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Why You Should Get Your Flu Vaccine Now: 2018-2019 Updates

Medically reviewed on Aug 27, 2018 by L. Anderson, PharmD

Don't Miss Work, School, and Maybe a Paycheck

No doubt, if you have your choice between getting the flu and going to work or school, you should prefer the latter.

Each year, the flu season results in millions of lost work days at a cost of billions of dollars. Although the CDC says people should get a flu vaccine when available -- typically in late summer/early fall -- many people wait too long, or never get it at all.

In the previous 2017-2018 flu season, the flu vaccine was roughly 36% effective at preventing flu (down from a 50% effectiveness in 2016-2017).

It's important to know that each year the flu vaccine is never 100% effective in preventing flu, but it drastically reduces your chances of getting it (and passing it on to others), and it lessens the severity of symptoms if you are infected with the virus. Regular hand washing and avoiding those with the flu makes good sense, too.

FluMist Updates: 2018-2019

For the 2018-2019 flu season FluMist Quadrivalent nasal spray (LAIV4), a live attenuated vaccine, will return to the U.S. market as a choice. FluMist is approved for use in certain populations between the ages of 2 to 49.

FluMist maker AstraZeneca/MedImmune said a small study found that a new version of the nasal spray vaccine seems to be more effective than the older version. However, the CDC notes that the effectiveness of the updated LAIV4 containing A/Slovenia/2903/2015 against currently circulating influenza A(H1N1)pdm09-like viruses is not yet known.

Over the previous two flu seasons (2016-17, and 2017-18), the CDC's Advisory Committee on Immunization Practices (ACIP) recommended that the nasal spray flu vaccine (FluMist Quadrivalent) not be used due to low effectiveness against influenza A(H1N1)pdm09-like viruses.

The CDC recommends an influenza vaccine for everyone 6 months and older. This means everyone eligible should get a flu vaccine in 2018-2019; either an inactive influenza vaccine (trivalent or quadrivalent), or the nasal spray flu vaccine.

Look Out For Your Little One

Each year thousands of children under the age of 5 are hospitalized due to influenza. Children younger than 5 -- but especially children under 2 years -- are especially at risk of severe flu infection. Sadly, as of June 2018, 172 children under the age of 18 had died from flu complications in the 2017-2018 flu season. Children with health problems like asthma or diabetes are at an especially high risk of developing complications.

In the 2018-2019 flu season, the shots available will include either the use of the inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV) for everyone aged 6 months or older based on eligibility. Children aged 6 months to 8 years require 2 vaccine doses (given ≥4 weeks apart) during their first season of vaccination. They should receive their first dose as soon as possible after vaccine becomes available.

The nasal spray flu vaccine FluMist, a live attenuated influenza vaccine is also back in the CDC recommendations for 2018-2019 and approved for children and adults aged 2 to 49. The nasal spray flu vaccines for the 2018-2019 season will contain four influenza virus strains: influenza A (H1N1) virus, influenza A (H3N2) virus and two influenza B viruses.

Overall, for 2018-2018, the ACIP states that providers may provide any licensed, age-appropriate influenza vaccine, including the inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV), or the FluMist nasal spray (LAIV4).

2018-2019 Flu Strains

Strains in the 2018–19 U.S. influenza vaccines, as recommended by the World Health Organization (WHO) and FDA's Vaccines Advisory Committee are:

  • A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Singapore/INFIMH-16–0019/2016 A(H3N2)-like virus, and a B/Colorado/06/2017-like (B/Victoria lineage) virus for the trivalent vaccine. This represents a change in one A and one B strain from 2017-2018 season: A/Hong Kong/4801/2014 (H3N2)–like virus and a B/Brisbane/60/2008–like virus (Victoria lineage) have been replaced.
  • Quadrivalent vaccines will include an additional B viral strain, a B/Phuket/3073/2013–like virus (Yamagata lineage), that remains the same from the previous year.
  • FluMist Quadrivalent (LAIV4) has also been updated for the 2018-2019 season.

The 2018-2019 ACIP recommendations must be approved by the CDC director before they are noted as official recommendations.

Quadrivalent Vaccines: A Boost of Protection

Quadrivalent vaccine injections add an additional B strain to the 3 recommended strains in the trivalent flu vaccines and protect against A and B strains of influenza (4 strains total).

Quadrivalent vaccines can give broader protection during the flu season, but experts say don't delay getting your vaccine if a particular formulation is not available.

  • The Fluarix Quadrivalent vaccine, the FluLaval Quadrivalent, and Fluzone Quadrivalent are all approved for ages 6 months and older.
  • Afluria Quadrivalent can be given to people five years of age or older.
  • Flublok Quadrivalent, a recombinant formulation can be used in adults 18 years and older.
  • FluMist Quadrivalent live attenuated influenza vaccine (LAIV4) nasal vaccine has returned as a vaccine option in the 2018-2019 flu season for those eligible; a new version of the nasal spray flu vaccine has been formulated for better effectiveness.

