Get a Flu Shot

Every year, many people choose to get the flu shot (or nasal spray) to protect themselves against the seasonal flu. There are several strains of the flu virus, multiple ways to fight against it, and various reasons people should be cautious before getting a vaccination. In general, everyone should get the flu vaccine, but those concerned should check with a physician. Follow the steps below to effectively fight the flu.

Steps

Choosing Your Flu Vaccine Location

1. Check with your insurance provider. In general, flu shots are required for any health coverage. It may be best practice, however, to check first with your insurance provider before going to get the vaccine, as they may have specific approved locations.
   • If you are uninsured, some locations offer the vaccine on a sliding scale fee.
2. Find the nearest location. The vaccine is offered in a variety of places. The government has handy search tool to determine where you may be able to get the vaccine: http://www.flu.gov/stay-connected/vaccinelocator_2011.html
3. Go to where nurses and doctors work. Your family doctor’s office is a great spot, but you can also go to urgent care clinics or health departments. Try to schedule your appointment to minimize the time required, and the likelihood of running into less sick people.
4. Stop at a pharmacy. Most pharmacies offer a quick flu vaccine, which works well when a doctor’s appointment is difficult to schedule. Convenience is sometimes an issue, and the availability at pharmacies has shown a significant increase in people who get vaccinated.
5. Opt for the Department of Public Health (DPH). Sometimes the local county or state DPH offers the flu vaccine. If you’re up to date on local websites, they may offer a quick drive-through option.
6. Ask if your employer offers the flu vaccine. Employers lose countless man-days per year due to flu illnesses. There are a variety of resources available to businesses wanting to offer the service.
7. Check your school or college. While many college students don't get a flu shot, the vaccine is almost universally available on campus. Go to university health centers or medical facilities nationwide to avoid the high-risk college environment.

Deciding on Your Flu Vaccine Type and the Delivery

1. Discuss which vaccine to get. There are several flu vaccine options. Sifting through all the information can be daunting, but there are currently two kinds of flu vaccines: trivalent and quadrivalent, both of which are similarly effective. The vaccine you get depends on your age.
   • Flu viruses are constantly changing and the vaccine composition is reviewed each year and updated as needed.
2. Get the trivalent vaccine. The trivalent vaccine protects against two types of A-strains of flu (the type that causes epidemics), and one type of B-strain, which is less severe. The A-strains covered are the H1N1 and H3N2, and the B-strain is either a derivative of Victoria or Yamagata lineage. Typically, the first B-strain included in the trivalent vaccine is the one predicted to be most prevalent in the annual flu season. There are four possible options for the trivalent vaccine.
   • Standard dosage shots use a virus grown in eggs. They are delivered via needle or jet injector. Under certain circumstances, the needle injection can be given to someone as young as six months old. The jet injector, however, is for ages 18 to 64 years old.
   • Because immune systems weaken with age, a higher dose shot is available for those over 65 years old. The higher dosage has four times the antibody creating substance antigen, and helps older people with their immune response.
   • A cell-based shot is also available for anyone over 18 as an alternative to the typical shot. Instead of an egg, animal cells are used to create the vaccine. The vaccine itself isn’t different, but the flexibility of this type of creation is beneficial because it doesn’t rely on egg supply. This is a good option if you have an egg allergy.
   • One other method using Recombinant Influenza Vaccine (RIV), also called Flublok, is produced quicker, without the influenza virus or eggs. The production is much faster, potentially better able to react to pandemics, but has a shorter shelf-life. This vaccination is also available for those 18 years and older.
3. Receive the quadrivalent vaccine. The quadrivalent vaccine includes both A-strains of the flu, the B-strain contained in the trivalent vaccine, and one more B-strain, hence the quad (meaning "four") prefix. Currently there are three options available.
   • The standard quadrivalent shots are grown inside eggs and manufactured into multiple varieties. The age group for these shots may start from six months old in certain cases, and as young as three years old in others.
   • An intradermal vaccine is available as an alternative to the traditional shot. While the traditional shot is delivered into the muscle, the intradermal shot uses a smaller needle and is injected under the skin. This shot requires less antigen, and is specifically for people 18-64 years old.
   • A nasal spray, also called the Live, Attenuated Influenza Vaccine (LAIV), is approved for people two to 49 years old. An attenuated vaccine is created using a lessened pathogen that removes the danger from the vaccine — 1 in 100 quintillion chances it reverts to actual influenza — but nonetheless keeps it partially live. This version of the vaccine should not be taken by anyone outside the age range, those with previous allergic history of reactions to vaccines or eggs, children two to 17 who are undergoing aspirin therapy, anyone with asthma, pregnant women, and those with weakened immune systems.

Getting the Vaccine

1. Expose your arm. Aside from the nasal spray, flu shots — including jet injection — are given intramuscularly in the deltoid (upper arm and shoulder) region. While the intradermal applied at 45 degrees just under the skin, the intramuscular injections are 90 degrees straight into the muscle.
2. Be prepared for the side effects. The viruses in the flu shot are killed (inactivated) or attenuated (weakened to ineffectiveness), so you will not get the flu from a flu shot. There are some minor side effects, however. If these problems occur, they begin soon after the shot and usually last one to two days:
   • Soreness, redness, or swelling where the shot was given
   • Hoarseness or wheezing
   • Sore, red or itchy eyes
   • cough
   • Low-grade fever, chills
   • Muscle aches and headaches
   • Runny nose/nasal congestion
   • Abdominal pain, vomiting, and diarrhea
   • Fatigue
3. Call a doctor if you observe a severe reaction. Look for any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat or dizziness. Tell the doctor what happened, the date and time it happened, and when the vaccination was given.
4. Report any complications. If in the US, ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967. As of July 1, 2005, people who think that they have been injured by the flu shot can file a claim for compensation from the National Vaccine Injury Compensation Program (VICP).

