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What's the Deal with FluMist, the Flu Vaccine Nasal Spray?

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Photo: Tim Sloan / Staff / Getty Images

Flu season is just around the corner, which means—you guessed it—it's time to get your flu shot. If you're not a fan of needles, there's good news: FluMist, the flu vaccine nasal spray, is back this year.

Wait, there's a flu vaccine spray?

Chances are, when you think of flu season, you think of two options: Either get your flu shot, an injection of a "dead" strain of the flu that helps your body build immunity to the virus, or you suffer the consequences when your coworker sniffles all over your office. (And, in case you were wondering: Yes, you can get the flu twice in one season.)

The flu shot is traditionally the recommended way to go, but it's actually not the only way to protect yourself from the flu—there's also a needle-free version of the vaccine, which is administered just like an allergy or sinus nasal spray.

There's a reason you may not have heard of FluMist: "For the past several years, the nasal flu spray was thought to be not as effective as the traditional flu shot," says Papatya Tankut, R.Ph., vice president of pharmacy affairs at CVS Health. (And it's thought to be especially less effective for people under 17, according to the Centers for Disease Control and Prevention.) So, while the flu vaccine spray has been available for years, the CDC hasn't recommended getting it for the past two flu seasons.

This flu season, however, the spray is back. Thanks to an update in the formula, the CDC has officially given the flu vaccine spray the stamp of approval for the 2018–2019 flu season. (Here's everything you need to know about the flu guidelines for this year, BTW.)

How does FluMist work?

Getting your flu vaccine via spray rather than shot actually means getting a totally different type of medicine (it's not like a doctor could just squirt the regular vaccine up your nose).

"The nasal spray is a live attenuated influenza vaccine, meaning that the virus is still 'alive,' but significantly weakened," says Darria Long Gillespie, M.D., an ER physician and author of Mom Hacks. "Contrast that to the shot, which is either the killed virus or a form that was manufactured in cells (and therefore never 'alive')," she explains.

That's an important difference for some patients, says Dr. Gillespie. Since you're technically getting a microdose of "live" flu virus in the spray, doctors don't recommend it for children under 2 years old, adults over 50 years old, people with weakened immune systems, and women who are pregnant. "Live virus exposure in any form could potentially affect the fetus," says Dr. Gillespie, so pregnant women are advised to get the regular shot.

Don't worry, though. The live flu in the spray won't make you sick. You may experience some mild side effects (such as a runny nose, wheezing, headache, sore throat, cough, etc.), but the CDC stresses that these are short-lived and aren't tied to any of the severe symptoms often associated with the actual flu.

If you're already sick with something mild (such as diarrhea or mild upper respiratory tract infection with or without fever), it's okay to get vaccinated. However, if you have nasal congestion, it might prevent the vaccine from effectively reaching your nasal lining, according to the CDC. Consider waiting until you've kicked your cold, or go for the flu shot instead. (And if you're moderately or severely ill, you should definitely wait or contact your doc before getting vaccinated.)

Is the flu vaccine spray as effective as the shot?

Even though the CDC says FluMist is okay this year, some health experts are still cautious "given the comparative superiority of the shot over the mist in the past few years," says Dr. Gillespie. The American Academy of Pediatrics, for example, is telling parents to stick with the flu shot over the spray this year, and CVS won't even be offering it as an option this season, says Tankut.

So, what should you do? Chances are, both CDC-approved methods of flu vaccine will help you stay healthy this flu season. But if you don't want to take any chances, stick with the shot. If you're unsure which flu vaccine you should get, talk to your doctor. (Either way, you should definitely get vaccinated. It's never too late or too early to get your flu shot.)

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