FluMist or Flu Shot: Which is more effective?

Both FluMist nasal flu vaccine and the flu shot offer good protection against influenza when vaccines are well-matched to the year’s circulating virus. In 2023-2024, the flu vaccine was 52% to 61% effective in preventing hospitalization in children 6 months to 17 years and 41% to 44% effective in preventing hospitalization in adults ages 18 years and older.

Maybe you are wondering is one flu vaccine better than another? Below we can offer some advice for specific groups.

• For people younger than 65 years, there is no preference for any one vaccine over another, as long as you qualify for it based on age and other factors.
• In people 65 years and older, certain influenza shots that offer better protection are recommended (such as Fluzone High Dose, FluBlok or Fluad).
• FluMist is a nasal vaccine that might be an option for children or adults who are prefer not to use needles, but check with your doctor or pharmacist to see if you are eligible.

FluMist is approved for use in people ages 2 through 49 years. In patients 50 years and older, it may not be as effective as other recommended vaccines. Children under 2 years old have an increased risk of wheezing (difficulty with breathing) after getting this nasal vaccine. Check with your doctor to see if you are eligible for FluMist.

FluMist for self- or caregiver administration, approved in Sept. 2024, is not expected to be available until the 2025-2026 influenza season. It will still require a prescription.

Ultimately, the best flu vaccine for you or your child is the one that is available and you are eligible to get. It’s more important to get protected against influenza than to wait on a specific vaccine to be available.

There can also be a risk to waiting: you may miss your vaccine altogether, catch the flu in the interim, and possibly spread it to others within your household or community.

The flu virus is highly contagious. It spreads through respiratory droplets when someone coughs, sneezes, or talks and from contaminated surfaces.

To help prevent flu, wash your hands frequently, stay at home when you are sick and don't share personal items, like eating utensils, drinking glasses and pillows.

Talk to your doctor about which flu vaccine is most appropriate for your or your family members, and consider factors like age, health conditions, and availability.

How effective is the flu vaccine?

Overall, the influenza vaccine typically reduces the risk of flu illness by 40% to 60% during seasons when the flu viruses are well-matched to the vaccine, but this can vary each year.

The effectiveness of the influenza vaccine varies by the season, the virus subtype, and how well the vaccine matches the circulating viruses.

• For example, early results from the 2023-2024 U.S. flu season show that among adults aged ≥18 years, effectiveness against medical visits ranged from 33% to 49% and against hospitalization from 41% to 44%. Specifically for children and teens less than 18 years, the flu vaccine was 71% effective for preventing symptomatic influenza A illness.
• All available vaccines in the 2023-2024 flu season were quadrivalent, which meant they targeted 4 strains of the flu - 2 type A flu viruses and 2 type B flu viruses. These vaccines were well-matched to the circulating viruses.
• The current 2024-2025 season vaccines are all trivalent. The influenza B/Yamagata vaccine component is being removed because those viruses have not been detected by global flu surveillance since March 2020.

Each year the flu vaccine is never 100% effective in preventing flu, but if you do get the flu, the vaccine can help to lessen the severity of your symptoms and lower your risk for hospitalization and death.

In addition, it is possible to have COVID and the flu at the same time, which may result in more serious illness overall. At-home tests are now available for purchase at the pharmacy that can detect both flu and COVID-19. Check with your pharmacist.

The flu viruses that circulate during each flu season can change from year-to-year, and that’s why the vaccine is updated each season. The CDC recommends that everyone aged 6 months of age and older get a yearly flu vaccine in the fall, if eligible.

If FluMist nasal vaccine isn't available, or you’re not eligible, ask your healthcare provider or pharmacist if you can get the flu shot.

The Pros and Cons: FluMist vs. Flu Shot

There are pros and cons to both the FluMist nasal vaccine and the flu shot. Which type of vaccine is best for you will depend upon factors like your age, health conditions, or if you take certain medicines. Your healthcare provider can help you sort these issues to determine which vaccine is best for you.

Here’s a list of 6 pros and cons:

1. Needle-free: FluMist is needle free, which is a big advantage for many people who may be wary of needles. Flu shots obviously require the use of a needle and a shot in the arm, and many people may skip the flu vaccine for this reason alone.
2. Effectiveness: Both vaccine types target the same viruses each year. Effectiveness really depends upon how well the strains in the vaccines are matched to the seasons circulating viruses. The CDC states that for people younger than 65 years, there is no preference for any one vaccine over another as long as it has been approved for your age group. In people 65 years and older, certain high-dose influenza shots have been recommended for better protection in this age group.
3. Live vs. Inactivated: Neither the flu shot nor the nasal flu vaccine can give you the flu, but you may have short-term side effects, like runny or stuffy nose, fever, sore throat, sore arm, muscle aches or tiredness. If you have people in your household that have a weakened immune system, talk to your doctor before you get FluMist. It's an attenuated live virus vaccine, which means it contains weakened but live viruses, and has the potential for transmission to household contacts with weakened immune systems.
4. Age: FluMist is only approved to be used in people aged 2 through 49 years of age, which excludes a large number of people. However, many flu shots are approved for ages 6 months and older, which means a larger population can use them. Children under 2 years old have an increased risk of wheezing (difficulty with breathing) after getting FluMist. In addition, higher-dose or adjuvanted flu shots (contains an ingredient to help create a stronger immune response) are now available to help protect people 65 years and older.
5. Egg allergy: Both FluMist and most flu shot vaccines contain egg proteins. Egg-free vaccines include Flublok for people 18 years and older and Flucelvax for people 6 months and older. The CDC now states that people with egg-allergy may receive any flu vaccine appropriate for their age and health status.
6. Availability: Both the FluMist nasal spray vaccine and the flu shot are easily available throughout the flu season at health clinics and pharmacies. Flu vaccines are usually covered as preventive care under insurance or can be found for free or low cost at your local health clinics.

