Why You Should Get Your Flu Vaccine Now: 2020-2021 Updates
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Sep 10, 2020.
Don't Miss Work, School, and Maybe a Paycheck
While many are working or learning from home this fall due to COVID-19, the flu vaccine is even more important this year. No doubt, if you have your choice between getting the flu or not, 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 early fall -- many people wait too long, or never get it at all.
How well does the flu vaccine work?
Vaccine effectiveness varies from year to year, based on the match of the circulating flu types to the strains contained in the vaccine. However, according to the CDC, recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% during seasons when the flu viruses are well-matched to the flu vaccine. In general, current flu vaccines tend to work better against influenza B and influenza A(H1N1) viruses and offer lower protection against influenza A(H3N2) viruses.
It's important to know that each year the flu vaccine is never 100% effective in preventing flu. However, 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. As with COVID-19, regular hand washing and maintaining distance makes good sense, too.
Over the 2016-17 and 2017-18 flu seasons 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.
However, in the 2018-2019 flu season FluMist Quadrivalent nasal spray, a live attenuated vaccine, returned to the U.S. market as an option. FluMist is approved for use in certain populations between the ages of 2 to 49 years. This year in the U.S, for the 2020-2021 season, the nasal flu vaccine is still an option for immunization and all are quadrivalent.
Two doses of the nasal flu vaccine (each, at least 1 month apart) may be required in children ages 2 years through 8 years who never been vaccinated for influenza. 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.
Who else should NOT get FluMist Quadrivalent?
You should not get FluMist Quadrivalent if you:
- have a severe allergy to eggs or to any inactive ingredient in the vaccine
- have ever had a life-threatening reaction to any flu vaccine
- 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 or FluMist Quadrivalent unless your healthcare provider tells you otherwise.
There are additional warnings for people who may not be able to get this nasal vaccine, ask your doctor if you fall into any of those groups.
If you or your child cannot take FluMist Quadrivalent, you may still be able to get an influenza shot. Talk to your healthcare provider about this.
The Flu Vaccines and Kids
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. Children with health problems like asthma or diabetes are at an especially high risk of developing complications.
In the 2020-2021 flu season, the shots available will include either the use of the inactivated influenza vaccine (IIV) or the recombinant influenza quadrivalent vaccine (RIV4) for everyone aged 6 months or older based on eligibility.
- Children aged 6 months through 8 years who require 2 doses should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later.
- They should receive their first dose as soon as possible after vaccine becomes available.
- Persons aged 9 years or older need only one dose for 2020-21.
The nasal spray flu vaccine FluMist, a live attenuated quadrivalent vaccine, is also noted in the CDC recommendations for 2020-2021 and approved for children and adults aged 2 to 49.
- The nasal spray flu vaccines for the 2020-2021 season will contain four influenza virus strains: influenza A (H1N1) virus, influenza A (H3N2) virus and two influenza B viruses.
- Children 2 years to 8 years may require 2 vaccine doses (given at least one apart) depending upon vaccine history.
Overall, for this flu season, the ACIP states that providers may provide any licensed, age-appropriate influenza vaccine, including the inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV4), or the FluMist nasal spray (LAIV4). There is no preference expressed for any one vaccine over another.
The 2020-2021 Flu Vaccine Composition
Strains in the 2020–21 U.S. influenza vaccines, as as recommended by the World Health Organization (WHO) and FDA's Vaccines Advisory Committee are:
- Trivalent, egg-based vaccines: A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus; A/Hong Kong/2671/2019 (H3N2)-like virus; B/Washington/02/2019 (B/Victoria lineage)-like virus. All 3 of these strains were updated from the previous year.
- Quadrivalent, egg-based vaccines: same as the 2020-2021 trivalent but includes an additional B viral strain - B/Phuket/3073/2013–like virus (Yamagata lineage), which remains the same from the previous year.
- Cell-based or recombinant-based quadrivalent vaccines: A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated); A/Hong Kong/45/2019 (H3N2)-like virus (updated); B/Washington/02/2019 (B/Victoria lineage)-like virus (updated); B/Phuket/3073/2013-like (Yamagata lineage) virus. All strains updated for 2020-2021 except for the B/Yamagata lineage.
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 protects 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 quadrivalent vaccines Fluarix, FluLaval, Fluzone, and Afluria are all approved for individuals 6 months of age or older. These are all inactivated influenza vaccines (IIVs) injections that are egg-based.
- Fluzone High Dose Quadrivalent is available for those 65 years of age and older. It's also an inactivated, egg-based injection. Fluad Quadrivalent is also used in those 65 years and older and it's a standard dose, adjuvanted-egg-based injection.
- Flublok Quadrivalent, a recombinant formulation can be used in adults 18 years and older and is inactivated but not egg-based.
- Flucelvax Quadrivalent injection can be used in those 4 years and older. It's cell culture-based and inactivated.
- FluMist Quadrivalent live attenuated influenza vaccine (LAIV4) nasal vaccine is available during the 2020-2021 flu season for those eligible. It's a live attenuated vaccine but also contains egg proteins.
Per the CDC, for the 2020-2021 season, the one available trivalent vaccine is:
- standard dose adjuvanted inactivated influenza vaccine (Fluad for those ≥65 yrs). It's inactivated and egg-based.
An adjuvant is an ingredient used in some vaccines that helps it to work better: it creates a stronger immune response in people receiving the vaccine.
The Flu Vaccine is Affordable and Convenient
The flu vaccine 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 Costco, CVS, Target, Walgreens, and Walmart. Your primary care clinic will offer them, too. Drive-through sites may be available in 2020-2021 due to COVID-19, call your local pharmacy.
