Flu Vaccine Options: Compare Effectiveness, Side Effects, and Cost

Although no prevention method will guarantee you won’t get sick, getting a flu vaccine is the best way to protect yourself and your loved ones from the nasty virus.

Why do I need a flu vaccine?

Because influenza (flu) viruses pass easily from person to person, they can cause many people to get sick. Even in best-case scenarios, getting the flu can be uncomfortable and inconvenient. You may have days or weeks of typical symptoms like fever, chills, muscle aches, cough, congestion and headaches.

Sometimes, severe cases of flu can lead to possibly life-threatening complications like pneumonia, inflammation of the heart or brain, and organ failure. Some people have to be hospitalized and may even die from flu complications.

Children under two years of age, adults above 64 years of age, people with chronic diseases, and others with weak immune systems have the highest risk of developing complications. Still, some strains of the flu can cause even young-to-middle-aged, healthy adults to be hospitalized or die.

That’s why the CDC recommends that everyone six months of age or older get a flu vaccine every year.

How do flu vaccines work?

There are many different types of flu viruses, and—at least for now—there’s no way to protect yourself against all of them. Instead, scientists use data to make their best predictions about which three to four flu strains will be the most common in the upcoming flu season, and then they recommend that the new flu vaccines target those strains. The effectiveness of the flu vaccine largely depends on how accurate the scientists’ predictions are.

When should I get a flu vaccine?

Because it takes time for vaccines to become effective, you should get vaccinated as soon as flu vaccines become available each fall! Flu vaccines contain antigens, or elements of flu viruses, that essentially teach your body how to mount an immune response if a live flu virus ever invaded your system. This learning process takes time; you won’t have full protection until about two weeks after vaccination.

What are my flu vaccine options?

Flu vaccines fall into many different categories. Here’s a rundown based on how they’re administered, how strong they are and what’s in them.

Route of Administration

Intramuscular (IM) injection

This is the traditional “flu shot” that’s usually injected into the muscle of your upper arm. Of all the flu vaccine options, the IM injection is probably the most convenient since it’s available almost everywhere that offers vaccinations and most insurance plans cover it. It’s also usually very effective, but it depends on your health and how well the season’s common flu strains match with the scientists’ predictions.

It’s normal to have a stiff or sore arm up to a few days after vaccination. Other common side effects include fever, muscle pain, a general feeling of sickness. These side effects are easy to mistake for the flu, but are typically much milder than actual flu symptoms.

If you can’t tolerate needles or if you have a severe egg allergy, don’t miss out on the protection flu vaccines offer. Other flu vaccine options may be better for you. (Keep reading to learn more about them!)

Intradermal injection

The intradermal flu vaccine, Fluzone Intradermal, is injected into the skin instead of the muscle. The needle required for this shot is 90% smaller than that of the IM flu shot. That’s much less intimidating for people who don’t like needles! Fluzone Intradermal protects against four flu strains and can be used in people between 18 and 64 years old.

­­­­The intradermal flu vaccine is still an injection, so if you can’t tolerate any needles, this may not be a viable option. You might have more redness, swelling, and itching where the intradermal shot is injected than you would with the IM flu shot. If you have a severe egg allergy, avoid this particular flu vaccine.

Nasal spray

The nasal spray, FluMist Quadrivalent, is a live, attenuated (weakened) influenza vaccine (LAIV) that has fallen in and out of favor over the years. The CDC generally lets the public know whether to use the nasal spray in a given flu season since it may work better in some years than others.

A nasal spray is a convenient option for people who don’t like needles, especially for young children. Even though the FDA has approved FluMist for people two to 49 years old who aren’t pregnant, there are some groups of people who should NOT get the nasal spray flu vaccine:

• Children two to 17 years old who are taking medications with aspirin or salicylates (for example, acetaminophen)
• Children two to four years old with asthma or wheezing in the past 12 months
• People with weakened immune systems or their caretakers

Side effects like runny nose, wheezing, headache, muscle aches, sore throat, and fever can occur with FluMist, but they are usually much milder than actual flu symptoms.

Strength

Flu vaccines can come in different strengths. Standard-dose flu vaccines are typically effective enough for people younger than age 64.

The high-dose flu vaccine (Fluzone High-Dose), which contains four times the amount of antigen as IM flu vaccines do, can be helpful for older adults whose immune systems are weaker because it allows the body to build up a stronger immune response. It may even lower their risk of being hospitalized due to flu complications. For this reason, Fluzone High-Dose is only recommended for people over age 64.

Note: Since Fluzone High-Dose contains egg protein, no one with a severe egg allergy should get the high-dose flu vaccine.

Vaccine Components

Trivalent vs. Quadrivalent

Some flu vaccines are trivalent, meaning they offer protection against three flu strains. Others are quadrivalent, meaning they offer protection against four flu strains. See the handy tables below to find out how many strains each vaccine option protects against.

Allergens

The exact makeup of a flu vaccine can change from year to year. Check with your doctor if you have allergies to flu vaccine components like egg protein, antibiotics (like neomycin or polymyxin), latex or certain preservatives.

• Egg protein. The egg-free, IM flu vaccine, Flublok, is a safe option for people 18 years or older who have egg allergies as is comparable to other IM flu vaccines in terms of effectiveness and side effects. Since Flublok isn’t made using eggs (whereas other flu vaccines are), there’s no risk of an allergic reaction in people with egg allergies of any severity. Flucelvax is another flu vaccine that is made with less egg protein than others. However, people with severe egg allergies may prefer to opt for Flublok, the completely egg-free option.
• Antibiotics. Sometimes, drugmakers use antibiotics like neomycin,  polymyxin, and kanamycin during the manufacturing process to prevent vaccines from becoming contaminated with bacteria. If you’re allergic to topical ointments like Neosporin, you may be allergic to these components. Anyone with an allergy to these antibiotics should choose a flu vaccine that does not contain them.
• Latex. Latex is sometimes a component of flu vaccine packaging (for example, vials that contain natural rubber). If you have a latex allergy, avoid flu vaccine products with latex in the packaging—Fluad, an IM flu shot, is one example, but some versions of the Fluvirin IM shot may also contain latex.

How do I choose the best flu vaccine for me?

Here’s a summary of the flu vaccines available in the US. Cash prices are what you’d pay out of pocket without insurance coverage. You can use a GoodRx coupon to save as much as 80% on these flu vaccines.

Note: All flu vaccines listed below are standard-dose vaccines except for the high-dose vaccine, Fluzone High-Dose.

Trivalent Flu Vaccines

 

Quadrivalent Flu Vaccines

 

Where can I get a flu vaccine?

Remember, there’s no way to guarantee you won’t get the flu, but getting a flu vaccine each year is the best way to protect yourself.

Fortunately, there are plenty of places where you can get a flu vaccine. You might already know you can get vaccinated at your doctor’s office or a local pharmacy, but here are a few other places you may not have thought about:

• Medical clinics
• Health departments
• Workplaces, depending on the employer
• Urgent care clinics
• School or college health center

VaccineFinder is a convenient (and free!) online tool you can use to locate flu vaccines in your area. Once you type in your zip code, you can even see what types of vaccines are available at different locations nearby (though we’d still recommend calling before you go to make sure the vaccine you want is in stock).

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