FAQ for Healthcare Providers about Flu

When is it appropriate to start administering seasonal influenza vaccine?

  • The Centers for Disease Control recommends that healthcare providers start administering seasonal influenza vaccine as soon as it is available.
  • It takes 2 to 4 weeks for a person’s body to mount a full immune response to the vaccine

How long does immunity from the influenza vaccine last?

  • It is thought to persist for one year or less because of waning antibody titers and because of changes in the circulating influenza virus from year to year
  • There is no evidence for late-season outbreaks among vaccinated persons that can be attributed to waning immunity

Can you get the flu from the flu shot?

  • No, the flu shot and mist do NOT cause the flu
  • Less than 1% of patients who are vaccinated will develop flu-like symptoms
  • The influenza vaccine is not 100% effective, especially in older patients
  • The seasonal influenza vaccine only protects against the 3 types of flu that are predicted to circulate for that year.
  • This year’s vaccine contains:
  • H1N1
  • H3N2
  • Type B (from the B / Yamagata lineage)

Can multiple vaccines be given at the same time as the flu shot?

  • Yes, there are no restriction on how many immunizations can be given on the same day
  • Zoster, flu, pneumonia, and Tdap can all be given on the same day just separate the injection sites by one inch
  • The only vaccines providers need to space out by 4 weeks are live vaccines (i.e. zoster, MMR, yellow fever, etc)
  • Can be given the same day (within 24 hours) or spaced out by 4 weeks

The package insert (PI) for Zostavax© advises providers to not give the pneumonia vaccine and shingles vaccine at the same time and to space them out by 4 weeks?

  • The PI for Zostavax© does in fact state the above, but the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control recommend that they be given on the same day
  • Reasoning behind this is that the study quoted in the PI found a decrease in antibody titers to shingles, however this does not necessarily correlate with a decrease in efficacy
  • Efficacy for the shingles vaccine was established by showing a decrease incidence in shingles, not measured antibody titers
  • Also, how many patients are going to remember in 4 weeks to come back to the pharmacy and get another vaccination?

Are healthcare providers required to give the patient a Vaccine Information Statement (VIS)?

  • Since January 1, 2006 the VIS is required to be given to the patient or guardian per the National Vaccine Injury Compensation Program.
  • Current copies of all VIS’s in multiple languages can be found online at
  • Also, the date of the VIS version must be printed on the consent form

What is the recommended interval for receiving influenza vaccine after an allergy injection?

  • Vaccines can be administered at any time before or after administration of an “allergy injection”

Can a patient who received blood products or IVIG get the flu vaccine?

  • Yes, but only receive inactivated influenza vaccine

Can pregnant women receive a flu shot at the pharmacy?

  • Yes as long as they are not excluded in your protocol (ie must explicitly state in your protocol that you cannot administer vaccinations to a pregnant patient)
  • Pregnant women are at increased risk for influenza-related complications as well as postpartum women
  • Vaccination can be given in any trimester

Is the influenza vaccine safe to administer to patients with multiple sclerosis (MS)?

  • MS is NOT a contraindication for any vaccine including influenza and pneumococcal
  • These patients should only receive inactivated influenza vaccine

Contraindications to the influenza vaccine

  • Patients who have experienced a severe allergic reaction to a previous dose of influenza vaccine or vaccine component
  • History of Guillain-Barre syndrome occurring within 6 weeks of previous influenza vaccination
  • Should be differed in patients who have moderate or severe acute illness until it improves
  • This does not include patients will a cold or low-grade fever
  • Do not differ immunization if patient is on antibiotics

What is the best way to screen patients for potential egg allergy in a busy pharmacy?

  • People who can eat eggs without reaction are unlikely to have an egg allergy
  • Ability to eat eggs in baked products may be misinterpreted as egg tolerance

What length needle should be used to administer the influenza vaccine?

  • Generally, intramuscular injections should be administered with a 1” needle in adults
  • Some experts feel that a shorter needle can be used in adults less than 132 lbs only if given over the deltoid and only if the skin is stretched tight and given at a 90 degree angle

What immunizations must be reported to the state immunization registry?

  • At this time, only immunizations given to patients 21 years of age and younger are required to be reported to the registry
  • It is recommended to report all immunizations to all ages to the registry
  • Send requests for access to the registry to

What influenza vaccine is safe for children?

Has ACIP recommended the use of high-dose and intradermal influenza vaccines?

  • High dose
  • only approved for patients 65 years of age and older
  • This vaccine is as least as good as the regular flu shot
  • Elicits a higher antibody response, but there are no studies to show this means more protection
  • Intradermal
  • Only approved for patients 18 to 64 years old
  • Uses a micro-injector given over the deltoid muscle

Once a dose has been drawn out of a vial of vaccine, does the remaining vaccine need to be discarded before the expiration date?

  • No, as long as the remaining vaccine in the vial is stored at the appropriate temperature, it is good until the expiration date

Is it okay to draw up vaccine into syringes at the beginning of the day or before a large clinic?

  • CDC discourages this practice
  • Increased possibility of administration and dosing errors
  • Risk of inappropriate storage
  • Probability of bacterial contamination
  • Reduction of vaccine potency overtime because of its interaction with the plastic syringe components
  • Although this practice is discouraged, a limited amount may be pre-drawn prior to a mass-immunization clinic if:
  • Only a single type of vaccine is administered
  • It is drawn up upon arrival to the clinic setting
  • Pre-drawn syringes are stored at temperature appropriate for vaccine
  • No more than 1 vial or 10 doses drawn into syringes
  • At the end of the clinic, all unused, pre-drawn doses are discarded

Adapted from on August 29, 2012. We thank the Immunization Action Coalition