Seasonal Flu Vaccine

There are two types of influenza vaccines that protect against seasonal flu. The "flu shot" is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use among people 6 months of age or older, including healthy people and those with chronic medical conditions (such as asthma, diabetes, or [Coronary Artery Disease|heart disease]]). A different kind of vaccine, called the nasal-spray flu vaccine (sometimes referred to as LAIV for Live Attenuated Influenza Vaccine or FluMist®), was approved in 2003. The nasal-spray flu vaccine contains attenuated (weakened) live viruses, and is administered by nasal sprayer. It is approved for use only among healthy* people 2-49 years of age who are not pregnant.

Each of the two types of seasonal influenza vaccines contain three influenza viruses, which are chosen based on information about recently circulating seasonal viruses. Each seasonal influenza vaccine contains – one A (H3N2) virus, one A (H1N1) virus (not the 2009 H1N1 virus), and one B virus. Viruses for both vaccines are grown in eggs.

This year, there also is a 2009 H1N1 vaccine currently in production. Initial doses of 2009 H1N1 vaccine are expected to be available in October. This 2009 H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine.

How do flu vaccines work?

Flu vaccines (the flu shot and the nasal-spray flu vaccine (LAIV)) cause antibodies to develop in the body. These antibodies provide protection against infection with the viruses that are in the vaccine.

Why should people get vaccinated against the flu?

Influenzais a serious disease, and people of any age can get it. In an average year, seasonal flu causes 36,000 flu-related deaths (mostly among those aged 65 years or older) and more than 200,000 flu-related hospitalizations in the United States. The "seasonal flu season" in the United States is usually from November through April each year. During this time, flu viruses are circulating in the population. An annual seasonal flu vaccine (either the flu shot or the nasal-spray flu vaccine) is the best way to reduce the chances that you will get seasonal flu and lessen the chance that you will transmit to others.

When should I get a flu vaccination?

CDC recommends that people get their seasonal flu vaccine as soon as vaccine becomes available in their community. Vaccination before December is best since this timing ensures that protective antibodies are in place before flu activity is typically at its highest. CDC continues to encourage people to get vaccinated throughout the flu season, which can begin as early as October and last as late as May. Over the course of the flu season, many different influenza viruses can circulate at different times and in different places. As long as flu viruses are still spreading in the community, vaccination can provide protective benefit.

In addition, there are other people who may benefit from seasonal flu vaccination as late or April or May, even if influenza viruses are no longer circulating in the United States. This includes:

• Persons likely to be traveling to the Southern Hemisphere where influenza may be circulating. and
• Children younger than 9 being vaccinated for the first time who still have not received their second recommended dose of vaccine. (If they get their second dose, then they will only need one dose of vaccine next season. If they do not get their second dose, they will still need to get two doses of vaccine the next season in order to best be protected by the vaccine. This is because studies have shown that two doses are needed in children younger than 9 the first year they are vaccinated in order to maximize the protective benefit from vaccination.)

Once you get vaccinated, your body makes protective antibodies in about two weeks. However, children younger than 9 years old who are being vaccinated for the first time need a second dose 4 or more weeks later in order to be protected.

Who Should Get Vaccinated

In general, anyone who wants to reduce their chances of getting seasonal flu can get a seasonal influenza vaccine. However, it is recommended by ACIP that certain people should get vaccinated each year. They are either people who are at high risk of having serious seasonal flu-related complications or people who live with or care for those at high risk for serious seasonal flu-related complications. During flu seasons when vaccine supplies are limited or delayed, ACIP makes recommendations regarding priority groups for vaccination.

People who should get the seasonal vaccine each year are:

• Children aged 6 months up to their 19th birthday
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:

• Health care workers
• Household contacts of persons at high risk for complications from the flu
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Does getting vaccinated against flu early in the season pose a risk that immunity may wane before the end of the season?

Seasonal flu vaccination provides protection against the seasonal influenza strains contained in the vaccine. Seasonal flu vaccination can begin as soon as vaccine is available. Studies do not show a benefit of receiving more than one dose of vaccine during a flu season, even among elderly persons with weakened immune systems.

Is it too late to get vaccinated after Thanksgiving (or the end of November)?

No. CDC recommends that providers begin to offer seasonal influenza vaccination as soon as vaccine becomes available in the fall, but if you have not been vaccinated by Thanksgiving (or the end of November), it can still be protective to get vaccinated in December or later because influenza disease usually peaks in January or February most years, and disease can occur as late as May.

The ACIP has issued separate recommendations on who should get the 2009 H1N1 influenza vaccine.

Does flu vaccine work right away?

No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. In the meantime, you are still at risk for getting the flu. That's why it's better to get vaccinated early in the fall, before the flu season really gets under way.

Can I get seasonal flu even though I got a flu vaccine this year?

Yes. The ability of flu vaccine to protect a person depends on two things: 1) the age and health status of the person getting vaccinated, and 2) the similarity or "match" between the virus strains in the vaccine and those circulating in the community. If the viruses in the vaccine and the influenza viruses circulating in the community are closely matched, vaccine effectiveness is higher. If they are not closely matched, vaccine effectiveness can be reduced. However, it's important to remember that even when the viruses are not closely matched, the vaccine can still protect many people and prevent flu-related complications. Such protection is possible because antibodies made in response to the vaccine can provide some protection (called cross-protection) against different, but related strains of influenza viruses.

Why do I need to get vaccinated against the flu every year?