Related questions

• How and where is a flu shot injection given?
• What flu vaccine can I use with an egg allergy?
• How well does the flu vaccine work?

What is FluMist?

FluMist, also known as a live attenuated influenza vaccine (or LAIV), is a needle-free option approved for use in eligible people between the ages of 2 through 49 years. FluMist may not protect all individuals receiving the vaccine.

The FluMist 2024-2025 formula contains 3 influenza virus strains that are weakened, including A(H1N1), A(H3N2), and B Victoria lineage. The vaccine is redeveloped each year based on worldwide surveillance to contain specific strains of activated (live) flu virus that public health officials recommend for that year.

FluMist is not to be used in children under 2 years old because they have an increased risk of wheezing (difficulty with breathing) when using this vaccine. In older patients, it may not be as effective as other vaccines.

How is it given?

FluMist is a liquid vaccine that is sprayed into the nose with one dose (0.1 mL spray per nostril) for most people. People 9 years of age and older need one dose each flu season. Two doses of the nasal flu vaccine (at least 1 month apart) may be required in children ages 2 through 8 years who have never been vaccinated for influenza.

Because it’s sprayed into the nose, it may be preferred by people who prefer not to use needles, especially children.

FluMist is not to be used in children under 2 years old due to an increased risk of wheezing (difficulty with breathing). Tell your doctor if you or your child are currently wheezing, or if your child has a history of wheezing if under 5 years old.

In the 2025-2026 flu season, FluMist will be available for self- or caregiver administration from the pharmacy (for example, it can be used at home), but it will still require a prescription.

It is recommended that everyone 6 months of age and older get an annual flu vaccination, with rare exceptions. Different vaccines are approved for different age groups and some vaccines can’t be used in certain people, so always ask for your doctor's or pharmacist's advice.

Related: How and where is a flu shot injection given?

Who can’t use FluMist?

FluMist should not be used:

• If you have a severe allergy to eggs or to any inactive ingredient in the vaccine, according to the manufacturer. You can find the inactive ingredients on the Information for Patients and Their Caregivers handout.
• If you have ever had a life-threatening reaction to any influenza vaccine.
• If you are 2 through 17 years old and take aspirin or medicines containing aspirin. Children or adolescents should not be given aspirin for 4 weeks after getting FluMist unless your healthcare provider tells you otherwise.

Please talk to your healthcare provider if you are not sure if the items listed above apply to you or your child.

Children under 2 years of age have an increased risk of wheezing (difficulty with breathing) after getting FluMist. Tell your doctor if you or your child are currently wheezing or have asthma, or if your child has a history of wheezing if under 5 years of age.

There are additional warnings for people who may not be able to use this nasal vaccine. Tell your healthcare provider if you or your child:

• have had Guillain-Barré syndrome
• have a weakened immune system or live with someone who has a severely weakened immune system
• have problems with your heart, kidneys, or lungs
• have diabetes
• are pregnant or nursing
• are taking the flu antivirals treatments like Tamiflu, Relenza, amantadine, or rimantadine.

If you or your child cannot use FluMist, you may still be able to get an influenza shot. If you have questions, check with your doctor or pharmacist to determine if you or your child are eligible.

If I have a cold can I use FluMist?

If you have a minor illness, such as mild diarrhea from a stomach problem or a mild upper respiratory tract infection, you can most likely still receive FluMist. Check with your doctor.

But if your nose is so stuffy and congested that it may prevent the vaccine from getting to the inside of the nose, then your healthcare provider may suggest an injection instead, or suggest you delay your or your child's vaccine.

Who can’t get a flu shot?

Standard flu shots are appropriate for most people, but some people should not receive a flu shot. This includes:

• children younger than 6 months of age
• if you or your child has a severe, life-threatening allergy to any ingredient in a flu vaccine (other than egg proteins)
• people who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines.
• if you have had a severe allergic reaction to an influenza vaccine in the past, it is important to talk with your healthcare provider to help determine whether vaccination is appropriate for you.

Studies have shown that severe allergic reactions when using either the nasal spray vaccine or flu shots in people with egg allergies is unlikely. The CDC found that the rate of a life-threatening severe allergic reaction (known as anaphylaxis) was 1.31 per one million vaccine doses given.

Flu shots are approved for different age ranges, some as young as 6 months and some only for adults 18 or 65 years of age and older. Your healthcare provider will select a vaccine that is approved for your age range and medical conditions.

Three flu vaccine shots are approved for people 65 years of age and older for better protection:

• Fluzone High-Dose vaccine
• FluBlok
• Fluad adjuvanted flu vaccine

Is the flu shot a live virus?

No, the flu shot is an inactivated virus vaccine, which means that the virus is killed. It can generate an immune response to help protect you against flu. It is given as an intramuscular injection in your upper arm area or the thigh in small children.

FluMist is an attenuated live virus vaccine, which means it contains weakened, but live, viruses, and has the potential for transmission to immunocompromised household contacts. If you have people in your household that have a weakened immune system, talk to your doctor before you or your child receives FluMist.

Neither the flu shot or the nasal flu vaccine can give you the flu. You may have short-term flu vaccine side effects like fever, muscle aches or tiredness that resembles flu symptoms, but these are usually short-lived.

This is not all the information you need to know about FluMist or the flu shot for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.