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-$50 cash price is well worth the price.
College students living in close quarters are especially susceptible to the flu, just like they are vulnerable to COVID-19. 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.
Fluzone High Dose Quadrivalent was approved in Nov. 2019 for adults 65 years of age and older.
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. Fluad Quadrivalent is also available this year for those 65 years and older.
Yes: You Need A Flu Vaccine Every Year
Unfortunately we cannot 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 -- preferably in September or October. But remember: it takes 14 days for immunity to build up in your body to fight the flu virus, so don't expect immediate protection.
What if you have put off the flu vaccine until December, or even later? It's never too late to get the vaccine to protect yourself and those around you, so visit your healthcare provider as soon as you can.
One Shot Can Help 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. Influenza vaccine can be administered at any time during pregnancy, before and during the influenza season.
Plus, there's an added value to the seasonal flu vaccine for pregnant women -- not only does it protect them against the flu and lower the risk of hospitalization, it also helps to protect their newborn infants for up to the first few months of life -- at a time when infants are too young to receive the vaccine themselves.
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. According to the CDC, FluMist nasal vaccine should not be used in women who are pregnant.
Early Fall is the Perfect Time
Flu season can start early, and it takes about two weeks after receiving your vaccine for the full antibody effect to develop and provide flu protection. That’s why it’s better to get vaccinated in the fall, before the end of October ideally, before the flu season really kicks in. Flu vaccines are usually available by mid-September in most years.
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).
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 most flu shots and the nasal spray flu vaccine 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 (do not use) to future receipt of the vaccine.
Egg-Free Vaccines for 2020-2021
There are 2 egg-free flu vaccines available for the 2020-2021 flu season:
- Flublok Quadrivalent (from Sanofi Pasteur) is a recombinant vaccine and does not contain any egg proteins. It can be used in patients 18 years and older.
- Flucelvax Quadrivalent (from Seqirus) is a standard dose, cell culture based vaccine and can be used in patients 4 years and older.
- Other vaccines than these two listed above are prepared in eggs and might contain trace amounts of egg proteins. Talk to your healthcare provider if you have an egg allergy.
In the 2020-2021 season, ACIP recommends the following regarding administration of influenza vaccines in those who report egg allergy:
Patient reports egg allergy with a history of hives (urticaria) only: may receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4), including FluMist nasal vaccine.
Egg allergy with a report of a more severe reaction than hives such as (angioedema or swelling, trouble breathing, lightheadedness, or recurrent vomiting), or who required epinephrine or another emergency medical intervention: may receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4), including FluMist nasal vaccine.
- If a vaccine other than ccIIV4 (Flucelvax Quadrivalent) or RIV4 (Flublok Quadrivalent) is used, the selected vaccine should be administered in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices).
- Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
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 (seated or laying down face up) 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. You are not alone - rougly 1 in 4 adults were shown to have a fear of needles in a research report . There are other options.
- FluMist Quadrivalent is a needle-free vaccine that is sprayed in the nose. FluMist is approved for children and adults ages 2 to 49 years; however, there are certain groups that can't use FluMist, so check with your doctor.
Afluria Quadrivalent from Seqirus can be used with the Stratis needle-free jet injector.
- 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 the jet injector first. It's not necessarily pain-free, but the shot creates a narrow stream of fluid that goes through the skin, without a needle, given in one-tenth of one second.
- Children 6 months through 17 years should receive Afluria Quadrivalent only by needle and syringe.
Can I Get a Flu Vaccine if I Have Suspected or Confirmed COVID-19?
According to the CDC, flu vaccination should be deferred (postponed) for people with suspected or confirmed COVID-19, whether they have symptoms or not, until they meet the criteria to stop isolation. Visits for a vaccine should be postponed to avoid exposing healthcare personnel and other patients to the coronavirus. If flu vaccination is delayed, patients should be reminded to return for vaccination once recovered from COVID-19.
If you think you have been recently exposed to COVID-19, call your healthcare provider before you go in to receive your flu vaccine.
Influenza (flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. While it’s not possible to say with 100% certainty what will happen in the fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading at the same time.
Getting a flu vaccine will not protect you against COVID-19; however, flu vaccination has many other important benefits and can help to keep you out of the hospital. Plus, you'll be less likely to spread flu to others. Less people in the community with severe flu symptoms will also help to conserve space in healthcare facilities, medical personnel and other needed resources.
Audenz: Protection for a Future Bird Flu Pandemic
In February 2020, the FDA approved Audenz (influenza A (H5N1) monovalent vaccine, adjuvanted) from Seqirus. Audenz is an inactivated, cell-based influenza vaccine designed to protect against influenza A (H5N1) in the event of a H5N1 (Asian bird flu) global pandemic. It is not currently found in other U.S. flu vaccine products. The U.S. government will stockpile this vaccine and distribute it in the event of an outbreak.
- Audenz is approved in people 6 months of age and older at increased risk of exposure to the influenza A virus H5N1 subtype contained in the vaccine.
- Audenz is given as 2 different shots. The two doses are given as an intramuscular (IM) injection 21 days apart. it is important you complete the two-dose immunization series if you need the vaccine.
- Audenz contains an adjuvant that increases the effectiveness of the vaccine and is developed using cell-based technology.
Common side effects with Audenz may include injection site pain, fatigue (feeling tired), headache, feeling unwell, joint and muscle pain, and nausea (stomach upset). Allergic reactions can occur and appropriate medical treatment must be available to manage possible anaphylactic reactions following administration of the vaccine.
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: 2020-2021 Updates
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