Dr. Dina Kulik: The Baby Doctor


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

Before you book your appointment for the flu vaccine, read this.

flu vaccine

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 optionsthe 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.

Ten Things NOT To Say To Someone Who Has Allergies


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


  • 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


  • The nasal spray may be more palatable to some people compared to the shot.
  • It may be more effective at preventing the flu in kids 2-8 years of age.


  • There are more limitations on who can safely get this vaccine.

Talk to your doctor or health care practitioner about which option is best for you! For more on colds and viruses going around, check this out.

Is It A Cold Or The Flu?

Entero-What? What You Need To Know About The Enterovirus 68.