FluMist or Flu Shot: Which is more effective?

Official answer

by Drugs.com

Both FluMist nasal flu vaccine and the flu shot offer good protection against influenza when vaccines are well-matched to the year’s circulating virus. In 2022-2023, the flu vaccine was 54% effective in preventing influenza A in people less than 65 years of age and 71% effective in children.

Maybe you are wondering is one flu vaccine better than another? Below we can offer some advice for specific groups.

FluMist is approved for use in people ages 2 through 49 years. In patients 50 years and older, it may not be as effective as other recommended vaccines. Children under 2 years old have an increased risk of wheezing (difficulty with breathing) after getting this nasal vaccine. Check with your doctor to see if you are eligible for FluMist.

Ultimately, the best flu vaccine for you or your child is the one that is available and that you are eligible for. It’s more important to get protected against influenza than to wait on a specific vaccine to be available.

There can also be a risk to waiting: you may miss your vaccine altogether, catch the flu in the interim, and possibly spread it to others within your household or community.

Talk to your doctor about which flu vaccine is most appropriate for your or your family members, and consider factors like age, health conditions, and availability.

How effective is the flu vaccine?

Overall, the influenza vaccine typically reduces the risk of flu illness by 40% to 60% during seasons when the flu viruses are well-matched to the vaccine, but this can vary each year.

The effectiveness of the influenza vaccine varies by the season, the virus subtype, and how well the vaccine matches the circulating viruses.

Each year the flu vaccine is never 100% effective in preventing flu, but if you do get the flu, the vaccine can help to lessen the severity of your symptoms and lower your risk for hospitalization and death.

In addition, it is possible to have COVID and the flu at the same time, which may result in more serious illness overall.

The flu viruses that circulate during each flu season can change from year-to-year, and that’s why the vaccine is updated each season. The CDC recommends that everyone aged 6 months of age and older get a yearly flu vaccine in the fall, with rare exceptions.

If FluMist nasal vaccine isn't available, or you’re not eligible, ask your healthcare provider or pharmacist if you can get the flu shot.

The Pros and Cons: FluMist vs. Flu Shot

There are pros and cons to both the FluMist nasal vaccine and the flu shot. Which type of vaccine is best for you will depend upon factors like your age, health conditions, or if you take certain medicines. Your healthcare provider can help you sort these issues to determine which vaccine is best for you.

Here’s a list of 6 pros and cons:

What is FluMist Quadrivalent?

FluMist Quadrivalent, also known as quadrivalent live attenuated influenza vaccine or LAIV4, is a needle-free option approved for use in eligible people between the ages of 2 through 49 years.

It’s called “quadrivalent” because it contains four influenza virus strains: two A strains and two B strains. Previously, trivalent vaccines were available that targeted 3 flu virus strains, but all vaccines in 2023 were developed as quadrivalent. The original FluMist was a trivalent vaccine, but was not available last year.

FluMist Quadrivalent is not to be used in children under 2 years old because they have an increased risk of wheezing (difficulty with breathing) when using this vaccine. In older patients, it may not be as effective as other vaccines.

How is it given?

FluMist is a liquid vaccine that is sprayed into the nose with one dose (0.1 mL spray per nostril) for most people. People 9 years of age and older need one dose each flu season. Two doses of the nasal flu vaccine (at least 1 month apart) may be required in children ages 2 through 8 years who have never been vaccinated for influenza.

Because it’s sprayed into the nose, it may be preferred by people who have a fear of needles, especially children.

FluMist Quadrivalent is not to be used in children under 2 years old due to an increased risk of wheezing (difficulty with breathing). Tell your doctor if you or your child are currently wheezing, or if your child has a history of wheezing if under 5 years old.

It is recommended that everyone 6 months of age and older get an annual flu vaccination, with rare exceptions. Different vaccines are approved for different age groups and some vaccines can’t be used in certain people, so always ask for your doctor's or pharmacist's advice.

Who can’t use FluMist?

FluMist Quadrivalent should not be used:

Tell your doctor if you or your child are currently wheezing or have asthma, or if your child has a history of wheezing if under 5 years old.

There are additional warnings for people who may not be able to use this nasal vaccine. Tell your healthcare provider if you or your child:

If you or your child cannot use FluMist Quadrivalent, you may still be able to get an influenza shot. If you have questions, check with your doctor or pharmacist to determine if you or your child are eligible.

If I have a cold can I use FluMist?

If you have a minor illness, such as mild diarrhea from a stomach problem or a mild upper respiratory tract infection, you can most likely still receive FluMist. Check with your doctor.

But if your nose is so stuffy and congested that it may prevent the vaccine from getting to the inside of the nose, then your healthcare provider may suggest an injection instead, or suggest you delay your vaccine.

Who can’t get a flu shot?

Standard flu shots are appropriate for most people, but some people should not receive a flu shot. This includes:

Studies have shown that severe allergic reactions when using either the nasal spray vaccine or flu shots in people with egg allergies is unlikely. The CDC found that the rate of a life-threatening severe allergic reaction (known as anaphylaxis) was 1.31 per one million vaccine doses given.

Flu shots are approved for different age ranges, some as young as 6 months and some only for adults 18 or 65 years of age and older. Your healthcare provider will select a vaccine that is approved for your age range and medical conditions.

Three flu vaccine shots are approved for people 65 years of age and older for better protection:

Is the flu shot a live virus?

No, the flu shot is an inactivated virus vaccine, which means that the virus is killed. It can generate an immune response to help protect you against flu. It is given as an intramuscular injection in your upper arm area or the thigh in small children.

FluMist is an attenuated live virus vaccine, which means it contains weakened, but live, viruses, and has the potential for transmission to immunocompromised household contacts. If you have people in your household that have a weakened immune system, talk to your doctor before you receive FluMist.

Neither the flu shot or the nasal flu vaccine can give you the flu. You may have short-term flu vaccine side effects like fever, muscle aches or tiredness that resembles flu symptoms, but these are usually short-lived.

This is not all the information you need to know about FluMist or the flu shot for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.