It’s that time of year again, flu season. Here is everything you need to know about the 2017-2018 influenza flu shot:  ingredients, what flu strains the 2017-2018 flu shot protects against, and who should get the flu shot.

What The 2017-2018 Flu Shot Protects Against

Each year in the late spring, the world’s leading health experts get together and come up with their predictions for what they think will be the most common flu viruses. There are hundreds of different flu strains. Each year the strains get narrowed down to just three to four viruses to be contained in the flu shot. Last year, it’s estimated that the flu vaccine was approximately 42% effective at preventing the flu (4).  These are the specific viruses that the 2017-2018 flu vaccine protects against this flu season:

What The 2017-2018 Flu Shot Protects Against:

1. An A/Michigan/45/2015 (H1N1)pdm09-like virus.
2. An A/Hong Kong/4801/2014 (H3N2)-like virus.
3. A B/Brisbane/60/2008-like (B/Victoria lineage) virus

Most flu vaccines guard against three strains of influenza, however, some contain four strains. For the 2017-2018 flu vaccines that contain four strains of the flu they will also include:

An Influenza B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

That’s the skinny on what this year’s flu shot has to offer (5). Below are some common questions in regards to the flu shot.

Does The 2017-2018 Flu Shot Have Mercury?

Some sites out there on the internet will tell you that all flu vaccines contain mercury. The truth: only multi-dose vials for the flu vaccine contain mercury. Multi-dose vials contain more than just one dose of the flu vaccine and mercury is used to help keep the vaccine from being infected with bacteria. So, unless you’re getting a flu shot from a multi-dose vial, your 2017-2018 flu vaccine will not contain mercury.

For those multi-dose vials that do contain mercury, the max mercury content contained is 25µg for each dose. According to the Environmental Protection Agency (EPA), the minimum lethal dose of mercury is 20-60mg/kg. The 2017-2018 flu shot multi-dose vials contain nowhere near that amount. From my experience in healthcare, multi-dose vials are not even used that often, so if mercury is you’re concern, make sure you’re getting your flu vaccine from a single-dose vial. If you’re still curious, just ask whoever is giving your vaccine for a full list of their ingredients.

The 2017-2018 Flu Shot and Egg Allergies

The majority of flu vaccines are created and cultivated in eggs. However, it’s a myth out there on the internet that all flu shots contain egg. As of 2013 there is a flu shot out there that was not created in eggs and is egg free. The egg free vaccine is known as Flublok and is available for the 2017-2018 flu season. Ask your provider about it if receiving a flu shot is something you’re interested in. Note: Flublok is also mercury and formaldahyde free. Flublok is only available for eighteen years of age or older.

Of the bigger news in regards to the flu vaccine and egg allergies, last year, the CDC changed its recommendations for people with egg allergies. The new flu vaccine and egg allergy recommendations are:

-People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
-People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, light-headedness, or recurrent emesis; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.

Difference Between The Flu Shot And The Flu Nasal Spray

If receiving a needle poke isn’t your thing, the flu vaccination also comes in the form of nasal spray. The difference is small. Here’s how it goes: in the flu shot the vaccine is inactivated using formaldehyde. In the flu nasal spray vaccine the vaccine is attenuated. This means that the virus is still alive but in a weakened. The CDC claims that this attenuated vaccine will not cause the flu. The CDC also claims that the nasal spray is conditioned to only be able to cause minor infections in the colder areas of your nose and can not cause infections in the warmer parts of your body like your lungs. For a list of common flu nasal spray side effects compared to the flu shot side effects, see below. The flu nasal spray is still FDA approved, however, the CDC is no longer recommending the flu nasal spray because of questions that have come up concerning how effective the flu nasal spray is versus the flu shot. Regardless, below are some side effects listed between the flu shot versus the flu nasal spray if you chose to get it:

Common Flu Shot Side Effects:

From The Shot:
1. Soreness, redness, or swelling from the injection site
2. Low grade fever
3. Aches

From The Nasal Spray:
1. Runny nose
2. Headache
3. Wheezing
4. Vomiting
5. Muscle Aches
6. Fever
7. Sore throat
8. Cough

The CDC has stated in the past that if these symptoms do happen, they will most likely be mild and short lived. Those that feel that they have been injured or have had a severe allergic reaction can file for compensation through the CDC as well.

