Questions & Answers
Influenza - Seasonal - The Vaccines
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Questions

General Questions

  1. How effective is influenza immunization in protecting me from illness caused by the different strains of influenza?
  2. What if I'm pregnant or breastfeeding? Can I still receive the seasonal influenza vaccine?
  3. Are influenza vaccines harmful during my pregnancy?
  4. If a child is receiving an influenza vaccination for the first time, what is the appropriate administration schedule?
  5. If a child 6 months - 8 years of age is receiving an influenza vaccination for the first time, must the same type of vaccine be administered for both doses?
  6. How are injectable and intranasal influenza vaccines shipped and stored?
  7. If I need to administer a tuberculin skin test (TST), should I be concerned about administering the influenza vaccine at the same time?
  8. Can live vaccines and the influenza vaccine be administered on the same day?
  9. Can I get seasonal flu illness from the flu vaccine?
  10. Why does my child need to get the flu vaccine?

Inactivated Influenza Vaccine (IIV3), Injectable

  1. What is Afluria®?

Inactivated Influenza Vaccine (IIV4), Injectable

  1. What is Fluzone® Pediatric?
  2. What is FluLaval®?
  3. Who should receive the injectable vaccines?
  4. Who should not receive the injectable influenza vaccines?
  5. What side effects can I expect when I receive the injectable influenza vaccine?
  6. What is Fluarix®?

Live Attenuated Intranasal Vaccine (LAIV), Intranasal

  1. Who should receive the live, attenuated intranasal vaccine?
  2. What side effects can I expect when I receive FluMist®?
  3. Who should not receive the live, attenuated intranasal vaccine?
  4. What is FluMist®?
Answers

General Questions

  1. How effective is influenza immunization in protecting me from illness caused by the different strains of influenza?
    Vaccines are developed each year in an attempt to match the predicted virus strains. When they are well-matched, immunization of healthy adults is 70-90% effective in preventing influenza illness. When the majority of circulating influenza strains is not well matched by the vaccine, effectiveness is lower. Vaccines may be somewhat less effective in elderly persons and very young children, but immunization can still help prevent serious complications from influenza illness.

  2. What if I'm pregnant or breastfeeding? Can I still receive the seasonal influenza vaccine?
    Yes. The ACIP, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians have all recommended the routine vaccination of women who are pregnant, or who become pregnant during the influenza season. Pregnant women, as well as lactating/postpartum women and their newborn babies, are at high risk for influenza complications. Pregnant women may receive the inactivated injectable influenza vaccine, during any point of gestation and postpartum; breastfeeding women may receive the inactivated or live vaccine.

  3. Are influenza vaccines harmful during my pregnancy?
    Pregnant women are at high risk for influenza related complications and are a priority group for vaccination. The ACIP, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians recommends the use of injectable influenza vaccine for immunization of pregnant women. Influenza vaccine may be given at any time in pregnancy and is recommended to be given as early as possible during influenza season. LAIV should be avoided in pregnancy because of the theoretical risk associated with live-virus vaccines.

  4. If a child is receiving an influenza vaccination for the first time, what is the appropriate administration schedule?
    According to the ACIP and the American Academy of Pediatrics (AAP):
    Children aged 6 months to 8 years who are receiving the influenza vaccine for the first time or whose previous vaccination status is unknown should receive two (2) doses of vaccine separated by at least four weeks.

  5. If a child 6 months - 8 years of age is receiving an influenza vaccination for the first time, must the same type of vaccine be administered for both doses?
    No. The first and second doses can be from different manufactures or age-appropriate formulations. IIV can be used when vaccinating children aged 6 months to 8 years and LAIV (FluMist®) for children aged 2 years and older, who have not been previously vaccinated.

  6. How are injectable and intranasal influenza vaccines shipped and stored?
    All injectable and intranasal vaccines are shipped and should be stored at 2 to 8 degrees Celsius. When the vaccine arrives at your facility, it must immediately be placed in a refrigerator. In addition, protect Fluarix, Flulaval, Afluria, and Fluzone from light until use. Do not use vaccines past the expiration date printed on the vaccine vial or syringe. Generally, once a multi-dose vial has been punctured the vaccine must be used within 28 days. However, Fluzone multi-dose vials may be used after puncture until the expiration date on the vial. Any prefilled syringes, sprayers or single dose vials must be discarded at the end of the day if the tip cap is removed, a needle is placed on the syringe or the cap of the vial has been removed.

  7. If I need to administer a tuberculin skin test (TST), should I be concerned about administering the influenza vaccine at the same time?

    Yes. The live vaccine (FluMist®) may suppress a positive response to a tuberculin skin testing (TST or PPD) in a person who is infected with tuberculosis (TB), resulting in a false negative skin test. If a person needs TB skin testing and LAIV, you can correctly administer both in one of three ways

    • Give the TST (PPD) and the vaccine simultaneously.
    • Give the TST (PPD) first and when the person returns to have the skin test results interpreted, administer the live vaccine.
    • Give the live vaccine and then delay administration of the TST (PPD) for 28 days. Injectable influenza vaccines and tuberculin skin test can be administered concurrently or at any interval.


  8. Can live vaccines and the influenza vaccine be administered on the same day?
    The inactivated injectable influenza vaccine may be administered on the same day as live vaccines or at any interval thereafter, but the LAIV (Flumist) vaccine must be administered on the same day as the other live non-oral vaccines or separated by an interval of at least 28 days.

  9. Can I get seasonal flu illness from the flu vaccine?

    Influenza vaccine does not cause flu illness. Some vaccinated people may have mild flu-like symptoms, such as mild fever and muscle aches which are caused by the immune system's response to the vaccine. These side effects are not the same as having influenza, but people often confuse them.

