The standard shot-in-the-arm flu vaccine hasn’t changed much in decades. But new options are arriving, including three offered for the first time this year in the U.S., for example, a quadrivalent vaccine formulated to trigger immunity to four viral strains rather than the usual three. It’s annoying that there’s no evidence yet to compare the effectiveness (while prices of the newer options run to double or triple that of the standard shot, which costs about $10.) But the newer alternatives have features that may make them preferable in some situations.
[This chart didn’t make it into a piece I wrote about flu this winter, but I don’t want it to go to waste, so here it is. (Red type = new this year in the U.S.)]
| Vaccine | Features | How it’s given | Target age group | Cautions | Cost per dose |
| Cell culture (Flucelvax) | Safer for those allergic to eggs because it’s not grown in chicken embryos. | Injection | 18 and older | First year available in U.S., so less is known about effectiveness and side effects. | $18 |
| High dose (Fluzone High-Dose) | Contains four times the dose of flu antigen, which may produce a stronger immune response. | Injection | 65 and older | • Associated with significant nausea and vomiting.• More likely to cause fever and injection redness and swelling. | $28 |
| Intradermal (Fluzone Intradermal) | Less painful shot; uses a micro-needle to inject vaccine into skin instead of muscle. | Micro-injection | 18-64 years | More likely to cause injection site redness and swelling. | $17 |
| Nasal spray (Flumist) | • Needle-free.• In children, may be more effective than standard flu shot.
• Now also quadrivalent. |
Sprayed into each nostril | 2-49 years | • Shouldn’t use if you are pregnant, immune suppressed or caring for someone who is.• In adults, appears to be less effective than the standard flu shot. | $22 |
| Recombinant (FluBlok) | • Safer for those allergic to eggs because it’s not grown in chicken embryos. • May produce a stronger immune response than standard flu shots. | Injection | 18-49 years | First year available in the U.S., so less is known about effectiveness and side effects. | $32 |
| Quadrivalent (Fluarix, FluLaval, Fluzone Quadrivalent) | Formulated to trigger immunity to four viral strains rather than just three, in theory providing broader protection. | Injection | 6 months or older | First year available in the U.S., so less is known about effectiveness and side effects. | $15-21 |
Sources:
- Summary Recommendations: Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—(ACIP)—United States, 2013-14.
- Two New Seasonal Influenza Vaccines, The Medical Letter, February 4, 2013.
- Evaluation of the safety, reactogenicity and immunogenicity of FluBlok® trivalent recombinant baculovirus-expressed hemagglutinin influenza vaccine administered intramuscularly to healthy adults 50–64 years of age, by R. Baxter & others, Vaccine, 28 January 2011.
- Traditional and New Influenza Vaccines, Sook-San Wong and Richard J. Webby, Clin. Microbiol. Rev. July 2013.
- Fluzone(®) Intradermal vaccine: a promising new chance to increase the acceptability of influenza vaccination in adults. Ansaldi F, & others, Expert Rev Vaccines. Jan 2012.
- Should seniors get the Fluzone High-Dose flu vaccine?, Consumer Reports News, September 21, 2012.
- Postlicensure Safety Surveillance for High-Dose Trivalent Inactivated Influenza Vaccine in the Vaccine Adverse Event Reporting System, 1 July 2010–31 December 2010, by Pedro L. Moro & others, CID, 1 June 2012.
joe rojas-burke 