Up the Nose or In the Arm? How to Choose Your Flu "Shot"

We can’t deny that viral season is upon us. My office and emergency room is filled with children and parents with runny noses, coughs, fevers, and fatigue. Many worry it’s the dreaded enterovirus-68, with fear over respiratory illness requiring hospitalization. Though I am sure that many of my patients do in fact have this infection, thankfully very few are becoming ill enough to require hospital-based care.

This high viral season reminds us that we should consider getting flu vaccines. Influenza has maintained a low profile so far this Fall, though no doubt it will rear its head in the coming month or two, as it does each year. Have you forgotten H1N1 from last year?

In North America, we now have two excellent flu vaccine options—the classic flu shot and the lesser-known flu nasal spray. Both offer similar levels of protection, but some people are better suited for one or the other option.

The Big Debate: Should You Even Get A Flu Shot?

Who should be vaccinated against the flu?

The Centre for Disease Control (CDC) and National Advisory Committee on Immunization (NACI) recommend that everyone 6 months and older get immunized against the flu, unless there is a medical reason not to. Why risk getting sick if you don’t have to?

Those most encouraged to get the vaccine include:

Children age 6 months and up
Adults 50 years and older
Children on Aspirin therapy, who are at higher risk of Reye’s syndrome (that can lead to liver and brain swelling) if they catch the flu
People with lung, heart, liver, and blood diseases, and those with diabetes
Kids and adults with weakened immune systems
People who work with those at risk (health care workers, caretakers of patients with the above conditions, teachers)
Caregivers to young children

Here are some details to help you decide which you want to use:

The Flu Shot

The vaccine is given by injection into the upper arm. It is made from dead influenza virus and cannot infect you with the flu.

Side effects:

Most side effects are mild and short lasting. Soreness of the arm is most typical. Mild fever and achiness is also possible.

Who can get the flu shot?

Children and adults 6 months and older

Who shouldn’t get the flu shot?

Babies less than 6 months of age
People who have had the illness Guillain-Barre Syndrome in the previous 6 months
People who have had life threatening anaphylaxis to the flu shot in the past

Egg allergy is no longer a contraindication to flu vaccine. The Canadian National Advisory Committee on Immunization (NACI) and American College of Allergy, Asthma, and Immunology say the vaccine has such a low amount of egg protein that it's unlikely to cause an allergic reaction. If you have a severe egg allergy, please discuss with your doctor.

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Pros:

Most patients can get the flu shot
It is considered safe and effective at preventing the flu

Cons:

Let’s face it, it’s a shot, which many kids and adults are not a fan of.

The Nasal Flu Vaccine

This vaccine is sprayed into the nose. The vaccine is ‘live,’ though weakened, and cannot cause the flu. Flu-like symptoms may occur, however.

Side effects:

Side effects from the nasal flu vaccine can be more severe that those from the shot.
Runny nose, wheezing, fever, vomiting, headache, sore throat, and cough are common side effects.

Who can get the nasal flu vaccine?

Most people between 2-49 who are healthy and not pregnant

Who cannot get the nasal vaccine?

Children less than 2 years of age
Adults older than 50 years
Pregnant women
Anyone taking ongoing ASA therapy
Children with heart disease, severe asthma, diabetes, and kidney disease, Guillain-Barre Syndrome, or with weakened immune systems
Anaphylaxis to eggs or previous flu vaccine

Pros: