I read about new types of flu shots.  What do you recommend for me?



Dear Ivy;

It used to be simple to get the flu shot…there was only one type and everyone was to get the same one.  Now, there are multiple options and it’s a bit confusing, so I’d like to give some clarification.

There are a few options out there, but generally, you will get what is available at the office or pharmacy that you go to.  For instance, our office will have the trivalent low and high dose only.  We will not have any of the other special vaccines, for logistical reasons.

So….first….let me go through the options and availability.  I’ll start with the most important that….the ones that apply to most people in my practice:

Low Dose (standard…OK) vs. High Dose (recommended):  The higher dose flu shot has become available in the past few years and provides a stronger immune reaction.  It is thought this will provide better protection, but there is no definitive proof.

It has been proven as safe as the standard flu shot in two seasons of widespread use.

Trivalent (3 flu strains…standard….recommended) vs. Quadrivalent (4 flu strains):   All flu shots contain the same virus protection, as it is based on national recommendations from the government bodies in charge of this issue.  Trivalent contains 2 Type A flu strains + 1 Type B.  Quadrivalent contains 2 Type A flu straines + 2 Type B.

Since Type B is a minority of the flu we see, and since this is a new vaccine, I would recommend passing on this shot until it has been used for a few seasons and proven safe and effective.  Then I may change my mind.

Live vs. Inactivated/Dead virus (recommended):   The live virus (weakened) is available as a nose spray only and is for people 2-49 years old.  This does not apply, in general, to our patient base.  They are equally effective, although perhaps the nose spray is better for children…but that is unclear.

Egg based (recommended) vs. Non-Egg based:  If you do not have an egg allergy of note (and most people who claim to have an egg allergy do not) then there is no advantage to the non-egg based flu shots.  That said, these are a great advance in the technology of flu immunization production and may become more common in the future.  Again, they are new and I would like to see them available for a few seasons before generally considering them.  For egg allergic patients who want the flu shot, this is a great option that was not formerly available.

Intramuscular (recommended) vs. Intradermal:  There are flu shots that can be given with a very tiny needle, like a bee stinger, just under the skin.  These flu shots are just as good as the standard one with the longer needle and will soon become standard, but they are not currently generally available.  In the next few years these will be the flu shot of choice.

So, rather than confuse the issue, this year I am recommending for those over 65 the HIGH DOSE, TRIVALENT VACCINE, but we do have the STANDARD DOSE, TRIVALENT VACCINE as well.  Either is fine.

As for the specialty vaccines, I would ask your local pharmacy if they have them available for special circumstances that may apply to you.



I recommend for all adults over 65: