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Influenza Vaccines: “Flu-Shot” or “Nasal Spray”- Do they differ?


The Influenza vaccine which is an annual vaccination that provides protection against various strains of influenza virus. The vaccine is available in two classes- the trivalent flu vaccine and the tetravalent flu vaccine. The vaccines can be administered either in the form of invasive technique by injecting into the sub dermal or intramuscular regions or it can be administered as a nasal spray. The former method is called “flu shot” while the later method is called “nasal spray” technique. The sub dermal injection is smaller than the intramuscular form and causes less pain as it is administered into the top layer of the skin. The nasal spray is directly sprayed into nostrils.

The “flu shot” usually contains the trivalent form and offers protections against three strains of influenza virus- influenza A virus (H3N2), influenza A virus (H1N1) and one strain of influenza B virus. On the other hand the “nasal spray” form contains the tetravalent form and offers protection to an additional strain of influenza B virus, in addition to the strains covered by the trivalent form. A comparison of both these forms of administration is discussed below:

Features Flu-Shot Nasal Spray
Class of Influenza Vaccine Usually the trivalent one Usually the tetravalent one
Nature of Influenza Vaccine inactivated or heat killed live attenuated
Dosage route Intramuscular or intradermal (flu vaccine injected into the muscles or beneath the skin) Intranasal (flu vaccine sprayed into the nose)
Frequency of administration Once a year Generally once, children who require two doses of the flu vaccine must be administered with a gap of minimum 28 days
Pain During administration Yes, as because it is a invasive technique No, as because it is a non-invasive technique
Magnitude Of Secondary Antibody Response Lower than the tetravalent form, as because heat killed antigens produces a less potent antigen-antibody response Higher than with trivalent form as because live attenuated antigens produces a more potent antigen-antibody response
Potency of administered vaccine Lower,  as because probability of coverage of all B strains are not possible Higher, as because probability of coverage of B strains are higher
Chance of incurring influenza or influenza like symptoms immediately after vaccination If trivalent form administered –no, If tetravalent form administered –yes If trivalent form administered –no, If tetravalent form administered –yes
General Safety Profile Higher than nasal spray Lower than flu-shot
Target Population vaccinated Individuals 6 months and older Individuals aged between 2 years and 50 years
Side effects Milder and lasts or a day or two. Common symptoms soreness in arms and to a lesser extent fever and pain Minor, however the side effects are more than flu-shot. In children the major side effects are running nose, headache, sore throat and cough while in adults the symptoms are wheezing, vomiting, fever and myalgia
Manufactured from Fertilized chicken eggs Fertilized chicken eggs
Safety Safe , may cause reactions like pain, redness and swelling at injection site Since live vaccine it is less safe than trivalent form
Population most susceptible to adverse reactions Young children having no previous exposure to influenza vaccine All individuals having no previous exposure to influenza vaccine
Contraindications Prior incidence of allergy to seasonal influenza vaccines(trivalent form)Should not be administered strictly to infant under age of 6 monthsSafe in pregnancy


Egg allergy


Safe in asthma

Prior incidence of allergy to seasonal influenza vaccines(tetravalent form)Should not be administered strictly to children under age of 2 years or adults over the age of 50 yearsPregnant woman and patients receiving aspirin or salicyclates

Egg allergy

Metabolic diseases and asthma


Administration to immune-compromised individuals and persons in contact No such restrictions People who are in contact with individuals having a weakened immune system for example in case of stem cell transplant, should not be given
Co-administration with other antiviral medications No, waiting period of 48 hours is a must No, waiting period of 48 hours is a must

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References :

[0]Jefferson., T, Di Pietrantonj, C; Al-Ansary, LA; Ferroni, E; Thorning, S; Thomas, RE (2010). "Vaccines for preventing influenza in the elderly". The Cochrane database of systematic reviews (2): CD004876

[1]Osterholm, MT; Kelley, NS; Sommer, A; Belongia, EA ( 2012). "Efficacy and effectiveness of influenza vaccines: a systematic review and meta- analysis.". The Lancet. Infectious diseases 12 (1): 36–44.


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