What You Need To Know About This Year’s Flu Shot

Although in some parts of the United States it still feels like summer, we’re already into the 2013-2014 flu season. If you have been to a drug store such as Walgreens or Rite-Aid recently you’ve no doubt seen the signs posted that they are now offering flu vaccinations. From drug stores, to hospitals, to the evening news, and to Dr. OZ getting it’s that time of year again where the general public is being advised to get a flu shot.

We have everything you need to know about the 2013-2013 flu shot including the CDC recommendations, what the flu shot protects against, and the ingredients inside this year’s flu shot. Hopefully with this information, you can make an educated decision to receive the shot or not.

What The 2013-2014 Flu Shot Protects Against

During the late spring/summer months each year the world’s “health experts” come together and make an educated guess on what the flu vaccine will guard against. There’s literally hundreds of different strains of influenza. When it comes time to make the flu shot only a handfull of three to four are picked.

The 2013-2014 Flu Shot Protects Against:
1. An Influenza A/California/7/2009 (H1N1) – like virus
2, An (H3N2) virus antigenically like the cell-propagated porototype virus Influenza A/Victora/361/2011 strain
3. An Influenza B/Massachusetts/2/2012 – like virus

Most flu vaccines only guard against three types of influenza. However, so do contain four. For the ones containing four they contain the above one and in addition to that (3):

1. An Influenza B/Brisbane/60/2008 – like virus

Does The Flu Shot Have Mercury?

There has been a lot of controversy out there suggesting flu vaccines contain mercury. The truth is that for the most part, the flu shot has been mercury free since about 2001. The only exception are for multi-dose vials (1). Multi-dose vials are used on more than one person. A needle is inserted into the vial, the vaccine is drawn up, and used on an individual. The next person to come along gets a different needle but that needle is inserted into the same vial, the vaccine is drawn up, then administered. The process continues until the vial is empty. The mercury is used to help prevent bacteria from infecting the content. Unless the flu shot is administered from a multi-dose vial, the flu shot does not contain mercury. If you really want to get the flu shot, get a single dose vaccine. From my experience in health care, I don’t even really see multi-dose vaccines very often. A detailed list from the CDC shows the dosage of mercury here.

There are a few different forms of mercury. The kind of mercury in flu shots is methylmercury (1). According to the Environmental Protection Agency (EPA), the minimum lethal dose of mercury is 20-60mg/kg (2). The multi-dose vials of the flu shot contains nowhere near that amount (1). If you happen to get a vaccine containing mercury, eat some brazil nuts. The compound selenium inactivates mercury (also a great thing to consume if you eat seafood frequently).

Flu Shot And Egg Allergies

It is typically recommended that anyone who has an egg allergy avoids the flu shot. To understand the reasoning behind this is to understand how the flu shot is made. The influenza virus is injected into chicken eggs and then the albumin (protein) containing the vaccine is taken from that. This year for the first time, a vaccine was released on the market under the brand name Flublok for people 18-49 years old. It’s the first flu vaccine ever to not be grown from the traditional method of injecting eggs with the flu virus then extracting the vaccine at a later date (5). For more information check out the manufacturer website here For those who are interested in getting the flu shot and have an egg allergy, that vaccine will be your only option. Note: Flublok is also formaldehyde and mercury free. The unfortunate thing about this vaccine is that it has been produced in low quantity.

Who Should Get The 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 (4). For times that there is a flu shot shortage they recommend that the flu shot be given to the following:

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

For a complete list on CDC recommendations and excemptions please see here.

Difference Between The Flu Shot And The Flu 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 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 (9). For a list of common flu nasal spray side effects compared to the flu shot side effects, see below.

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 states that if these symptoms do happen, they will most likely be mild and short lived (8). Those that feel that they have been injured or have had a severe allergic reaction can file for compensation through the CDC as well.

