Feature Article: Fall and Flu Vaccines: 3 Things to Know and 1 Common Misconception

So much attention has been on COVID-19 vaccine and booster doses that influenza vaccination may not be on your radar. However, each year hundreds of thousands of people in the U.S. are hospitalized with influenza infections, and sadly, thousands to tens of thousands die. So as school starts; leaves start to turn red, yellow and orange; and pumpkin spice scents the air, we wanted to make sure you had the latest info on influenza vaccine.

Like the start of school, timing of influenza vaccination is important.

Influenza season can start as early as October, but it typically peaks in January or February and cases continue into the spring. As such, most people are not recommended to get their flu vaccine until September or October. Those who have not been vaccinated during the current season can continue being vaccinated into the winter or spring. As long as the disease continues circulating, people can benefit from vaccination.

Importantly, it takes about two weeks for immunity to develop following vaccination, so it makes sense to get vaccinated before influenza virus arrives in your community. By scheduling flu vaccinations for yourself and your family during September or October, you won’t need to worry about influenza vaccinations during the holiday frenzy later in the year.

A few groups are recommended to get vaccinated as soon as influenza vaccine is available, even if it is in July or August. As such, these individuals should get vaccinated soon if they have not already:

• Children who will need two doses of influenza vaccine, such as those getting vaccinated for the first time. Because the two doses need to be separated by at least four weeks, earlier vaccination ensures they will be protected before the virus starts circulating in their community.
• Women in their third trimester of pregnancy should get vaccinated a few weeks before delivery, so that their baby will have antibodies to protect them in the months after birth before they can get vaccinated against influenza themselves.
• Children who will need a single dose of influenza vaccine can also get vaccinated earlier (during the summer) because they may be visiting their healthcare providers for physicals and their vaccine-induced immunity wanes less rapidly than for adults.

Regardless of which group you or family members are in, add flu vaccination to your calendar today! Virtually everyone is recommended to be vaccinated against influenza annually.

Similar to the way that we like particular leaf colors, some of us should opt for particular influenza vaccines.

Several types of influenza vaccine are available, as described on the VEC’s recently updated Q&A (English | Spanish). Some doses of the versions given as shots are available in “high-dose” formulations. These doses either:

• Contain greater quantities of the part of the vaccine that induces immunity to influenza virus
• Include an adjuvant, which is an additional ingredient that causes a greater immune response to the vaccine

In 2022, adults 65 years and older are recommended to get a high-dose or adjuvanted version if it is available when they go for their vaccine. These individuals can also preferentially receive the recombinant version of influenza vaccine.

Adults 65 years and older are at increased risk of experiencing severe influenza, and their vaccine-induced immunity decreases more quickly than in younger people. Both are the result of having an aging immune system. As such, the high-dose and adjuvanted versions generate an immune response that is greater and, therefore, will not wane as quickly.

Because the intranasal influenza vaccine is not recommended for people more than 49 years of age, it is not available in a high-dose version.

Like pumpkin spice enhances various products each fall, specific influenza strains are chosen to enhance annual influenza vaccines.

Most people are aware that we need to get vaccinated against influenza each year because the virus changes so frequently. Since influenza season occurs earlier in the Southern Hemisphere, experts monitor the strains of influenza causing illness there and make recommendations about which strains to include in the vaccine for the Northern Hemisphere. This decision must be made several months before influenza season begins to allow for sufficient time to produce the vaccine. Unfortunately, sometimes the virus continues to change, resulting in a vaccine that is less effective. However, until we have a better way to make the influenza vaccine, this approach gives us the best chance of having a vaccine that will protect against the types of influenza that are causing illness each year.

All the influenza vaccines used in the U.S. protect against four strains of influenza. Two are influenza A viruses, and two are influenza B viruses. The influenza vaccines that will be administered this fall and winter will include one new influenza A strain and one new influenza B strain, compared with the versions used during last influenza season (2021-2022).

Because of waning immunity and the ever-changing nature of influenza virus, it is important to be vaccinated even if you received influenza vaccine last year.

One final note … a common misconception

People with a history of Guillain-Barré syndrome (GBS) often contact us and say that they “can’t get the flu vaccine because they have had GBS.” Most people with a history of GBS can, in fact, be protected against influenza through vaccination. The only people with a history of GBS that typically prevents them from getting influenza vaccine are those whose GBS was diagnosed within six weeks of receipt of a previous influenza vaccine. In some cases, even these individuals may opt for vaccination after consulting with their healthcare provider. For example, they may have other conditions that increase their risk for complications if infected with influenza. In these situations, the patient and their healthcare provider should evaluate the potential risks and benefits to decide whether they should get vaccinated. For more information about GBS and vaccines, see this page of our website.

Resources for additional information

You can find out more about influenza and the vaccine from these resources:

• A Look at Each Vaccine: Influenza Vaccine (webpage)
• Influenza: What you should know (Q&A), also available in Spanish
• Influenza (infographic)
• How are strains of influenza chosen for the annual vaccine? (video)
• Can a flu vaccine give me the flu? (video)
• Why doesn’t the influenza vaccine work for more than one year? (video)
• Influenza segment from Hilleman: A Perilous Quest to Save the World’s Children (video)
• Classroom lessons for HS students (lessons): Case Study: The 1918 Influenza Pandemic – Factors Beyond the Biological that Influence the Spread of Disease | Case Studies: Influenza and HIV
• Perspectives on COVID-19 vaccination from families affected by flu (videos): Amber M. | Angie W. | Jennifer M.

Amber, Angie and Jennifer are part of an organization called Families Fighting Flu, which aims to “educate about the seriousness of influenza and the importance of annual vaccination” based on their personal experiences with this disease that is often considered to be a mild and harmless infection. Sadly, the families brought together in this organization know that influenza can be anything by mild and harmless. Check their website for more information and personal stories.

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