doctor may not offer enough guidance. The facts you need to know…  


People who have never had the flu may think that it’s easy to manage, like a common cold. Those who have had it know better. The flu can leave you bedridden, achy and feverish—sometimes for weeks.

The CDC recommends that everyone six months and older get vaccinated. That’s because every year, an average of more than 30,000 Americans die from flu-related complications. Older adults and those with other health problems, such as diabetes, asthma, heart disease or cancer, are at highest risk for flu and its complications.


Flu season in the US can begin as early as October and last until May. My advice: Get vaccinated as soon as the vaccine becomes available (ideally by October), so you don’t forget. It takes about two weeks for the body to develop flu-fighting antibodies. The main optionsall are usually covered by insurance…

• High dose. Because older adults are more likely to get seriously ill from the flu and their immune response is often weaker than a younger person’s after being vaccinated, they face a double risk. Fluzone High-Dose is a trivalent vaccine, meaning that it protects against three types of flu—two strains of Type A and one strain of Type B. The high-dose vaccine has four times more of the active ingredient than is used in regular flu shots. Studies have shown that people age 65 or older who get the high-dose vaccine have a stronger immune response, but experts aren’t completely sure if this vaccine gives greater flu protection than the standard flu shot.

My advice: Since the high-dose vaccine appears to be just as safe as standard flu shots, it’s a good choice for older patients.

An alternative: A vaccine booster. It’s an effective way to increase immunity in older adults. I administer one dose of a standard vaccine early in the season, then give another dose about four months later.

• Four-way protection. Even though trivalent vaccines that protect against three flu strains have long been the standard, there are now quadrivalent vaccines, which add an additional B strain. However, the quadrivalent vaccine may not be available from your doctor or pharmacy.

My advice: If a quadrivalent vaccine is not available, get the trivalent vaccine. Both vaccines should protect against the most common flu strains. People over age 65 should ask their doctor whether the high-dose or quadrivalent vaccine is right for them based on their level of immunity and the circulating Type B strains.

• Nasal spray. FluMist is a nasal spray that is an effective alternative to shots—with no pain or crying children. A quick spritz and you are done. However: It’s not for everyone. FluMist is a quadrivalent vaccine that isn’t approved for children under age two or for adults age 50 and older. Unlike the killed-virus vaccines that are used in injections, the spray contains a live, attenuated (weakened) form of the flu virus. For this reason, it shouldn’t be used by those with an impaired immune system or chronic lung disease, such as asthma.

• Ouchless. What if you do not want a shot, but you have a health condition that prevents you from using the nasal vaccine? You can now opt for an intradermal quadrivalent shot, which is less painful because it uses a needle that is 90% smaller than those used for regular flu shots. It is injected into the skin, unlike other flu shots, which are injected deep into muscle.

Also: In 2014, the FDA approved Afluria, a trivalent vaccine that’s administered via “jet injection”—a device is used to shoot a high-pressure stream of liquid through the skin. (It feels like the snap of a rubber band.)

The downside: Both intradermal and jet injections may be more likely to cause redness, swelling and itching than standard shots.

On the other hand, they are believed to provide the same level of protection as standard injections…and are less upsetting for those who don’t like shots.

• Egg-free. Traditional vaccines are made by culturing viruses in chicken eggs—a potential problem for those with severe egg allergies. Now there are two options (Flucelvax and Flublok) that rely on cell-based technology instead of using the flu virus and eggs in the manufacturing process. The egg-free vaccines are just as effective as the standard flu vaccines and can be produced more rapidly in a sudden flu outbreak. However: In my experience, most people with mild egg allergies can tolerate the older, egg-based vaccines—a cell-based vaccine might be helpful, though, if your allergies are unusually severe. Ask your doctor for advice.


Anyone who has ever gotten a flu shot knows that some arm soreness, swelling and/or redness may occur for a day or so around the injection site. But what are the recent reports of SIRVA (it stands for shoulder injury related to vaccine administration) all about? This condition, marked by severe pain, limited flexibility and/or weakness in the shoulder, is actually quite rare and occurs only when an injection of any kind in the shoulder’s deltoid muscle is given too deep or too high. If you’re concerned about injection site side effects, including SIRVA, consider getting your flu shot from a trained professional who can provide follow-up care…or ask for a flu vaccine that doesn’t require an injection.

And what about the mercury-based preservative known as thimerosal? No link has ever been found to autism. Very credible research has repeatedly shown that the low doses used in vaccines do not cause harm. However: You can ask for a single-dose vial. Unlike the multidose vials, which contain thimerosal to avoid possible contamination, single-dose units are free of the preservative.