    Some people think because the nasal spray flu vaccine contains live viruses that it can cause flu illness. The live viruses in the nasal flu vaccine (LAIV) are weakened and cannot cause flu illness. They are designed to only cause a mild infection in the cooler temperatures within the nose. They cannot infect the lungs or other areas where warmer temperatures occur.



  10. Why does my child need to get the flu vaccine?
    Annual influenza vaccines are recommended for everyone older than 6 months. Annual vaccinations are the best way to protect your child from getting the flu. Influenza is more dangerous than the common cold for children. Infants and children are more likely to have serious complications from the flu virus. Each year many children get sick with seasonal influenza, sometimes resulting in death.

Inactivated Influenza Vaccine (IIV3), Injectable

  1. What is Afluria®?
    Afluria® is an inactivated injectable influenza virus vaccine manufactured by CSL Biotherapies. The single-dose syringes are preservative and latex free. However, the multi-dose vials contain preservatives but are latex free. Afluria is licensed for persons aged 5 years and older; however, ACIP recommends Afluria be administered to children aged 9 years and older due to increased reports of febrile reactions in children 5 to 8 years of age. Afluria may be given, if no other age-appropriate, licensed seasonal influenza vaccine is available for children aged 5 through 8 years who are at high risk for influenza complications.

Inactivated Influenza Vaccine (IIV4), Injectable

  1. What is Fluzone® Pediatric?
    Fluzone® Pediatric (IIV4) manufactured by Sanofi-Pasteur. Presentations available include a multi-dose vial and a thimerosal-free single-dose syringe. All vaccine products are latex free. It is licensed for immunization of persons 6 – 35 months of age.

  2. What is FluLaval®?
    FluLaval® is an inactivated injectable influenza virus vaccine manufactured by Glaxo-Smith-Kline. The presentations available in a multi-dose vial containing preservative but are latex free. It is licensed for persons 3 years and older. Flu viruses used in FluLaval® are grown in the allantoic cavity of embryonated hens’ eggs so the vaccine contains a minuscule amount of egg protein.

  3. Who should receive the injectable vaccines?
    Injectable inactivated influenza vaccines (IIV) are approved for use in adults and children who are at least 6 months old, especially those for whom the live virus vaccine is contraindicated.

  4. Who should not receive the injectable influenza vaccines?

    Patients who should not receive the injectable influenza vaccine include persons who have had a serious systemic or anaphylactic reaction to prior dose of the vaccine or to any of its components.

    Precautions to receipt of the injectable influenza vaccines are:

    • Moderate or severe acute illness with or without fever.
    • History of Guillain Barre syndrome within 6 weeks of a previous influenza vaccination.
    • Immunocompromised individuals or those on immunosuppressive therapies that may have a reduced immune response to the vaccination.


  5. What side effects can I expect when I receive the injectable influenza vaccine?
    The viruses in inactivated influenza vaccine have been killed so you cannot become infected with influenza. Side effects which may occur are: soreness, redness, or swelling at the vaccination site, fever, weakness, headache, and muscle aches. If these problems occur, they usually begin soon after immunization and typically last for one or two days. Most people who receive influenza vaccine experience no serious problems. In rare instances, serious problems such as a severe allergic reaction can occur.

  6. What is Fluarix®?
    Fluarix® is an inactivated injectable influenza virus vaccine manufactured by Glaxo-Smith-Kline. It is presented in a latex and thimerosal free single-dose syringe. It is licensed for persons aged 3 years and older. Flu viruses used in Fluarix are grown in embryonated chicken eggs so the vaccine contains a minuscule amount of egg protein.

Live Attenuated Intranasal Vaccine (LAIV), Intranasal

  1. Who should receive the live, attenuated intranasal vaccine?
    FluMist® is approved for all healthy people aged 2-49 years who are not pregnant. For more information, see:
    http://www.vaccines.mil/flu

  2. What side effects can I expect when I receive FluMist®?
    The viruses in the intranasal vaccine are weakened and do not cause severe symptoms associated with influenza. Common side effects may include runny nose, headache, fever, cough, and sore throat. Other possible side effects are chills, cough, decreased activity, decreased appetite, headache, irritability, muscle aches, and tiredness/weakness. For more information, see:
    http://www.flumist.com

  3. Who should not receive the live, attenuated intranasal vaccine?

    The following populations should not be immunized with the Live Attenuated Intranasal Vaccine:

    • Person with a history of an anaphylactic allergy to eggs or any of the components of LAIV.
    • Pregnant women.
    • Persons who are immunosuppressed (including that caused by medications or HIV).
    • Persons less than 2 years old and those 50 years or older.
    • Persons receiving influenza antivirals (e.g., amantadine, rimantadine, zanamivir, or oseltamivir) within the previous 48 hours.
    • Persons who received any live non-oral vaccines in the last 28 days.
    • Persons who care for a severely immunosuppressed person who requires a protective environment.
    • Children or adolescents receiving aspirin therapy.

    Precautions to receipt of LAIV:

    • Moderate or severe acute illness with or without fever.
    • History of Guillain Barre syndrome within 6 weeks of a previous influenza vaccination.
    • Immunocompromised individuals or those on immunosuppressive therapies that may have a reduced immune response to the vaccination.
    • Persons with a medical condition which might predispose them to higher risk of complications attributable to influenza (e.g., chronic pulmonary [including asthma], cardiovascular [excluding isolated hypertension], renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic [including diabetes] disorders.


  4. What is FluMist®?
    FluMist® is a quadrivalent influenza vaccine manufactured by MedImmune. The presentations available in a latex and thimerosal free prefilled intranasal sprayer. It is licensed for healthy persons, non-pregnant persons 2-49 years of age. Flu viruses used in FluMist are grown in Specific pathogen-free (SPF) eggs so the vaccine contains a minuscule amount of egg protein.