Americans seeking a flu vaccine this year will be able to choose from more than a dozen varieties, including some available for the first time.
There will be shots injected in the arm and vaccines sprayed into the nose; ones that protect against three strains of flu and others that protect against four.
There will even be 21st-century shots made in cell cultures, rather than eggs, a technology used since the 1950s.
"It does make for a dizzying amount of choices," says Lisa Grohskopf, a medical officer at the Centers for Disease Control and Prevention.
The CDC recommends everyone over the age of 6 months receive a flu shot, even if they're allergic to eggs.
Consumers may have to shop around to find exactly the vaccine they want, however, given that few doctors will stock every shot, says H. Cody Meissner, who heads the division of pediatric infectious diseases at the Floating Hospital for Children at Tufts Medical Center in Boston.
People also may be ineligible for some vaccines because of their age.
Choices this year include:
• Quadrivalant vaccine. For the first time, some flu vaccines will protect against four strains of influenza, rather than the usual three, says Andrew Pekosz, associate professor at Johns Hopkins University's Bloomberg School of Public Health.
Traditionally, flu vaccines protect against two types on influenza A and one type of influenza B. Including a second strain of influenza B should provide broader protection, Pekosz says.
Although the CDC expects there to be up to 139 million doses of influenza vaccine this year, only about 30 million will be quadrivalent.
All FluMist intranasal sprays will be quadrivalent, says Melissa Garcia, spokeswoman for manufacturer MedImmune. FluMist is approved only for those ages 2 to 49.
Other quadrivalent flu shots are approved for anyone over 6 months.
• Cell-culture vaccines. Flu vaccines are traditionally cultured in eggs, which makes production very slow, Pekosz says. "During the 2009 H1N1 pandemic, we had to wait for chickens to lay more eggs," he says.
This year, for the first time, vaccines made from viruses grown in animal cells will be available, Pekosz says. The viruses used in flu shots are killed so that they cannot cause the flu. FlucelVax, made by Novartis, is approved for those over 18.
One of the main advantages to a cell-culture vaccine is that manufacturers can quickly ramp up production in a pandemic, Pekosz says.
Cell-culture vaccines have already been used to protect against rotavirus, polio, smallpox, hepatitis, rubella and chickenpox, according to the CDC. They're used in flu shots in several European countries, as well.
• Recombinant protein vaccine. The new FluBlok vaccine is made through genetic engineering. And, like FlucelVax, it's also egg-free.
Instead of starting with a whole virus, scientists create the vaccine using only a small piece of virus, a hemagglutinin protein, according to Protein Sciences, which makes FluBlok. Researchers grow the proteins in cells, then purify them before putting them into the vaccine.
FluBlok is approved for adults 18 to 49.
Doctors may want to consider a cell-culture or recombinant flu vaccine for people with egg allergies, according to the American Academy of Pediatrics.
But the academy notes that most people with egg allergies, even those who break out in hives, can safely receive conventional flu shots. People with severe egg allergies - which cause breathing problems - should stay at the doctor's office for 30 minutes of observation after getting a vaccine.
• High-dose vaccines. Although the elderly are among those most likely to die from the flu, they're far less likely than others to benefit from a standard flu shot, Pekosz says. That's because the immune system - like the joints, eyesight and hearing - tends not to work as well as people age.
High-dose shots approved for those over 65 aim to overcome this problem by including four times the usual level of immunity-producing antigens, Groskopf says.
Because these vaccines contain more of the proteins that stimulate the immune system, they could be expected to produce more side effects, such as soreness in the arms.
A sore arm "is usually a good thing, because it shows that your body is responding to the vaccine, and it shows that your immune cells are coming" to the injection site, Pekosz says.
• Intradermal shots. These shots are designed for needle-phobic adults ages 18 to 64, Pekosz says. They have shorter needles that penetrate just the skin, rather than traditional intramuscular shots, which go into the muscle, he says. These shots also use a lower dose of vaccine, so they cause fewer reactions.
Yet Pekosz says people shouldn't delay vaccination to look for their favorite shot. The CDC hasn't said that one vaccine is any better than another. And the American Academy of Pediatrics notes that any flu shot is better than nothing.
At least 154 children died of the flu last season, according to the CDC. Most weren't vaccinated. And nearly half of those who died had no underlying condition to put their doctors or parents on alert, Meissner says.
By Liz Szabo, USA Today
Gannett / USA Today