Who Should Get The 2017-2018 Flu Shot?

There’s big money behind the flu shot. It’s up to the point that now the CDC recommends that everyone ages 6 months or older should be vaccinated each year, with rare exceptions. For times that there happens to be a flu vaccine shortage they recommend that the flu shot be given to the following (updated for the 2017-2018 flu season):

1. All children aged 6 through 59 months
2. All persons age 50 and older
3. Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematolgic, or metabolic disorders (including diabetes).
4. Persons who have immunosuppression (including immunosuppression caused by medications or by HIV).
5. Women who are or will be pregnant during the influenza season
6. Children and adolescents (ages 6 months to 18 years) who are receiving long term-aspirin therapy and who might be at risk for experiencing Reye’s syndrome after influenza virus infection
7. Residents of nursing homes and other long term care facilities
8. American Indians/Alaska Natives
9. Anyone obese with a BMI of 40 or greater
10. Healthcare personnel
11. All household contacts and caregivers of children aged younger than 5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged younger than 6 months; and
12. Are household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

Current recommendations are that flu vaccinations begin before any major outbreaks of influenza, and optimally by October.

Who Shouldn’t Get The 2017-2018 Flu Vaccine

The CDC currently recommends that the following groups abstain from receiving the flu shot:

General Population Groups:

1. People who have ever had a live threatening allergic reaction to the flu vaccine.
2. People with a history of Guillain-Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine.
3. People who are moderately or severely ill with or without fever should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.

These Groups Should Avoid Certain Flu Shots:

1. People under 65 years of age should not receive the high-dose flu shot
2. People who are under 18 years old or over 64 years old should not receive the intradermal flu shot

These Groups Should Not Receive The Nasal Influenza Vaccine:

1. Children younger than 2 years
2. Adults 50 years and older
3. People with asthma
4. Children or adolescents on long-term aspirin treatment.
5. Children and adults who have chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or metabolic disorders
6. Children and adults who have immunosuppression (including immunosuppression caused by medications or by HIV)
7. Pregnant women
8. People with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine
9. People who have taken antiviral flu medications within the last forty-eight hours

Influenza Flu Shot Ingredients

The problem with keeping track of the ingredient list of flu vaccines is that each company based off the way that they specifically make the vaccine can add their own ingredients. Vaccine ingredients can also change from year to year. Here is a current list of flu vaccine ingredients provided by the CDC (5).

Flu VaccineIngredients
Influenza (Afluria)beta-propiolactone, thimerosol (multi-dose vials only), monobasic sodium phosphate, dibasic sodium phosphate, monobasic potassium phosphate, potassium chloride, calcium chloride, sodium taurodeoxycholate, neomycin sulfate, polymyxin B, egg protein, sucrose
Influenza (Agriflu)egg proteins, formaldehyde, polysorbate 80, cetyltrimethylammonium bromide, neomycin sulfate, kanamycin, barium
Influenza (Fluarix) Trivalent and Quadrivalentoctoxynol-10 (Triton X- Į-tocopheryl hydrogen succinate, polysorbate 80 (Tween 80), hydrocortisone, gentamicin sulfate, ovalbumin, formaldehyde, sodium deoxycholate, sucrose, phosphate buffer
Influenza (Flublok)monobasic sodium phosphate, dibasic sodium phosphate, polysorbate 20, baculovirus and host cell proteins, baculovirus and cellular DNA, Triton X-100, lipids, vitamins, amino acids, mineral salts
Influenza (Flucelvax)Madin Darby Canine Kidney (MDCK) cell protein, MDCK cell DNA, polysorbate 80, cetyltrimethylammonium bromide, ȕ-propiolactone, phosphate buffer
Influenza (Fluvirin)nonylphenol ethoxylate, thimerosal (multidose vial–trace only in prefilled syringe), polymyxin, neomycin, beta-propiolactone, egg proteins, phosphate buffer
Influenza (Flulaval) Trivalent and Quadrivalentthimerosal, formaldehyde, sodium deoxycholate, egg proteins, phosphate buffer
Influenza (Fluzone: Standard (Trivalent and Quadrivalent), High-Dose, & Intradermal)formaldehyde, octylphenol ethoxylate (Triton X-100), gelatin (standard trivalent formulation only), thimerosal (multi-dose vial only) , egg protein, phosphate buffers, sucrose
Influenza (FluMist) Quadrivalentethylene diamine tetraacetic acid (EDTA), monosodium glutamate, hydrolyzed porcine gelatin, arginine, sucrose, dibasic potassium phosphate, monobasic potassium phosphate, gentamicin sulfate, egg protein