Per the CDC, for the 2018–19 season, it is expected that all standard-dose, unadjuvanted inactivated influenza vaccines will be quadrivalent, with the exception of Afluria, which will be available in both trivalent and quadrivalent formulations.

High-dose unadjuvanted inactivated influenza vaccine (Fluzone High-Dose) and adjuvanted inactivated influenza vaccine (Fluad) will be trivalent.

The Flu Vaccine is Affordable and Convenient

The flu vaccine (see the 2018-2019 options here) has never been easier to get.

You don't have to wait in long lines or make a future appointment -- the flu vaccine can be found at most independent pharmacies and major retailers such as CVS, Walgreens, and Walmart. Your primary care clinic will offer them, too.

Across the country, most pharmacists are now licensed to immunize, meaning they can give you the vaccine with little waiting. In addition, pharmacies or clinics will accept insurance for the vaccine which results in little or no copay to you.

If you have don't have insurance, check to see if your local or state health clinic or employer is offering free vaccines. Even if you have to pay, the average $30 cash fee is well worth the price.

College students living in close quarters are especially susceptible to the flu. They may be offered the flu vaccine at little to no cost in the campus clinic. College students should make it a priority to get their flu vaccine each fall.

Seniors Can Get Even More Protection

Seniors are an especially high-risk group for severe flu, hospitalization, and death due to influenza complications like pneumonia. Boosting the immune system with one of the below vaccines may be preferred for this age group, but vaccination should not be delayed if a specific product is not readily available.

Fluzone High Dose vaccine is specifically made for adults 65 years of age and older. Fluzone, a trivalent vaccine, contains four times the amount of antigen of the regular flu vaccine.

Flublok Quadrivalent is used in adults 18 years and older and contains 3 times the active ingredients of other quadrivalents.

The FDA also approved Fluad (influenza vaccine, adjuvanted), a trivalent flu vaccine injection for adults 65 years and older. Fluad contains the adjuvant squalene (MF59), a naturally occurring substance found in humans, animals and plants. Adjuvants are incorporated into some vaccine formulations to boost the immune response.

Yes: You Need A Flu Vaccine Every Year

You can't predict the severity of the flu season, and flu vaccine effectiveness does not last from year to year. In fact, each year experts research which flu strains are most likely to be circulating, so the strains that make up the annual flu vaccine may change, as they have this year.

In addition, studies have shown that the body's ability to fight off the flu after a vaccine wanes over time, so that's another reason why you need a vaccine each year -- as soon it's available according to the CDC -- preferably by October.

It takes 14 days for immunity to build up in your body to fight the flu virus, so don't expect immediate protection.

But say you do put off the flu vaccine until December, or even later. Remember it's never too late to get the vaccine to protect yourself and those around you.

One Shot Can Protect You and Your Newborn

The U.S. Advisory Committee on Immunization Practices (ACIP) recommends an annual flu vaccine for anyone 6 months of age or older, including pregnant women, if they are eligible.

Pregnant women may receive any licensed, age-appropriate influenza vaccine, as recommended by the CDC. Influenza vaccine can be administered at any time during pregnancy. FluMist nasal vaccine should not be used during pregnancy.

Plus, there's an added value to the seasonal flu vaccine for pregnant women -- not only does it protect them against the flu, it also protects their newborn infants for up to the first few months of life at least -- at a time when infants are too young to receive the vaccine themselves.

Early Fall is the Perfect Time

Flu season can start early, and it takes about two weeks after your vaccination for the full antibody effect to develop and provide flu protection. That’s why it’s better to get vaccinated in late August, September or early October, before the flu season really kicks in. In fact, get vaccinated as soon as it's available.

But it's never too late to get the flu vaccine if you miss out in the fall. Seasonal influenza disease usually peaks in January and February most years, but can occur as late as May or as early as December (as it did in 2013). And be sure to get re-vaccinated each fall.

Can I Get the Flu Vaccine if I am Allergic to Eggs?

Yes, if you are allergic to eggs you can still be protected in most cases, even though flu shots and the nasal spray flu vaccine (except two) are made using egg-based technology. However, a previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

In the 2018-2019 season, ACIP recommends that persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate influenza vaccine, including FluMist. Flublok, a trivalent or quadrivalent inactivated vaccine, does not contain any egg proteins and can also be used patients 18 years and older.

