According to the Centers for Disease Control and Prevention (CDC), it is recommended to get an influenza (flu) vaccine by the end of October every year.
The CDC goes on to recommend that everyone 6 months of age or older should receive a flu vaccine every season with certain rare exceptions; this has been recommended by CDC and CDC’s Advisory Committee on Immunization Practices (ACIP) since 2010. These exceptions are specific to children less than 6 months of age and individuals that have serious allergies to the flu vaccine or any of its components.
For a listing of all available flu vaccines broken down by category for the 2020-2021 influenza season, reference this resource from the CDC. Flu vaccines are broken down into 4 broad categories: IIV4 (Quadrivalent), IIV3 (Trivalent), RIV4 (Recombinant), and LAIV4 (Live Attenuated). Similarly, this resource shows how the different flu vaccine types are produced. For reference, the four manufacturers that produce flu vaccines in the United States for the 2020-2021 season are Seqirus, GlaxoSmithKline, Sanofi Pasteur, and AstraZeneca.
There are many flu vaccines available on the market, and certain individuals may have exception(s) to receiving certain flu vaccine type(s). In order to receive an appropriate flu vaccine, see below for a listing of considerations to mind prior to receiving a flu vaccine.
NOTE: If you are an adult and none of the below categories apply to you, you most likely are able to receive any flu vaccine. However, ask a pharmacist or other healthcare provider for more personalized information.
Individuals Aged 65+ Years
Unless directed otherwise or if applicable inventory stock is unavailable, it is recommended that individuals aged 65 years or older receive a high-dose flu vaccine or an adjuvanted flu vaccine. The flu vaccines that meet this recommendation are the Fluzone High-Dose Quadrivalent, Fluad, and Fluad Quadrivalent.
The high-dose flu vaccine contains 4x the amount of inactivated virus that promotes a protective immune response. Alternatively, the adjuvanted flu vaccine can create a stronger immune response to vaccination compared to other flu vaccines. Either one of these vaccine types in this population is appropriate.
However, any age-appropriate IIV formulation (standard dose or high dose, trivalent or quadrivalent, nonadjuvanted or adjuvanted) or RIV4 is an acceptable option. For one exception, the nasal flu vaccine (FluMist) should be avoided.
Pregnant Women
It is important for pregnant and postpartum women to receive a flu vaccination as they are seen to be at higher risk for complications from the flu. Any age-appropriate inactivated flu vaccine may be administered via injection to pregnant women, but pregnant women should not receive the nasal flu vaccine (FluMist) as it is a live attenuated vaccine.
Individuals with Egg Allergies
For the 2020-2021 season, the two flu vaccines that are considered egg-free are Flublok Quadrivalent and Flucelvax Quadrivalent.
Individuals with egg allergies should avoid the following flu vaccines: Afluria Quadrivalent, Fluad Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent, Fluzone High-Dose Quadrivalent, and FluMist.
Individuals with Immunocompromising Conditions and/or Take Antiviral Medication(s)
According to ACIP, immunocompromising conditions “[include] but are not limited to persons with congenital and acquired immunodeficiency states, persons who are immunocompromised due to medications, and persons with anatomic and functional asplenia.”
Similarly to pregnant women, any age-appropriate inactivated flu vaccine may be administered via injection to individuals that are immunocompromised, but these individuals should not receive the nasal spray flu vaccine (FluMist) as it is a live attenuated vaccine. This information holds true for individuals who take antiviral medications.
Adults and children with chronic pulmonary (including asthma), cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes)
Any age-appropriate flu vaccine.
Children Ages 6 Months or Older
Children ages 6 months to 35 months may receive either Afluria, Fluarix, or FluLaval but children otherwise may receive any flu vaccine. Healthy children older than the age of 2 years may alternatively receive the nasal flu vaccine (FluMist). Children less than 6 months of age generally should not be vaccinated for influenza.
Additionally, some children less than 8 years of age require 2 doses of flu vaccine. However, not all children less than 8 years of age need 2 doses of flu vaccine and many require only 1 dose of flu vaccine per year. As this operates on a case-by-case basis, a child’s healthcare provider can inform a parent if two doses may be needed.
Individuals with a History of Guillain-Barré Syndrome
Guillain-Barré Syndrome, commonly abbreviated GBS, is a neurological disorder by which the immune system attacks nerves in the body outside of the brain and spinal cord. This can lead to muscle weakness or paralysis in rare occasions, but most people eventually recover from GBS (per the NIH). GBS tends to affect 1 in every 100,000 people every year.
The data on an association between influenza vaccines and GBS varies from season-to-season; the risk of GBS development remains low. However, in individuals that do develop GBS, it is important to be cautious while receiving future vaccines even if a past case of GBS is not thought to be caused by a vaccination.
For specific recommendations, it is imperative to follow the directions of a healthcare professional. Recommendations for this category fall on a case-by-case basis.
References
- 2020-2021 ACIP Table. TABLE 1. Influenza vaccines — United States, 2020–21 influenza season. Centers for Disease Control and Prevention. Accessed 26 October 2020.
- Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season. Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention. Accessed 26 October 2020.
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