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Harvard Commentaries
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Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Kids and Flu Shots -- What's New

October 15, 2013

By Claire McCarthy M.D.

Boston Children's Hospital

Flu season has begun—so it's time for you, and everyone in your family, to get their flu shots!

There are a few new options this season you need to know about.

  • Quadrivalent - This version protects against four strains of the influenza virus instead of the usual three (the trivalent version). The nasal spray flu vaccine (also known as LAIV or Live Attenuated Influenza Vaccine) is quadrivalent. Some of the injectable vaccines will be this new version as well. The Centers for Disease Prevention and Control (CDC) isn't recommending one over the other, partly because the quadrivalent is new.
  • Egg-free - The flu vaccine has traditionally been made using eggs. Most people with an egg allergy can tolerate the vaccine without a problem. However, some people with severe egg allergies cannot. This new version is safe for them. Unfortunately, it hasn't yet been approved for children; it's only available for adults ages 18-49.
  • "Micro-needle" - If you are afraid of needles and don't like the idea of the nasal spray (or can't get the nasal spray), you can opt for this version. It uses a smaller needle that goes into the skin instead of the muscle. It's only available for adults (ages 18 to 64).
  • High-dose - The flu tends to be particularly hard on the elderly.  The high-dose vaccine creates a stronger immune response. It has four times the amount of antigen (the part of the vaccine that triggers the body to make antibody) as regular flu shots. It's for people 65 and older. It is only available in the trivalent version.

Here's what's the same:

  • The flu vaccine is recommended for everyone ages 6 months and older. It's especially recommended for anyone with health problems, such as asthma, but everyone should get it. The only people who shouldn't, really, are those who have had an allergic reaction to it, those with severe egg allergies who can't get the new egg-free version, or those who have another medical reason not to get it (very rare).
  • The nasal spray, or LAIV, is an option for anyone ages 2 to 49 who is generally healthy, isn't pregnant and isn't in close regular contact with someone who has a severe problem with their immune system (someone receiving chemotherapy for cancer).
  • Children under the age of 9 who are getting it for the first time need to get two doses, at least a month apart.
  • Common side effects include pain at the injection site or a runny nose (the spray), as well as mild fever and aches and pains. These usually last for a day or two. 
  • You can't catch the flu from the flu shot. The virus in the shot is dead. And the nasal spray contains a very weak version of the virus. Neither can make you sick, unless you have a severe problem with your immune system.
  • Even if you or your child is generally healthy, you still need the flu shot. Not only can the flu make even healthy people very sick, it can affect the people around you. While you may weather the flu just fine, the people who may catch it from you (like babies or the elderly or kids with asthma at school) might not. This is a decision that isn't just about you. 

Most health insurers cover the cost of the flu vaccine as part of preventive care. But you may want to check with your insurance company before getting vaccinated. If you don't have insurance, or it doesn't cover vaccines, visit for other options.

If you have any questions about the flu vaccine, talk to your doctor or visit the CDC's flu web page. To find out where you can get a shot, check out the Health Map Vaccine Finder.

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Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.

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