Egg-allergic people who have any symptom other than hives -- like severe swelling (angioedema), heart or breathing changes, lightheadedness, recurrent vomiting, or a reaction requiring epinephrine or other emergency medical treatment -- should be vaccinated in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, and physician office). Vaccination should occur under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

No specific periods of observation is required for egg-allergic patients after flu vaccination, but ACIP recommends that vaccine providers consider observing patients for 15 minutes after receipt of any vaccine to decrease the risk for injury should fainting occur.

Hate Shots? You're Not Alone

Please do not skip the flu vaccine just because you hate getting a shot. There are other options, now:

The nasal vaccine FluMist Quadrivalent is needle-free, and a new reformulated version will return to the U.S. market this 2018-2019 season. FluMist is approved for children and adults ages 2 to 49. However, there are certain groups that can't use FluMist, so check with your doctor.

Afluria and Afluria Quadrivalent are used with the Stratis needle-free jet injector and are now FDA-approved. Anyone 18 through 64 years of age who can get Afluria may ask for needle-free Afluria, but check with your doctor, clinic, or pharmacy to be sure they have it first.

In the past, Fluzone Intradermal Quadrivalent has been available. However, in the 2018-2019 flu season, intradermal flu vaccine will not be available. Although not needed-free, it has a very short needle and is given as an intradermal (in the skin) injection, which may be less painful; it is for adults ages 18 through 64 years.

History Has Proven: The Flu is a Monster

If you've ever had the flu, you know it's not your average virus. The illness can land you flat on your back and its effects can span 2 weeks or longer.

For children under two, seniors, and people with chronic health conditions like:

the flu can be especially severe or even fatal. Dehydration, worsening of health conditions, and pneumonia are just a few of the possible complications.

And, NO, the flu vaccine CANNOT cause the flu (just in case you are trying to use this excuse in a last ditch effort). The vaccine is made up of inactivated (killed) or weakened viruses that have no ability to infect the lungs.

So, go on -- you're out of excuses -- fight off the monster known as the flu today and go get your vaccine.

Finished: Why You Should Get Your Flu Vaccine Now: 2018-2019 Updates

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Sources

  • Centers for Disease Control and Prevention (CDC). 2018-19 Summary of Recommendations. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2018-19. Accessed August 28, 2018 at https://www.cdc.gov/flu/professionals/acip/2018-2019/2018-19summary.htm
  • Grohskopf LA, Sokolow LZ, Broder K, 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 August 27, 2018 at https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_e
  • Centers for Disease Control and Prevention (CDC). Influenza (Flu). Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine). https://www.cdc.gov/flu/about/qa/nasalspray.htm
  • Centers for Disease Control and Prevention (CDC). Influenza (Flu). Seasonal Influenza Vaccine Effectiveness, 2005-2018. Accessed August 18, 2018 at https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm
  • Grohskopf LA, Sokolow LZ, Fry AM, Walter EB, Jernigan DB. Update: ACIP Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) — United States, 2018–19 Influenza Season. MMWR Morb Mortal Wkly Rep 2018;67:643–645. Accessed August 19, 2018 at https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a5.htm
  • New Version of Nasal Flu Vaccine to Return for Next Season. Feb 22, 2018. Drugs.com. Accessed Feb. 23, 2018 at https://www.drugs.com/news/new-version-nasal-flu-vaccine-return-next-season-68783.html
  • GSK Receives FDA Approval for Expanded Indication for Fluarix Quadrivalent (Influenza Vaccine) for Persons 6 Months and Older. January 11, 2018. Drugs.com. Accessed January 29, 2018 at https://www.drugs.com/newdrugs/gsk-receives-fda-approval-expanded-indication-fluarix-quadrivalent-influenza-vaccine-persons-6-4680.html
  • US Centers for Disease Control and Prevention (CDC). ACIP votes down use of LAIV for 2016-2017 flu season. June 22, 2016 (archived). http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
  • AAFP. CDC: 2016-2017 Flu Vaccine Nearly 50 Percent Effective. February 21, 2017. Accessed 8/25/2017 at http://www.aafp.org/news/health-of-the-public/20170221fluvacceffect.html. Accessed
  • Dicker R. Days and Dollars Lost to the Flu Hit a Fever Pitch Last Season. Daily Finance September 21, 2011. Accessed 11/21/2016. http://www.dailyfinance.com/2011/09/21/flu-season-economic-impact-vaccine-walgreens/
  • US Centers for Disease Control and Prevention (CDC). Misconceptions about seasonal flu and flu vaccines. Questions and Answers. Accessed 8/25/2017. http://www.cdc.gov/flu/about/qa/misconceptions.htm
  • US Vaccine Guidelines for Flu, HPV Updated. Drugs.com. Accessed Feb. 27, 2017 at https://www.drugs.com/news/u-s-vaccine-guidelines-flu-hpv-updated-64390.html

Further information

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