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Truths about the top 5 excuses for not getting a flu shot

The first cases of seasonal influenza have been reported. We are expecting a severe flu season nationally this year. To put it in perspective, the Centers for Disease Control and Prevention is reporting early increases in influenza activity this year, higher than what we have seen in the last two seasons.

The best available way to protect yourself and your loved ones is the flu vaccine. Vaccine can reduce illness severity, and/or the number of flu illnesses, trips to the doctor, missed days at school and work and flu-related deaths in children. A 2022 study showed that flu vaccination reduced children’s risk of severe life-threatening influenza by 75%.

People with excuses why they don’t “want” or “need” flu vaccine should reconsider.

Excuse #1 - “I don’t get the flu.”

In the average season, influenza disease affects 5–15 percent of adults and 20–30 percent of children both globally and in the United States. Attack rates are higher in seasons with antigenic shift (possible this year) or a pandemic strain, but lower in seasons when influenza strains change little from prior seasons. Based on changes in 2021-22 vaccine strains, there will likely be changes in circulating strains, so we expect higher than average attack rates, particularly for the H3N2 virus. The Southern Hemisphere (including countries like Australia) have also seen a worse influenza season during their winter months, which makes us believe our season would be worse as well.

Excuse #2 “The influenza vaccine doesn’t work.”

The influenza vaccine effectiveness varies from year-to-year and is anywhere between 30-80 percent depending on factors such as season (do circulating strains match vaccine strains), age (youngest and oldest are less-well protected) and which subtype predominates (H3N2 worse in older adults and H1N1 worse in children). While the flu shot may not be as effective as other vaccines, if the entire eligible U.S. population (estimated 300 million) was flu immunized, there could be 100 million fewer influenza illnesses even in a suboptimal vaccine effectiveness year. We know the flu vaccine does decrease the odds of needing intensive care or hospitalization, even for individuals who are less protected.

Excuse #3 “The flu shot makes me sick.”

Injectable inactivated influenza vaccines (the shots) cannot cause influenza infection. “Inactivated” means there is no living virus in the vaccine. Most patients readily tolerate the usual mild local pain, swelling and redness at injections sites. The systemic effects (mild headache, achiness or fatigue) are interpreted as “getting the flu,” but these symptoms are similar to those that the day after a hard workout and represent the hard work our immune systems do to produce protection.

Of note the intranasal flu vaccine drops are acceptable this year and do have a weakened live virus in it. Side effects are mostly a mild runny nose and perhaps low-grade fever. For those with needle phobia – this could be an option. One caveat – while it is at least as effective as the shot against H3N2 and B strains, we are not sure how protective it is against the H1N1 flu.

Excuse #4 “I already had the flu earlier this year.”

People who say they already had the flu, or as many put it “stomach flu,” haven’t had influenza. True influenza starts off with heavy duty muscle pain, sore throat, headache, eye pain, fatigue and cough that may last for two weeks. It is also possible to have influenza again since there are different strains that circulate in any given season. Most current vaccines protect us against four of the most common strains we are expecting this season.

And that’s simple influenza. Each year, 100-150 children die from the flu due to complications. Children, the elderly and pregnant women are at higher risk for complications, but anyone can have an influenza complication. Influenza vaccine is the best way to avoid influenza-related complications.

Excuse #5 “I have an egg allergy.”

The American Academy of Pediatrics’ policy states that physicians can administer egg-based influenza vaccine to children and teenagers with egg allergies without special precautions beyond those that apply to other vaccines. In addition, there are “cell-based” vaccines that are made in test tubes and not from eggs, approved for anyone over the age of 6 months with a history of severe egg allergy.

Flu activity in our region has already started and is expected to peak between November and March, so it’s not too late to receive your vaccination. You’ll want to get it sooner rather than later now that we are nearing the holidays and influenza is expected to peak earlier this year. It takes two weeks for the vaccine to build up immunity in an adult and it may take two doses at least one month apart to protect children under 9 years old if they have not had two prior doses in their lifetime.

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Infectious Diseases