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 2022-2023, the flu vaccine was 54% effective in preventing influenza A in people less than 65 years of age and 71% effective in children.

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 Quadrivalent, FluBlok Quadrivalent or Fluad Quadrivalent).
• FluMist is a nasal vaccine that might be an option for children or adults who are fearful of needles, but check with your doctor or pharmacist to see if you 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.

Ultimately, the best flu vaccine for you or your child is the one that is available and that you are eligible for. 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.

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 2022-2023 U.S. flu season show that overall, vaccine effectiveness reduced the risk of flu that needed medical care by about 54% in people 65 years of age and younger with influenza A, the most common flu virus in circulation that season.
• 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 2022-2023 flu season were quadrivalent, which means they target 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.

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.

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, with rare exceptions.

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 Quadrivalent is needle free, which is a big advantage for many people who may have fears 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. In the 2022-2023 flu season, all flu vaccines were quadrivalent and targeted the 4 designated circulating strains of virus.
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 or 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 immunocompromised household contacts.
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 Quadrivalent. In addition, higher-dose or adjuvanted flu shots 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 Quadrivalent, for people 18 years and older and Flucelvax Quadrivalent 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. At pharmacies, online coupons may help to save you money if you are paying cash for your vaccine.

What is FluMist Quadrivalent?

FluMist Quadrivalent, also known as quadrivalent live attenuated influenza vaccine or LAIV4, is a needle-free option approved for use in eligible people between the ages of 2 through 49 years.

It’s called “quadrivalent” because it contains four influenza virus strains: two A strains and two B strains. Previously, trivalent vaccines were available that targeted 3 flu virus strains, but all vaccines in 2023 were developed as quadrivalent. The original FluMist was a trivalent vaccine, but was not available last year.

FluMist Quadrivalent 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.

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?

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 have a fear of needles, especially children.

FluMist Quadrivalent 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.

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 Quadrivalent should not be used:

• In children under 2 years old because they have an increased risk of wheezing (difficulty with breathing) and hospitalization when using this vaccine.
• If you have a severe allergy to eggs or to any inactive ingredient in the vaccine, according to the manufacturer.
• If you have ever had a life-threatening reaction to any influenza vaccine.
• If your immune system is weakened (you are immunocompromised)
• 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 Quadrivalent unless your healthcare provider tells you otherwise.

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 old.

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 Tamiflu, Relenza, amantadine, or rimantadine.

If you or your child cannot use FluMist Quadrivalent, 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 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 Quadrivalent vaccine
• FluBlok Quadrivalent
• Fluad Quadrivalent 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 receive 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.