Determining if You Should Get the Flu Vaccine

1. Consider your demographics. While it is recommended that nearly everyone receive the flu vaccine in some fashion, certain people are more susceptible to flu-related complications. If you or someone you know falls into one of the following conditions, it may be best if they consult with a physician should they have concerns about taking the flu vaccine.
   • Children younger than five years old — particularly those younger than two — are particularly vulnerable to complications. Approximately 20,000 children each year have difficulties with the flu vaccine, resulting in potential dehydration, pneumonia, or sometimes worse conditions..
   • People older than 65 should be cautious because their immune system gets weaker with age. It’s estimated that over half the flu-related hospitalizations each year are people over the age of 65. Even worse, 80 – 90% of all seasonal flu deaths are from the same age group.
   • Pregnant women, including two weeks postpartum, may not want to get the flu shot. During pregnancy, there are a myriad of changes in a woman’s immune system, as well as her cardiovascular system. As such, pregnant women are more likely to face flu related illnesses, hospitalizations, and potentially death.
   • Residents of nursing homes or long-term care facilities are highly susceptible to outbreaks and illnesses. In fact, in late 2005 the Centers for Medicare and Medicaid Services (CMS) began a program that not only offered, but tracked compliance with, the flu vaccine. Because of the aging residents, and the potential for virus introduction from new members, many facilities make the flu vaccine a mandatory part of admission and retention.
   • American Indians and native Alaskans may have elevated risks associated with the flu vaccine.
2. Check for medical conditions. There are a variety of conditions that may exacerbate the potential for flu related problems. If you have a condition listed below, check with a healthcare professional regarding the flu vaccine.
   • Asthma is a naturally vicious pairing with the flu. While those with asthma may not be more likely to actually contract the flu, they are more prone to complications. Swollen airways already affected by asthma can be further aggravated by the flu. What’s more, asthma attacks may be caused, and worse conditions like pneumonia can be the result.
   • Lung diseases such as chronic obstructive pulmonary disease (COPD)and cystic fibrosis are at greater risk to flu complications. Complications with asthma and flu can eventually lead to such a worsened condition.
   • Congestive heart failure symptoms can be exacerbated by flu.
   • Anything neurological or neurodevelopmental (e.g. epilepsy, stroke, muscular dystrophy) is at high risk.
   • Heart, blood, endocrine (such as diabetes), kidney, or liver conditions likely make a person more susceptible to flu complications.
   • Refrain if you have Guillain-Barre Syndrome (GBS). In 1976 there was a connection between an influenza vaccine and GBS. People who have GBS naturally have flawed immune systems, are therefore susceptible to flu vaccine complications, and should check with a physician before getting treated.
3. Check your medication. If you are taking long-term medication for diseases like HIV, AIDS, or cancer, your immune system may be weakened. This also applies if you have been on steroids for a long time, or if you are under 19 years old and have been on aspirin therapy.
4. Lose weight. If you are morbidly obese — categorized by a Body Mass Index (BMI) of greater than 40 — you are more likely to have various heart ailments, metabolic issues, and even certain cancers. As such, there is a greater risk with the flu vaccine.

Deciding When to Get the Flu Vaccine

1. Act when the vaccine is released. There is an annual window to receive the vaccine before peak flu season, and it’s only a few months. Vaccines are typically produced earlier in the year, with shipments arriving in stores a few months later — around July or August.
2. Get the vaccine by October if possible. Influenza can occur at any time, but most activity ranges from October to May. The zenith of the problems in the United States is from December to February. The earlier people get vaccinated the better, because that creates a large group of vaccinated people. If you miss the window, don’t fret; it’s never too late to receive the vaccination.
   • In addition, the body needs time to build immunity, so getting the vaccine before the flu season gives the body a chance to do this.
3. Go early for childhood vaccinations. There are two doses for children aged six months to eight years old, and ensuring an early delivery of the first dose allows plenty of time for the second dose. The second dose must be given at least four weeks after the first, and should be administered prior to flu season for maximum efficacy.
   • Wait if you are moderately or severely ill. You should wait until you recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.

Tips

• It takes up to 2 weeks for protection to develop after the seasonal flu vaccination.
• Protection from the flu vaccine lasts approximately one year.
• Getting the flu vaccine does not guarantee immunity to the flu. There are constant changes ongoing within the flu viruses, and there is always a chance of a different strain.
• When you get the vaccine, ask for a small needle if needles in general make you flinch.

Warnings

• Some inactivated influenza vaccine contains a preservative called thimerosal. Some people have erroneously suggested that thimerosal may be related to developmental disabilities (such as autism) in children. No studies support these claims, however, there are options for those who wish to avoid thimerosal:
  • Thimerosal-free seasonal influenza shots are available. Multi-dose vials of seasonal influenza vaccine contain thimerosal to prevent potential contamination after the vial is opened; single-dose vials usually do not.

Related Articles

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• Avoid the Flu at University
• Stop the Spread of a Pandemic Flu Virus

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