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FluMist vs. a Flu Shot

2011–2012 Flu Season


Updated May 20, 2014

Doctor giving injection to baby boy (2-5 months)
Science Photo Library - IAN HOOTON./Brand X Pictures/Getty Images

Most parents understand that a flu vaccine each year for their kids is a good idea to help them avoid the flu.

And in recent years, the recommended ages for getting a flu vaccine has greatly expanded, from just high-risk kids a few years ago, to:

  • all kids between the ages of 6 months and 2 years (2004)
  • all kids 6 months to age 5 (2006)
  • all kids 6 months to 18 years (2008)

Although it doesn't directly affect children, this year's flu shot recommendations again includes healthy nonpregnant adults between the ages of 18 and 49 years, so that flu shots continue to be recommended for all persons 6 months and older.

Most kids didn't appreciate the fact that getting a flu vaccine meant actually getting a flu shot each year, though.

Fortunately, there has been an alternative: the FluMist nasal spray flu vaccine.


If you could avoid a shot, why wouldn't you jump on the chance of getting Flumist?

For one thing, Flumist can't be given to everyone, including:

  • children younger than age 2
  • adults older than 50 years old
  • children with medical conditions, such as asthma or reactive airway disease, diabetes, chronic heart disease, chronic lung disease or a weakened immune system
  • children younger than age 5 who have had problems with recurrent wheezing
  • children who are taking aspirin
  • teens who are pregnant

So, basically, that means it should mostly be given to healthy children, which leaves out most high-risk children who need a flu vaccine.

And like the flu shot, FluMist shouldn't be given to children who are allergic to eggs.

FluMist vs. Flu Shots

There are also some differences between FluMist and flu shots that may influence a parent's decision between the two, such as:

  • Price - in general, FluMist is a little more expensive than a flu shot, although most insurance companies have started to pay for FluMist, so your cost may not be any different.
  • Live vs. Killed Viruses - a big difference between FluMist and the flu shot is that FluMist is made with live influenza viruses. They are weakened and won't actually give your child the flu, though.
  • Nasal Congestion - since FluMist is given as a nose spray, some experts think that it may not be as effective if your child is very congested, such as if he has allergies or a cold.
  • Thimerosal - FluMist does not contain preservative thimerosal. Although a preservative-free flu shot is available, it is not as widely available as the regular flu shot with thimerosal, so your pediatrician may not have it.

Is FluMist as good as a flu shot, though? Sure it is great to save your child the pain from a flu shot, even if FluMist is a little bit more expensive, knowing it is as good or better than a flu shot, would likely make the decision between the two easier for parents.

Although many experts initially thought Flumist would be effective, several studies have already shown that FluMist may actually work better than a flu shot. One that compared the two concluded that "live attenuated influenza vaccine was a safe and more effective alternative to inactivated vaccine."

Research also shows that it may offer longer and better protection against mismatched strains, such as when the flu vaccine doesn't exactly cover the flu virus strains that are going around that year.

Getting FluMist

If FluMIst is as safe and effective, or perhaps more effective than a flu shot, then why don't all healthy children get FluMist?

Although the price of FluMist is getting more competitive, the extra cost is still a big issue for many parents. Since there is no official recommendation that states a preference for FluMist and says it is better, is the extra cost worth your child not getting a shot? And what if your insurance doesn't cover it? To make sure yours does, it can be a good idea to call and ask your insurance company before you go to your pediatrician for your flu vaccine.

The other main issue is that FluMist is still relatively new, being approved in 2003. In addition to the many clinical trials that have shown FluMist to be safe and effective, however, parents should now be reassured by the millions of doses that have safely been given over the past five years.

FluMist isn't for every child, but it is a good option to consider in getting your child vaccinated against the flu if he is older than age 2 and doesn't have any health problems.


CDC. Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR. August 26, 2011 / 60(33);1128-1132

A randomized, double-blind study of the safety, transmissibility and phenotypic and genotypic stability of cold-adapted influenza virus vaccine. Vesikari T - Pediatr Infect Dis J - 01-JUL-2006; 25(7): 590-5

Intranasal influenza vaccine may be a safe, effective option for many children. Lin K - J Pediatr - 01-JUL-2007; 151(1): 102-3

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