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Painless and convenient. I chose to get my flu shot from my clinical pharmacist.

Painless and convenient. I chose to get my flu shot from my clinical pharmacist.

Choosing an influenza vaccine this year is overwhelming. Even the Public Health Agency of Canada agrees.

“With the recent availability of a number of new vaccines…the choice of product is no longer straightforward” National Advisory Committee on Immunization, Statement on Seasonal Influenza Vaccine for 2015-2016

In this post I’m going to break down the vaccine choices based on your age, medical conditions, and preferred method of administration (nasal or injectable).  For consistency and clarity I will be referring to each vaccine product by its trade name or brand name. But first, let’s start with a brief explanation about trivalent and quadrivalent vaccines.

Valent What?

Health care professionals and the pharmaceutical industry love to use medspeak when it comes to explaining the different strains of virus that the flu shot protects against. This year there are two broad types of vaccines available, trivalent and quadrivalent. Simply put “tri” means three and “quad” means four, so vaccines labelled trivalent protect against the same three strains of influenza (two types of influenza A and one type of influenza B) and vaccines labelled quadrivalent protect against four strains of influenza (the same three strains contained in trivalent vaccine plus one additional strain of influenza B). FluMist Quadrivalent, Flulaval Tetra, and Fluzone Quadrivalent are the three quadrivalent vaccines available this year; the remaining vaccines are trivalent. Basically your immune response is improved against the influenza B strains contained in the quadrivalent vaccine. This may be beneficial in children as they have a greater burden of influenza B infection.

Vaccine Options

As a guide for Albertans, I have underlined this flu season’s publicly funded vaccines. Vaccine coverage is different in each province and territory so check with your specific ministry of health. It is important to note that even though brand names for vaccines differ, they all protect against the same strains of influenza in any given season.

You’ll also notice that the term adjuvant is used to describe some specific vaccines. An adjuvant is a substance added to vaccines that boosts your immune response. The vaccines that contain an adjuvant, however, more often cause pain or swelling when compared to vaccines without the adjuvant.

Who should not receive the flu shot?

Reasons to not get the shot (contraindications) for all patients:

  • Severe allergic reaction (anaphylaxis) to previous flu shot or a component of the vaccine
  • Previous Guillain Barré syndrome within 6 weeks of a previous flu shot
  • Less than 6 months of age (use calendar months to count age, not 28 day months)

Reasons to not get the shot (contraindications) specific to Flumist Quadrivalent:

  • Egg allergy
  • Children under 2 years of age
  • Severe asthma
  • Immunocompromised due to underlying disease or therapy (e.g., chemotherapy)
  • Pregnancy
  • For children aged 2-17 years of age on active acetylsalicylic acid (ASA, Aspirin)
  • People with sickle cell anemia

Vaccines for Children (6 to 23 months old)

For children in this age group who have never received a flu shot, they should receive two doses, separated by a minimum interval of four weeks. If available, quadrivalent vaccine is preferred since it provides better coverage against the influenza B virus strains.

Quadrivalent Injectable

  • Flulaval Tetra
  • Fluzone Quadrivalent

Trivalent Injectable

  • Fluviral
  • Agriflu
  • Vaxigrip
  • Fluzone

Trivalent Injectable (with adjuvant)

  • Fluad Pediatric

Vaccines for Children (2 to 17 years old)

The preferred vaccine in this category is the Flumist Quadrivalent nasal vaccine, with the noted exceptions earlier in the post.

Quadrivalent Nasal

  • FluMist Quadrivalent

Quadrivalent Injectable

  • Flulaval Tetra
  • Fluzone Quadrivalent

Trivalent Injectable

  • Fluviral
  • Agriflu
  • Vaxigrip
  • Fluzone

Pregnant Women: a trivalent injectable or quadrivalent injectable vaccine are used. Quadrivalent nasal is not recommended. Breastfeeding Women: trivalent and quadrivalent injectable vaccine and quadrivalent nasal can be used

Vaccines for Adults (18 to 64 years old)

The trivalent injectable vaccines are preferred in this age group. If you can’t handle a needle, you can get the nasal vaccine, again with the exceptions noted above.

Trivalent Injectable

  • Fluviral
  • Influvac
  • Agriflu
  • Vaxigrip
  • Fluzone

Quadrivalent Nasal

  • FluMist Quadrivalent

Pregnant Women: a trivalent injectable or quadrivalent injectable vaccine are used. Quadrivalent nasal is not recommended.

Breastfeeding Women:trivalent and quadrivalent injectable vaccine and quadrivalent nasal can be used

Vaccines for Adult Seniors (65 years +)

Trivalent injectable with adjuvant is preferred. If this product is not available you can use the trivalent injectable vaccine.

Trivalent Injectable (with adjuvant)

  • Fluad

Trivalent Injectable

  • Fluviral
  • Influvac
  • Agriflu
  • Vaxigrip
  • Fluzone

The bottom line, is that depending on your personal situation, there may be more than one flu shot option for you this year. If you have a specific question please leave a comment or email me by clicking on the contact page. In the next post, I’ll discuss how you can prepare for your flu shot, so that the experience is positive and swift.