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. If you’re interested in seeing the ingredients of a specific flu vaccine, please check the influenza vaccine insert of the one being offered to you. As a general rule of thumb the CDC does list several common ingredients:

In addition to those listed ingredients, the Institute For Vaccine Safety through the John Hopkins Bloomberg School Of Public Health does list ingredients for several flu shot makers here

So far the best resource that I’ve found for the 2013-2014 flu season was put out by the Minnesota Department of Health (8). They list this year’s brands of flu vaccines and what ingredients they contain:

Ingredient Vaccine Brand Ingredient Vaccine Brand
Egg Albumin Fluarix, FluLaval Octyphenol ethoxylate Fluzone
Arginine Flumist Phosphate buffers (disodium monosodium, potassium, sodium dihydrogenphosphate) Afluria, Fluarix, FluMist, Fluzone, Fluvirin, FluLaval, Flucelvax, Flublok
Beta-propeolactone Fluvirin, Afluria Polyethylene glycol Flublok
Calcium chloride Afluria Polymyxin-B Afluria, Fluvirin
Egg protein Fluzone, FluMist, Fluvirin, Fluarix, Afluria, FluLaval Polyoxyethylene 9-10 nonylphenol Fluvirin
Formaldehyde Fluzone, Fluarix, FluLaval Polysorbate 80 or Polysorbate 20 Fluarix, Flublok
Gelatin Fluzone (only in Fluzone trivalent), FluMist Sodium chloride Afluria, Fluarix, FluLaval
Gentamicin Fluarix, FluMist Potassium chloride Afluria
Hydrocortisone Fluarix Sodium deoxycholate Afluria, Fluarix, FluLaval
Latex Fluarix in syringe presentation, Fluvirin in syringe presentation, Flucelvax Sucrose FluMist, Fluzone, Fluarix
Monosodium glutamate (MSG) FluMist Thimerosal (Mercury) Afluria, Fluzone, and Fluvirin in multidose vials, FluLaval
Neomycin Afluria, Fluvirin Tocopheryl hydrogen succinate Fluarix, FluLaval
Octoxynol-10 Fluarix

Influenza Vaccine Ingredients And Their Uses

Ingredient Uses Ingredient Uses
Egg albumin Type of protein found in egg that the vaccine is grown in. Octyphenol ethoxylate Surfactant used to bring two different compounds together. Commonly used in cleaning agents and textile manufacturing.
Arginine A 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-propeiolactone Used as a disinfectant to maintain sterility. Considered a carcinogen. Polyethelyne Glycol A synthetic resin used as a solvent.
Calcium chloride A simple mineral salt used to help control temperature. Polymyxin B Antibiotic used to prevent bacterial growth.
Egg protein Self-explanatory. Polyoxyethylene9-10 nonylphenol Surfactant used to blend compounds.
Formaldehyde Common precursor to make resins in the textile industry. Used to inactivate live viruses. Considered a carcinogen. Polysorbate 80 or Polysorbate 20 Surfactant and emulsifier used to bring compounds together.
Gelatin Gelling agent. Commonly found in animal byproducts like the hoofs of horses. Potassium chloride Salt normally found in the body.
Gentamicin Antibiotic used to prevent bacterial growth. Sodium chloride Salt compound normally found in the body.
Hydrocortisone A steroid commonly used to treat skin irritation. Sodium deoxycholate Bile acid used as an emulsifier to bring compounds together.
Latex Found in the top of the vaccine where the needle punctures. It's a rubber. Sucrose Sugar.
Monosodium Glutamate MSG - 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.
Neomycin Antibiotic used to prevent bacterial growth. Tocopheryl hydrogen succinate A form of vitamin E used to prevent oxidation.
Octoxynol-10 Used 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 in a major hospital in San Diego 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 opted to wear the mask. I know I won’t be the only nurse doing so. In a later post I would like to present some of the inconsistencies in the research that revolves around flu vaccines. Use the information in this post to help make you make an educated decision as to whether or not you want the flu vaccine.

Have you gotten the flu shot before? What side effects did you have (other than a sore arm:)?

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Sources:

1. http://www.cdc.gov/flu/protect/vaccine/vaccines.htm
2. http://www.epa.gov/ttnatw01/hlthef/mercury.html
3. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Post-MarketActivities/LotReleases/ucm343828.htm
4. http://www.cdc.gov/flu/protect/whoshouldvax.htm
5. http://www.prnewswire.com/news-releases/us-fda-approves-flublok-the-worlds-first-recombinant-highly-purified-egg-free-influenza-vaccine-187206411.html
6. http://www.rxlist.com/fluzone-drug.htm
7. http://www.cdc.gov/vaccines/vac-gen/additives.htm
8. http://www.cdc.gov/flu/protect/keyfacts.htm#side-effects
9. http://www.cdc.gov/flu/about/qa/nasalspray.htm