The list above contains vaccine ingredients but also substances used during the manufacturing process and vaccine production media that are removed from the final product and present only in trace quantities. However, some vaccine manufactures may change their product contents before release. For full vaccine ingredients, please check your institutions flu vaccine ingredient list.

Influenza Vaccine Ingredients And Their Uses

Here is a list of common flu vaccine ingredients:

IngredientUsesIngredientUses
Egg albumin Type of protein found in egg that the vaccine is grown in. Octyphenol ethoxylateSurfactant used to bring two different compounds together. Commonly used in cleaning agents and textile manufacturing.
ArginineA common protein found in the body. Phosphate Buffers (disodium, monosodium, potassium, sodium dihydrogenphosphate)Formed from phosphorus (naturally found in diet and body)and used to maintain pH levels.
Beta-propeiolactoneUsed as a disinfectant to maintain sterility. Considered a carcinogen. Polyethelyne GlycolA synthetic resin used as a solvent.
Calcium chlorideA simple mineral salt used to help control temperature.Polymyxin BAntibiotic used to prevent bacterial growth.
Egg proteinSelf-explanatory. Polyoxyethylene9-10 nonylphenolSurfactant used to blend compounds.
FormaldehydeCommon precursor to make resins in the textile industry. Used to inactivate live viruses. Considered a carcinogen.Polysorbate 80 or Polysorbate 20Surfactant and emulsifier used to bring compounds together.
GelatinGelling agent. Commonly found in animal byproducts like the hoofs of horses. Potassium chlorideSalt normally found in the body.
GentamicinAntibiotic used to prevent bacterial growth.Sodium chlorideSalt compound normally found in the body.
HydrocortisoneA steroid commonly used to treat skin irritation.Sodium deoxycholateBile acid used as an emulsifier to bring compounds together.
LatexFound in the top of the vaccine where the needle punctures. It's a rubber. SucroseSugar.
Monosodium GlutamateMSG - a compound people are advised to stay away from in packaged food. Used to help stabilize the vaccine when it's exposed to light, heat, acidity, or humidity. Thimersol (Mercury)Toxic metal used to prevent contamination in multi-dose vials.
NeomycinAntibiotic used to prevent bacterial growth. Tocopheryl hydrogen succinateA form of vitamin E used to prevent oxidation.
Octoxynol-10Used as an emulsifier/surfactant/detergent.

My Personal Disclaimer About Flu Shots:

I do not get the flu shot. As part of my profession of being an ER nurse the staff is required to receive a flu shot or wear a face mask during the flu season from the dates of October 15 to March 31. I opt to wear the mask. I know I’m not the only nurse doing so. Hopefully you can use this information to help you make a more informed decision on if you want to get the flu shot or not. 

Did you get the flu shot last year? Will make the same choice that you made last year?

Sources:
1. http://yourlivingbody.com/flu-shot-vaccine-information/
2. http://yourlivingbody.com/2015-2016-flu-vaccine-information/
2. N.a. “Influenza Vaccine Products By Excipient.” Minnesota Department Of Health. 26 September 2013. Web. 1 September 2014.
3. N.a. “Prevention and Control of Seasonal Influenza with vaccines” Centers For Disease Control. 24 August 2017. Web. 12 September 2016.
4. N.a. “Seasonal Influenza Vaccine Effectiveness, 2005-2017.” Centers For Disease Control. 25 June 2015. Web. 4 August 2015.
5. N.a. “Vaccine Excipient & Media Summary. Excipients Included in U.S. Vaccines, By Vaccine.” Centers For Disease Control. February 2015. Web. 6 September 2015.