Flu viruses change from year to year, which means two things. First, you can get the flu more than once during your lifetime. The immunity (natural protection that develops against a disease after a person has had that disease) that is built up from having the flu caused by one virus strain doesn't always provide protection when a new strain is circulating. Second, a vaccine made against flu viruses circulating last year may not protect against the newer viruses. That is why the influenza vaccine is updated to include current viruses every year.

Another reason to get flu vaccine every year is that after you get vaccinated your immunity declines over time and may be too low to provide protection after a year.

How are the viruses for flu vaccine selected?

Each year, many laboratories throughout the world, including in the United States, collect flu viruses. Some of these flu viruses are sent to one of four World Health Organization (WHO) reference laboratories, one of which is at the Centers for Disease Control and Prevention (CDC) in Atlanta, for detailed testing. These laboratories also test how well antibodies made to the current vaccine react to the circulating virus and new flu viruses. This information, along with information about flu activity, is summarized and presented to an advisory committee of the U.S. Food and Drug Administration (FDA) and at a WHO meeting. These meetings result in the selection of three viruses (two subtypes of influenza A viruses and one influenza B virus) to go into flu vaccines for the following fall and winter. Usually, one or two of the three virus strains in the vaccine are changed each year.

Why do manufacturers and distributors take a phased approach to vaccine distribution?

Influenza vaccine production begins as early as 6-9 months before the beginning of vaccine distribution. Even with this early start, it isn't possible to complete the entire production and distribution process prior to the vaccination season, particularly given the limited number of influenza vaccine manufacturing plants in the United States and the large number of doses that are produced each year. Instead, influenza vaccine distribution takes place in a phased fashion over a number of months. It begins in late summer for some manufacturers and vaccine products and usually completes near the end of November or early in December. This system can leave doctors and other vaccine providers with uncertainty about when they can expect to receive their full order of vaccine and can make it difficult for them to plan their vaccination activities. Manufacturers and distributors work to try to get some vaccine to as many providers as possible as soon as possible so that they can begin vaccinating their patients. Getting some vaccine to all providers early in the season is important, because all providers serve at least some high-risk patients (such as people 50 years of age and older or those with chronic health conditions such as asthma, kidney disease, diabetes, lung disease and weakened immune system) and their household contacts.

What role does the Department of Health and Human Services play in the supply and distribution of the seasonal influenza vaccine?

Influenza vaccine production and distribution are primarily private sector endeavors. The Department of Health and Human Services and CDC do not have the authority to control influenza vaccine distribution nor the resources to manage such an effort. However, the Department has made significant efforts to enhance production capacity of seasonal influenza vaccines, including supporting manufacturers as they invest in processes to stabilize and increase their production capacity and improving guidance about the approval process at the Food and Drug Administration.

Key Facts About Seasonal Flu Vaccine

There are two types of vaccines:

• The "flu shot" — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

• The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.

Each seasonal influenza vaccine contains three influenza viruses-one A (H3N2) virus, one regular seasonal A (H1N1) virus (not the 2009 H1N1 virus), and one B virus. The viruses in the vaccine change each year based on international surveillance and scientists' estimations about which types and strains of viruses will circulate in a given year. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

The seasonal flu vaccine will not provide protection against 2009 H1N1 flu.

When to Get Vaccinated

Yearly flu vaccination should begin in September or as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary. While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later.

Use of the Nasal Spray Flu Vaccine

It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy* people 2-49 years of age who are not pregnant.

The ACIP has issued separate recommendations on who should get the 2009 H1N1 vaccine.

Who Should Not Be Vaccinated

There are some people who should not get a flu vaccine without first consulting a physician. These include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
• Children less than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

Vaccine Effectiveness

The ability of a flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or "match" between the viruses or virus in the vaccine and those in circulation.

Vaccine Side Effects (What to Expect)

Different side effects can be associated with the flu shot and LAIV.

The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:

• Soreness, redness, or swelling where the shot was given
• Fever (low grade)
• Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions. 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).

The nasal spray (also called LAIV or FluMist®): The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)

In children, side effects from LAIV (FluMist®) can include:

• runny nose
• wheezing
• headache
• vomiting
• muscle aches
• fever

In adults, side effects from LAIV (FluMist®) can include

• runny nose
• headache
• sore throat
• cough

More Information

• Flu Shot: Vaccination Information Statement (VIS)
• Nasal Spray: Vaccination Information Statement (VIS)
• For information about the 2009 H1N1 flu vaccine, see http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.

Related Videos

In this video from BigThink, James Merson, Chief Scientific Officer of the Vaccines Research Unit at Pfizer, discusses how vaccines are made and stresses the importance of developing a universal vaccine for Influenza:

In this video from the CDC, moving personal stories help inform parents about the dangers of flu to children and the benefits of vaccination.

For More Information

For information about the 2009-10 influenza vaccine including vaccine supply, visit "2009-2010 Flu Season" at http://www.cdc.gov/flu/about/season/

For general information about seasonal flu vaccine side effects, visit http://www.cdc.gov/flu/protect/keyfacts.htm

For specific information related to the seasonal flu shot, visit http://www.cdc.gov/flu/about/qa/flushot.htm

For information specific to the nasal spray vaccine, visit http://www.cdc.gov/flu/about/qa/nasalspray.htm

For information about the efficacy of flu vaccine, visit http://www.cdc.gov/flu/about/qa/vaccineeffect.htm

For information about the 2009 H1N1 flu vaccine, visit http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm