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{{Short description|Vaccine against influenza}}
{{redirect|Flu shot|the TV episode|Flu Shot (30 Rock)}}
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'''Influenza vaccines''', colloquially known as '''flu shots'''<ref>{{cite web |title=Key Facts About Seasonal Flu Vaccine |url=https://www.cdc.gov/flu/vaccines/keyfacts.html |website=Influenza (Flu) |language=en-us |date=30 September 2024}}</ref> or the '''flu jab''',<ref>{{cite web |title=The flu jab in pregnancy |url=https://www.nhs.uk/pregnancy/keeping-well/flu-jab/ |website=nhs.uk |language=en |date=3 December 2020}}</ref> are [[vaccine]]s that protect against infection by [[influenza viruses]].<ref name=WHO2012>{{cite journal |author=World Health Organization | author-link = World Health Organization | title = Vaccines against influenza WHO position paper | journal = Weekly Epidemiological Record | volume = 87 | issue = 47 | pages = 461–76 | date = November 2012 | pmid = 23210147 | hdl=10665/241993 | hdl-access=free }}</ref><ref name=WHO2022>{{cite journal |author=World Health Organization | author-link = World Health Organization | title = Vaccines against influenza: WHO position paper – May 2022 | journal = Weekly Epidemiological Record | volume = 97 | issue = 19 | pages = 185–208 | date = May 2022 | hdl=10665/354265 | hdl-access=free }}</ref> New versions of the vaccines are developed twice a year, as the influenza virus rapidly changes.<ref name=WHO2012/> While their effectiveness varies from year to year, most provide modest to high protection against [[influenza]].<ref name=WHO2012/><ref name=Man2012>{{cite journal | vauthors = Manzoli L, Ioannidis JP, Flacco ME, De Vito C, Villari P | title = Effectiveness and harms of seasonal and pandemic influenza vaccines in children, adults and elderly: a critical review and re-analysis of 15 meta-analyses | journal = Human Vaccines & Immunotherapeutics | volume = 8 | issue = 7 | pages = 851–62 | date = July 2012 | pmid = 22777099 | pmc = 3495721 | doi = 10.4161/hv.19917 | author-link2 = John P.A. Ioannidis }}</ref> Vaccination against influenza began in the 1930s, with large-scale availability in the United States beginning in 1945.<ref>{{cite book |url=https://books.google.com/books?id=uOE-3atWZssC&pg=PA49 |title=Vaccines for pandemic influenza |vauthors=Compans RW |date=2009 |publisher=Springer |isbn=978-3-540-92165-3 |location=Dordrecht |page=49 |access-date=September 9, 2017 |archive-url=https://web.archive.org/web/20200803101300/https://books.google.com/books?id=uOE-3atWZssC&pg=PA49 |archive-date=August 3, 2020 |url-status=live}}</ref><ref>{{cite book |url=https://books.google.com/books?id=vJKeBQAAQBAJ&pg=PA61 |title=Vaccine Analysis: Strategies, Principles, and Control |date=2014 |publisher=Springer |isbn=978-3-662-45024-6 |page=61 |access-date=September 9, 2017 |archive-url=https://web.archive.org/web/20200803141329/https://books.google.com/books?id=vJKeBQAAQBAJ&pg=PA61 |archive-date=August 3, 2020 |url-status=live}}</ref>
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===Origins and development===
During the worldwide [[Spanish flu]] pandemic of 1918, "Pharmacists tried everything they knew, everything they had ever heard of, from the ancient art of [[bleeding]] patients, to [[oxygenotherapy|administering oxygen]], to developing new vaccines and serums (chiefly against what we
In 1931, viral growth in embryonated hens' eggs was reported by [[Ernest William Goodpasture]] and colleagues at [[Vanderbilt University]]. The work was extended to growth of influenza virus by several workers, including [[Thomas Francis, Jr.|Thomas Francis]], [[Jonas Salk]], Wilson Smith, and [[Macfarlane Burnet]], leading to the first experimental influenza vaccines.<ref>Plotkin, S.L. and Plotkin, S.A. "A short history of vaccination". In: ''Vaccines'', Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit, eds. Elsevier Health Sciences, 2008, pp. 6–7.</ref> In the 1940s, the US military developed the first approved inactivated vaccines for influenza, which were used during [[World War II]].<ref>Artenstein, A. W. "Influenza" In: ''Vaccines: A Biography'', Andrew W. Artenstein, ed. pp. 191–205.</ref> Hens' eggs continued to be used to produce virus used in influenza vaccines, but manufacturers made improvements in the purity of the virus by developing improved processes to remove egg proteins and to reduce systemic reactivity of the vaccine.<ref>{{cite journal | vauthors = Hampson AW | title = Vaccines for pandemic influenza. The history of our current vaccines, their limitations and the requirements to deal with a pandemic threat | journal = Annals of the Academy of Medicine, Singapore | volume = 37 | issue = 6 | pages = 510–17 | date = June 2008 | doi = 10.47102/annals-acadmedsg.V37N6p510 | pmid = 18618064 | s2cid = 17102174 | doi-access = free }}</ref> In 2012, the US [[Food and Drug Administration]] (FDA) approved influenza vaccines made by growing virus in [[cell culture]]s<ref>{{cite journal |vauthors=Milián E, Kamen AA |title=Current and emerging cell culture manufacturing technologies for influenza vaccines |journal=Biomed Res Int |volume=2015 |page=504831 |date=2015 |pmid=25815321 |pmc=4359798 |doi=10.1155/2015/504831 | doi-access = free | title-link = doi }}</ref><ref name="FDA Flucelvax PR" /><ref>{{cite web | url=https://www.cdc.gov/flu/prevent/cell-based.htm | title=Cell-Based Flu Vaccines | publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=October 11, 2019 | archive-url=https://web.archive.org/web/20191202213512/https://www.cdc.gov/flu/prevent/cell-based.htm | archive-date=December 2, 2019 | url-status=live | access-date=December 2, 2019}} {{PD-notice}}</ref> and influenza vaccines made from [[recombinant protein]]s<ref name="FDA Flublok PR">{{cite press release | url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm335891.htm | title=FDA approves new seasonal influenza vaccine made using novel technology | date = January 16, 2013 | archive-url=https://web.archive.org/web/20130518014553/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm335891.htm | archive-date=May 18, 2013 | publisher=U.S. [[Food and Drug Administration]] (FDA)}} {{PD-notice}}</ref> have been approved, with [[Pharming (genetics)|plant-based]] influenza vaccines being tested{{when|date=October 2019}} in clinical trials.<ref>{{cite journal | vauthors = Landry N, Ward BJ, Trépanier S, Montomoli E, Dargis M, Lapini G, Vézina LP | title = Preclinical and clinical development of plant-made virus-like particle vaccine against avian H5N1 influenza | journal = PLOS ONE | volume = 5 | issue = 12 | page = e15559 | date = December 2010 | pmid = 21203523 | pmc = 3008737 | doi = 10.1371/journal.pone.0015559 | bibcode = 2010PLoSO...515559L | doi-access = free | title-link = doi }}</ref>
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In February 2020, the FDA approved Fluad Quadrivalent for use in the United States.<ref name="Fluad Quadrivalent" /><ref>{{cite press release | title=Seqirus Receives FDA Approval for Fluad Quadrivalent for Adults 65 Years and Older | website=Seqirus | date=February 24, 2020 | url=https://www.seqirus.us/news/seqirus-receives-fda-approval-for-fluad-quadrivalent-for-adults-65-years-and-older | access-date=August 25, 2020 | archive-date=August 26, 2020 | archive-url=https://web.archive.org/web/20200826060136/https://www.seqirus.us/news/seqirus-receives-fda-approval-for-fluad-quadrivalent-for-adults-65-years-and-older | url-status=live }}</ref> In July 2020, the FDA approved both Fluad and Fluad Quadrivalent for use in the United States for the 2020–2021 influenza season.<ref name="Fluad Quadrivalent" /><ref>{{cite press release | title=Seqirus Begins Shipping 2020/21 Influenza Vaccines to U.S. Market | website=Seqirus | date=July 30, 2020 | url=https://www.seqirus.us/news/seqirus-ships-2020-2021-influenza-vaccines-to-us-market | access-date=August 25, 2020 | archive-date=August 26, 2020 | archive-url=https://web.archive.org/web/20200826060135/https://www.seqirus.us/news/seqirus-ships-2020-2021-influenza-vaccines-to-us-market | url-status=live }}</ref>
The B/Yamagata lineage of [[influenza B]], one of the four lineages targeted by quadrivalent vaccines, might have become extinct in 2020/2021 due to [[COVID-19 pandemic]] measures,<ref name="Koutsakos2021">{{cite journal | vauthors = Koutsakos M, Wheatley AK, Laurie K, Kent SJ, Rockman S | title = Influenza lineage extinction during the COVID-19 pandemic? | journal = Nature Reviews. Microbiology | volume = 19 | issue = 12 | pages = 741–742 | date = December 2021 | pmid = 34584246 | pmc = 8477979 | doi = 10.1038/s41579-021-00642-4 }}</ref> and there have been no naturally occurring cases confirmed since March 2020.<ref name="WHOflu2023"/><ref name="UMN2023"/> In 2023, the [[World Health Organization]] concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine, so future vaccines are recommended to be trivalent instead of quadrivalent.<ref name="WHOflu2023">{{cite web | title=Questions and Answers: Recommended composition of influenza virus vaccines for use in the southern hemisphere 2024 influenza season and development of candidate vaccine viruses for pandemic preparedness | author=[[World Health Organization]] | url=https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5 | date=September 29, 2023 | access-date=October 26, 2023 | archive-date=October 10, 2023 | archive-url=https://web.archive.org/web/20231010045859/https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5 | url-status=live }}</ref><ref name="UMN2023">{{cite web | title=WHO advisers recommend switch back to trivalent flu vaccines |
==Medical uses==
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|caption=US vaccine effectiveness (%) against [[symptomatic]] disease.<ref name="cdc-flu-effectiveness">{{cite web | title=Past Seasons Vaccine Effectiveness Estimates | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=January 29, 2020 | url=https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html | archive-url=https://web.archive.org/web/20200212115345/https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html | archive-date=February 12, 2020 | url-status=live | access-date=March 4, 2019}} {{PD-notice}}</ref><ref>{{Cite journal |publisher=Centers for Disease Control and Prevention |date=August 13, 2004 |title=Assessment of the effectiveness of the 2003-04 influenza vaccine among children and adults--Colorado, 2003 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a1.htm |journal=MMWR. Morbidity and Mortality Weekly Report |volume=53 |issue=31 |pages=707–710 |issn=1545-861X |pmid=15306754 |author1=Centers for Disease Control Prevention (CDC) |access-date=April 27, 2022 |archive-date=April 27, 2022 |archive-url=https://web.archive.org/web/20220427184713/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a1.htm |url-status=live }} At table.</ref><ref>{{Cite journal |publisher=Centers for Disease Control and Prevention |date=January 16, 2004 |title=Preliminary assessment of the effectiveness of the 2003-04 inactivated influenza vaccine--Colorado, December 2003 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301a3.htm |journal=MMWR. Morbidity and Mortality Weekly Report |volume=53 |issue=1 |pages=8–11 |issn=1545-861X |pmid=14724559 |author1=Centers for Disease Control Prevention (CDC) |access-date=April 25, 2022 |archive-date=May 29, 2022 |archive-url=https://web.archive.org/web/20220529044407/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301a3.htm |url-status=live }}</ref><ref>{{cite web |title=Past Weekly Surveillance Reports |url=https://www.cdc.gov/flu/weekly/pastreports.htm |website=Centers for Disease Control and Prevention |date=April 29, 2022 |access-date=April 25, 2022 |archive-date=April 22, 2022 |archive-url=https://web.archive.org/web/20220422191530/https://www.cdc.gov/flu/weekly/pastreports.htm |url-status=live }}</ref><ref>{{Cite journal |vauthors=Chung JR |date=March 11, 2022 |title=Interim Estimates of 2021–22 Seasonal Influenza Vaccine Effectiveness — United States, February 2022 |url=https://www.cdc.gov/mmwr/volumes/71/wr/mm7110a1.htm |journal=MMWR. Morbidity and Mortality Weekly Report |volume=71 |issue=10 |pages=365–370 |doi=10.15585/mmwr.mm7110a1 |pmid=35271561 |pmc=8911998 |issn=0149-2195 |access-date=May 25, 2022 |archive-date=May 16, 2022 |archive-url=https://web.archive.org/web/20220516045141/https://www.cdc.gov/mmwr/volumes/71/wr/mm7110a1.htm |url-status=live }}</ref> Notes: inestimable for the 2020–2021 flu season,<ref name="unable to estimate">{{cite web|url=https://www.healio.com/news/infectious-disease/20210603/cdc-unable-to-estimate-flu-vaccine-effectiveness-after-historically-mild-season|title=CDC unable to estimate flu vaccine effectiveness after historically mild season|
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The effectiveness of seasonal flu vaccines varies significantly, with an estimated average efficacy of 50–60% against [[symptomatic]] disease,<ref name=sautto >{{cite journal |vauthors=Sautto GA, Kirchenbaum GA, Ross TM |date=January 19, 2018 |title=Towards a universal influenza vaccine: different approaches for one goal |journal=Virology Journal |volume=15 |issue=1 |pages=17 |doi=10.1186/s12985-017-0918-y |pmc=5785881 |pmid=29370862 |doi-access=free }}</ref> depending on vaccine strain, age, prior immunity, and immune function, so vaccinated people can still contract influenza.<ref name=chow >{{cite journal |vauthors=Chow EJ, Doyle JD, Uyeki TM |date=June 12, 2019 |title=Influenza virus-related critical illness: prevention, diagnosis, treatment |journal=Critical Care |volume=23 |issue=1 |pages=214 |doi=10.1186/s13054-019-2491-9 |pmc=6563376 |pmid=31189475 |doi-access=free }}</ref> The effectiveness of flu vaccines is considered to be suboptimal, particularly among the elderly,<ref name=krammer >{{cite journal |vauthors=Krammer F, Smith GJ, Fouchier RA, Peiris M, Kedzierska K, Doherty PC, Palese P, Shaw ML, Treanor J, Webster RG, García-Sastre A |date=June 28, 2018 |title=Influenza |journal=Nature Reviews Disease Primers |volume=4 |issue=1 |pages=3 |doi=10.1038/s41572-018-0002-y |pmc=7097467 |pmid=29955068}}</ref> but vaccination is still beneficial in reducing the mortality rate and hospitalization rate due to influenza as well as duration of hospitalization.<ref name=chow /><ref name=dabestani >{{cite journal |vauthors=Dabestani NM, Leidner AJ, Seiber EE, Kim H, Graitcer SB, Foppa IM, Bridges CB |date=September 2019 |title=A review of the cost-effectiveness of adult influenza vaccination and other preventive services |journal=Preventive Medicine |volume=126 |pages=105734 |doi=10.1016/j.ypmed.2019.05.022 |pmc=6778688 |pmid=31152830}}</ref> Vaccination of school-age children has shown to provide [[Herd immunity|indirect protection]] for other age groups. LAIVs are recommended for children based on superior efficacy, especially for children under 6, and greater immunity against non-vaccine strains when compared to inactivated vaccines.<ref name=ghebrehewet >{{cite journal |vauthors=Ghebrehewet S, MacPherson P, Ho A |date=December 7, 2016 |title=Influenza |journal=The BMJ |volume=355 |pages=i6258 |doi=10.1136/bmj.i6258 |pmc=5141587 |pmid=27927672}}</ref><ref name=principi >{{cite journal |vauthors=Principi N, Esposito S |date=March 4, 2018 |title=Protection of children against influenza: Emerging problems |journal=Human Vaccines & Immunotherapeutics |volume=14 |issue=3 |pages=750–757 |doi=10.1080/21645515.2017.1279772 |pmc=5861800 |pmid=28129049}}</ref>
From 2012 to 2015 in New Zealand, vaccine effectiveness against admission to an [[intensive care unit]] was 82%.<ref>{{Cite journal |vauthors=Thompson MG, Pierse N, Huang QS, Prasad N, Duque J, Newbern EC, Baker MG, Turner N, McArthur C
Repeated annual influenza vaccination generally offers consistent year-on-year protection against influenza.<ref name="CDC Effectiveness" /> There is, however, suggestive evidence that repeated vaccinations may cause a reduction in vaccine effectiveness for certain influenza subtypes; this has no relevance to recommendations for yearly vaccinations but might influence future vaccination policy.<ref name="pmid30626399">{{cite journal |vauthors=Ramsay LC, Buchan SA, Stirling RG, Cowling BJ, Feng S, Kwong JC, Warshawsky BF
There is not enough evidence to establish significant differences in the effectiveness of different influenza [[Vaccine#Types|vaccine types]],<ref>{{Cite journal |vauthors=Gemmill I, Young K |date=June 7, 2018 |title=Summary of the NACI literature review on the comparative effectiveness of subunit and split virus inactivated influenza vaccines in older adults |url=https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-6-june-7-2018/article-2-summary-subunit-split-virus-influenza-vaccine.html |journal=Canada Communicable Disease Report |volume=44 |issue=6 |pages=129–133 |doi=10.14745/ccdr.v44i06a02 |issn=1481-8531 |pmc=6449119 |pmid=31015805 |access-date=June 2, 2020 |archive-date=May 17, 2020 |archive-url=https://web.archive.org/web/20200517233323/https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-6-june-7-2018/article-2-summary-subunit-split-virus-influenza-vaccine.html |url-status=live }}</ref> but there are high-dose or [[Immunologic adjuvant|adjuvanted]] products that induce a stronger immune response in the elderly.<ref>{{Cite web |date=August 26, 2021 |title=Flu & People 65 Years and Older |url=https://www.cdc.gov/flu/highrisk/65over.htm |access-date=April 21, 2022 |website=Centers for Disease Control and Prevention |archive-date=April 22, 2022 |archive-url=https://web.archive.org/web/20220422000747/https://www.cdc.gov/flu/highrisk/65over.htm |url-status=live }}</ref>
According to a 2016 study by faculty at the University of New South Wales, getting a flu shot was as effective or better at preventing a heart attack than even quitting smoking.<ref>{{cite journal | vauthors = MacIntyre CR, Mahimbo A, Moa AM, Barnes M | title = Influenza vaccine as a coronary intervention for prevention of myocardial infarction | journal = Heart | volume = 102 | issue = 24 | pages = 1953–1956 | date = December 2016 | pmid = 27686519 | doi = 10.1136/heartjnl-2016-309983 | pmc = 5256393 }}</ref>
A 2024 CDC study found that the 2024 flu vaccine reduced the risk of hospitalization from the flu by 35% in the Southern Hemisphere.<ref>{{Cite journal | vauthors = Zeno EE |date=2024 |title=Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalization — REVELAC-i Network, Five South American Countries, March–July 2024 |url=https://www.cdc.gov/mmwr/volumes/73/wr/mm7339a1.htm?s_cid=mm7339a1_w |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=73 |issue=39 |pages=861–868 |doi=10.15585/mmwr.mm7339a1 |pmid=39361525 |issn=0149-2195|pmc=11449270 }}</ref> The research, conducted across five countries—Argentina, Brazil, Chile, Paraguay, and Uruguay—showed the vaccine was less effective than the one used in the previous season.<ref>{{Cite web | vauthors = Benadjaoud Y |title=Flu vaccine lowered risk of hospitalization in Southern Hemisphere by 35%: CDC |url=https://abcnews.go.com/Health/flu-vaccine-lowered-risk-hospitalization-southern-hemisphere-35/story?id=114470697 |access-date=2024-10-04 |website=ABC News |language=en}}</ref>
===Children===
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The group most vulnerable to non-pandemic flu, the elderly, benefits least from the vaccine. There are multiple reasons behind this steep decline in vaccine efficacy, the most common of which are the declining immunological function and frailty associated with advanced age.<ref>{{cite journal | vauthors = Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA | title = Mortality benefits of influenza vaccination in elderly people: an ongoing controversy | journal = The Lancet. Infectious Diseases | volume = 7 | issue = 10 | pages = 658–66 | date = October 2007 | pmid = 17897608 | doi = 10.1016/S1473-3099(07)70236-0 }}</ref> In a non-pandemic year, a person in the United States aged 50–64 is nearly ten times more likely to die an influenza-associated death than a younger person, and a person over 65 is more than ten times more likely to die an influenza-associated death than the 50–64 age group.<ref>{{cite journal | vauthors = Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K | title = Mortality associated with influenza and respiratory syncytial virus in the United States | journal = JAMA | volume = 289 | issue = 2 | pages = 179–86 | date = January 2003 | pmid = 12517228 | doi = 10.1001/jama.289.2.179 | s2cid = 5018362 | doi-access = free }}</ref>
There is a high-dose flu vaccine specifically formulated to provide a stronger immune response.<ref>{{cite web |url=http://www.sciencebasedmedicine.org/index.php/high-dose-flu-vaccine-for-the-elderly/ |title=High Dose Flu Vaccine for the Elderly « Science-Based Medicine |date=October 19, 2010 |publisher=Sciencebasedmedicine.org |access-date=October 17, 2013 |url-status=live |archive-url=https://web.archive.org/web/20130508081643/http://www.sciencebasedmedicine.org/index.php/high-dose-flu-vaccine-for-the-elderly/ |archive-date=May 8, 2013 }}</ref> Available evidence indicates that vaccinating the elderly with the high-dose vaccine leads to a stronger immune response against influenza than the regular-dose vaccine.<ref>{{cite web |url=https://www.cdc.gov/flu/prevent/qa_fluzone.htm |title=Fluzone High-Dose Seasonal Influenza Vaccine |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=September 6, 2019 |archive-url=https://web.archive.org/web/20191202211420/https://www.cdc.gov/flu/prevent/qa_fluzone.htm | archive-date=December 2, 2019 | url-status=live | access-date=December 2, 2019}}</ref><ref>{{cite journal | vauthors = DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, Pollak R, Christoff J, Earl J, Landolfi V, Martin E, Gurunathan S, Nathan R, Greenberg DP, Tornieporth NG, Decker MD, Talbot HK
A flu vaccine containing an [[adjuvant]] was approved by the US [[Food and Drug Administration]] (FDA) in November 2015, for use by adults aged 65 years of age and older. The vaccine is marketed as Fluad in the US and was first available in the 2016–2017 flu season. The vaccine contains the [[MF59|MF59C.1 adjuvant]]<ref>{{cite journal | vauthors = Mascagni P, Vicenzi E, Kajaste-Rudnitski A, Pellicciotta G, Monti A, Cervi C, Vitalucci R, Toffoletto F
*{{lay source |template=cite web |date=May 1, 2018 |title=Literature Review Update on the Efficacy and Effectiveness of High-Dose (Fluzone High-Dose) and MF59-Adjuvanted (Fluad) Trivalent Inactivated Influenza Vaccines in Adults 65 Years of Age and Older |website=Public Health Agency of Canada |url=https://www.canada.ca/en/public-health/services/publications/healthy-living/executive-summary-literature-review-update-efficacy-effectiveness-fluzone-high-dose-fluad-trivalent-inactivated-influenza-vaccines-adults-65-older.html }}</ref><ref>{{cite journal | vauthors = Van Damme P, Arnou R, Kafeja F, Fiquet A, Richard P, Thomas S, Meghlaoui G, Samson SI, Ledesma E
Vaccinating health care workers who work with elderly people is recommended in many countries, with the goal of reducing influenza outbreaks in this vulnerable population.<ref>{{cite journal | vauthors = Haverkate M, D'Ancona F, Giambi C, Johansen K, Lopalco PL, Cozza V, Appelgren E |collaboration=VENICE project gatekeepers contact points collective | title = Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes | journal = Euro Surveillance | volume = 17 | issue = 22 | date = May 2012 | pmid = 22687916 | doi = 10.2807/ese.17.22.20183-en | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Field RI | title = Mandatory vaccination of health care workers: whose rights should come first? | journal = P & T | volume = 34 | issue = 11 | pages = 615–18 | date = November 2009 | pmid = 20140133 | pmc = 2810172 }}</ref><ref>{{cite journal | vauthors = Kassianos G | title = Willingness of European healthcare workers to undergo vaccination against seasonal influenza: current situation and suggestions for improvement | journal = Drugs in Context | volume = 4 | page = 212268 | year = 2015 | pmid = 25657810 | pmc = 4316812 | doi = 10.7573/dic.212268 }}</ref> While there is no conclusive evidence from [[randomized clinical trial]]s that vaccinating health care workers helps protect elderly people from influenza, there is tentative evidence of benefit.<ref>{{cite journal | vauthors = Thomas RE, Jefferson T, Lasserson TJ | title = Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions | journal = The Cochrane Database of Systematic Reviews | issue = 6 | page = CD005187 | date = June 2016 | volume = 2016 | pmid = 27251461 | doi = 10.1002/14651858.CD005187.pub5 | pmc = 8504984 | doi-access = free | title-link = doi }}</ref>
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As well as protecting mother and child from the effects of an influenza infection, the immunization of pregnant women tends to increase their chances of experiencing a successful full-term pregnancy.<ref>{{cite journal | vauthors = Fell DB, Sprague AE, Liu N, Yasseen AS, Wen SW, Smith G, Walker MC | title = H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes | journal = American Journal of Public Health | volume = 102 | issue = 6 | pages = e33–40 | date = June 2012 | pmid = 22515877 | pmc = 3483960 | doi = 10.2105/AJPH.2011.300606 | type = Submitted manuscript }}</ref>
The trivalent inactivated influenza vaccine is protective in pregnant women infected with [[HIV/AIDS|HIV]].<ref name="MadhiCutland2014">{{cite journal | vauthors = Madhi SA, Cutland CL, Kuwanda L, Weinberg A, Hugo A, Jones S, Adrian PV, van Niekerk N, Treurnicht F, Ortiz JR, Venter M, Violari A, Neuzil KM, Simões EA, Klugman KP, Nunes MC
==Safety==
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In some people, a flu vaccine may cause serious side effects, including an [[Anaphylaxis|allergic reaction]], but this is rare. Furthermore, the common side effects and risks are mild and temporary when compared to the risks and severe health effects of the annual [[influenza]] epidemic.<ref name="CDC Facts" />
Contrary to a [[List of common misconceptions|common misconception]], flu shots cannot cause people to get the flu.<ref>{{Cite news |
===Guillain–Barré syndrome===
Although [[Guillain–Barré syndrome]] had been feared as a complication of vaccination, the CDC states that most studies on modern influenza vaccines have seen no link with Guillain–Barré.<ref>{{cite journal | vauthors = Haber P, Sejvar J, Mikaeloff Y, DeStefano F | title = Vaccines and Guillain-Barré syndrome | journal = Drug Safety | volume = 32 | issue = 4 | pages = 309–23 | year = 2009 | pmid = 19388722 | doi = 10.2165/00002018-200932040-00005 | s2cid = 33670594 }}</ref><ref>{{cite journal | title = Reorganized text | journal = JAMA Otolaryngology–Head & Neck Surgery | volume = 141 | issue = 5 | page = 428 | date = May 2015 | pmid = 25996397 | doi = 10.1001/jamaoto.2015.0540 | s2cid = 26612829 }}</ref> Infection with influenza virus itself increases both the risk of death (up to one in ten thousand) and the risk of developing Guillain–Barré syndrome to a far higher level than the highest level of suspected vaccine involvement (approximately ten times higher by 2009 estimates).<ref>{{cite journal | vauthors = Stowe J, Andrews N, Wise L, Miller E | title = Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenza-like illness using the United Kingdom General Practice Research Database | journal = American Journal of Epidemiology | volume = 169 | issue = 3 | pages = 382–88 | date = February 2009 | pmid = 19033158 | doi = 10.1093/aje/kwn310 | doi-access = free | title-link = doi }}</ref><ref name="ReferenceB">{{cite journal | vauthors = Sivadon-Tardy V, Orlikowski D, Porcher R, Sharshar T, Durand MC, Enouf V, Rozenberg F, Caudie C, Annane D, van der Werf S, Lebon P, Raphaël JC, Gaillard JL, Gault E
Although one review gives an incidence of about one case of Guillain–Barré per million vaccinations,<ref>{{cite journal | vauthors = Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P | title = Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring | journal = Vaccine | volume = 27 | issue = 15 | pages = 2114–20 | date = March 2009 | pmid = 19356614 | doi = 10.1016/j.vaccine.2009.01.125 | url = https://zenodo.org/record/1259425 | access-date = May 21, 2020 | archive-date = August 1, 2020 | archive-url = https://web.archive.org/web/20200801190854/https://zenodo.org/record/1259425 | url-status = live }}</ref> a large study in China, covering close to a hundred million doses of vaccine against the 2009 H1N1 "swine" flu found only eleven cases of Guillain–Barré syndrome, (0.1 per million doses) total incidence in persons vaccinated, actually lower than the normal rate of the disease in China, and no other notable side effects.<ref name="ReferenceB"/><ref>{{cite news| title = Last Year's H1N1 Flu Vaccine Was Safe, Study Finds| date = February 2, 2011| url = http://health.usnews.com/health-news/managing-your-healthcare/research/articles/2011/02/02/last-years-h1n1-flu-vaccine-was-safe-study-finds| vauthors = Reinberg S | work = [[U.S. News & World Report]]| url-status = live| archive-url = https://web.archive.org/web/20130425164738/http://health.usnews.com/health-news/managing-your-healthcare/research/articles/2011/02/02/last-years-h1n1-flu-vaccine-was-safe-study-finds| archive-date = April 25, 2013 }}</ref>
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[[File:Ampliação e Modernização da Fábrica de Vacina (40225018103).jpg|thumb|Fresh eggs being prepared for influenza vaccine production at [[Instituto Butantan]]]]
Although most influenza vaccines are produced using egg-based techniques, influenza vaccines are nonetheless still recommended as safe for people with [[egg allergy|egg allergies]], even if severe,<ref name="CDCegg"/> as no increased risk of allergic reaction to the egg-based vaccines has been shown for people with egg allergies.<ref name="cell2021">{{cite news |date=March 27, 2021 |title=Australia's first cell-based influenza vaccines to roll out this flu season |website=ABC News |url=https://www.abc.net.au/news/health/2021-03-27/flu-new-vaccine-cell-based-australian-first/100023908 |url-status=live |access-date=April 28, 2021 |archive-url=https://web.archive.org/web/20210427180254/https://www.abc.net.au/news/health/2021-03-27/flu-new-vaccine-cell-based-australian-first/100023908 |archive-date=April 27, 2021 |vauthors=Roberts L}}</ref>
Monitoring for symptoms from vaccination is recommended in those with more severe symptoms.<ref>{{cite journal|author=National Advisory Committee on Immunization (NACI) |title=Statement on Seasonal Influenza Vaccine for 2012–2013|journal=Canada Communicable Disease Report|date=August 2012|volume=38|url=http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-2/assets/pdf/acs-dcc-2-eng.pdf|archive-url=https://web.archive.org/web/20130117234635/http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-2/assets/pdf/acs-dcc-2-eng.pdf|archive-date=January 17, 2013|access-date=July 18, 2013 | location=Ottawa }}</ref> A study of nearly 800 children with egg allergy, including over 250 with previous anaphylactic reactions, had zero systemic allergic reactions when given the live [[attenuated vaccine|attenuated]] flu vaccine.<ref>{{cite journal | vauthors = Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse M | title = Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study | journal = BMJ | volume = 351 | page = h6291 | date = December 2015 | pmid = 26645895 | pmc = 4673102 | doi = 10.1136/bmj.h6291 }}</ref><ref>{{cite journal | vauthors = Greenhawt M | title = Live attenuated influenza vaccine for children with egg allergy | journal = BMJ | volume = 351 | page = h6656 | date = December 2015 | pmid = 26657778 | doi = 10.1136/bmj.h6656 | s2cid = 37037904 }}</ref>
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Some injection-based flu vaccines intended for adults in the United States contain [[thiomersal]] (also known as thimerosal), a [[mercury (element)|mercury]]-based preservative.<ref>{{cite web | title=Thimerosal in Flu Vaccine | website=U.S. [[Centers for Disease Control and Prevention]] | date=October 16, 2015 | url=https://www.cdc.gov/flu/prevent/thimerosal.htm | archive-url=https://web.archive.org/web/20191202222555/https://www.cdc.gov/flu/prevent/thimerosal.htm | archive-date=December 2, 2019 | url-status=live | access-date=December 2, 2019}} {{PD-notice}}</ref><ref>{{cite web | title=Thimerosal in Vaccines Thimerosal – Concerns – Vaccine Safety | website=U.S. [[Centers for Disease Control and Prevention]] | date=October 27, 2015 | url=https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html | archive-url=https://web.archive.org/web/20191102181824/https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html | archive-date=November 2, 2019 | url-status=live | access-date=December 2, 2019}} {{PD-notice}}</ref> Despite some [[thiomersal controversy|controversy]] in the media,<ref>{{cite journal | vauthors = Offit PA | title = Thimerosal and vaccines – a cautionary tale | journal = The New England Journal of Medicine | volume = 357 | issue = 13 | pages = 1278–79 | date = September 2007 | pmid = 17898096 | doi = 10.1056/NEJMp078187 | s2cid = 36318722 | doi-access = free }}</ref> the [[World Health Organization]]'s [[Global Advisory Committee on Vaccine Safety]] has concluded that there is no evidence of toxicity from thiomersal in vaccines and no reason on grounds of safety to change to more-expensive single-dose administration.<ref>{{cite web |title= Thiomersal and vaccines |author= Global Advisory Committee on Vaccine Safety |publisher= [[World Health Organization]] (WHO) |url=https://www.who.int/vaccine_safety/topics/thiomersal/en/index.html |date= July 14, 2006 |access-date= November 20, 2007 |archive-url= https://web.archive.org/web/20091106092438/http://www.who.int/vaccine_safety/topics/thiomersal/en/index.html |archive-date= November 6, 2009 }}</ref>
Exercising before the influenza vaccine is not thought to be harmful but there is no evidence of a beneficial effect either.<ref>{{cite journal | vauthors = Grande AJ, Reid H, Thomas EE, Nunan D, Foster C | title = Exercise prior to influenza vaccination for limiting influenza incidence and its related complications in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 8 | pages = CD011857 | date = August 2016 | pmid = 27545762 | pmc = 8504432 | doi = 10.1002/14651858.CD011857.pub2 }}</ref>
==Types==
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The influenza vaccination strategy is generally that of protecting vulnerable people, rather than limiting influenza circulation or eliminating human influenza sickness. This is in contrast with the high [[herd immunity]] strategies for other infectious diseases such as [[polio]] and [[measles]].<ref name=ECDC2>{{cite news|title=ECDC Reviews – New WHO recommendations on seasonal influenza ...|url=http://ecdc.europa.eu/en/activities/sciadvice/_layouts/forms/Review_DispForm.aspx?List=a3216f4c-f040-4f51-9f77-a96046dbfd72&ID=698|access-date=December 25, 2016|work=[[European Centre for Disease Prevention and Control]] (ECDC)|url-status=live|archive-url=https://web.archive.org/web/20170510115326/http://ecdc.europa.eu/en/activities/sciadvice/_layouts/forms/Review_DispForm.aspx?List=a3216f4c-f040-4f51-9f77-a96046dbfd72&ID=698|archive-date=May 10, 2017}}</ref> This is also due in part to the financial and logistics burden associated with the need of an annual injection.<ref>{{cite web |title= ECDC Guidance: Priority risk groups for influenza vaccination |pages= 7–8 |url= http://ecdc.europa.eu/en/publications/Publications/0808_GUI_Priority_Risk_Groups_for_Influenza_Vaccination.pdf |publisher= [[European Centre for Disease Prevention and Control]] (ECDC) |access-date= December 25, 2016 |archive-url= https://web.archive.org/web/20161225214347/http://ecdc.europa.eu/en/publications/Publications/0808_GUI_Priority_Risk_Groups_for_Influenza_Vaccination.pdf |archive-date= December 25, 2016 }}</ref>
===United Kingdom===
The [[National Health Service]] in the United Kingdom provides flu vaccination to:
* people who are aged 65 or over
* people who have certain long-term health conditions
* people who are pregnant
* people who live in a care home
* people who are the main carer for an older or disabled person, or receive a carer's allowance
* people who live with someone who has a weakened immune system.<ref>{{cite web |title=Flu vaccine |url=https://www.nhs.uk/vaccinations/flu-vaccine/ |website=nhs.uk |language=en |date=6 March 2024}}</ref>
This vaccination is available free of charge to people in these groups. People outside these groups aged between 18 and 65 years of age can also receive a private flu vaccination for a small fee from pharmacies and some private surgeries.<ref>{{cite web |title=Private Flu Vaccinations {{!}} Book a pharmacy appointment {{!}} Patient Access |url=https://www.patientaccess.com/services/flu/private-flu-vaccination |website=www.patientaccess.com |language=en}}</ref>
===United States===
[[File:Flu_Shot_Advertising.jpg|thumb|alt=A young woman displays her bandage after receiving the vaccine at a drug store|A young woman displays her bandage after receiving the vaccine at a [[drug store]].]]
In the United States routine influenza vaccination is recommended for all persons aged six months and over.<ref>{{cite journal | vauthors = Grohskopf LA, Ferdinands JM, Blanton LH, Broder KR, Loehr J | title = Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024–25 Influenza Season | journal = MMWR. Recommendations and Reports | volume=73 | issue=5 | date = August 2024 | pmid = 39197095 | doi = 10.15585/mmwr.rr7305a1 | doi-access = free | pages = 1–25 | pmc = 11501009 | url = <!-- Official URL --> https://www.cdc.gov/mmwr/volumes/73/rr/pdfs/rr7305a1-H.pdf }}</ref><ref name="pmid34448800">{{cite journal |vauthors=Grohskopf LA, Alyanak E, Ferdinands JM, Broder KR, Blanton LH, Talbot HK, Fry AM
According to the CDC, the live attenuated virus (LAIV4) (which comes in the form of the nasal spray in the US) should be avoided by some groups.<ref name="pmid34448800" /><ref>{{cite web | title=Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine) | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=September 16, 2019 | url=https://www.cdc.gov/flu/prevent/nasalspray.htm | archive-url=https://web.archive.org/web/20191014221155/https://www.cdc.gov/flu/prevent/nasalspray.htm | archive-date=October 14, 2019 | url-status=live | access-date=October 14, 2019}} {{PD-notice}}</ref>
Within its blanket recommendation for general vaccination in the United States, the CDC, which began recommending the influenza vaccine to health care workers in 1981, emphasizes to clinicians the special urgency of vaccination for members of certain vulnerable groups, and their [[caregivers]]:
:Vaccination is especially important for people at higher risk of serious influenza complications or people who live with or care for people at higher risk for serious complications.<ref>{{cite web|url=https://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm|title=Influenza Vaccination: A Summary for Clinicians – Health Professionals – Seasonal Influenza (Flu)|publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC)|url-status=live|archive-url=https://web.archive.org/web/20080224040716/http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm|archive-date=February 24, 2008|date=September 6, 2018}} {{PD-notice}}</ref> In 2009, a new high-dose formulation of the standard influenza vaccine was approved.<ref>{{cite web | title=Fluzone, Fluzone High-Dose and Fluzone Intradermal | publisher=U.S. [[Food and Drug Administration]] (FDA) | url=https://www.fda.gov/vaccines-blood-biologics/vaccines/fluzone-fluzone-high-dose-and-fluzone-intradermal | date=July 11, 2017 | archive-date=July 22, 2017 | archive-url=https://wayback.archive-it.org/7993/20170722071642/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm112854.htm | url-status=live | access-date=June 1, 2020}}</ref> The Fluzone High Dose is specifically for people 65 and older; the difference is that it has four times the antigen dose of the standard Fluzone.<ref>{{cite journal | vauthors = Couch RB, Winokur P, Brady R, Belshe R, Chen WH, Cate TR, Sigurdardottir B, Hoeper A, Graham IL, Edelman R, He F, Nino D, Capellan J, Ruben FL
The US government requires hospitals to report worker vaccination rates. Some US states and hundreds of US hospitals require health care workers to either get vaccinations or wear masks during flu season. These requirements occasionally engender union lawsuits on narrow [[collective bargaining]] grounds, but proponents note that courts have generally endorsed forced vaccination laws affecting the general population during disease outbreaks.<ref>{{cite web | vauthors = Tanner L |url= https://www.nbcnews.com/health/hospitals-crack-down-workers-who-refuse-flu-shots-1B7956764 |title=Hospitals crack down on workers who refuse flu shots |publisher=NBC News |date=January 13, 2013 |access-date=July 24, 2014 |url-status=live |archive-url=https://web.archive.org/web/20131203052836/https://www.nbcnews.com/health/hospitals-crack-down-workers-who-refuse-flu-shots-1B7956764 |archive-date=December 3, 2013 }}</ref>
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===Health care workers===
Frontline health care workers are often recommended to get seasonal and any pandemic flu vaccination. For example, in the UK all health care workers involved in patient care are recommended to receive the seasonal flu vaccine, and were also recommended to be vaccinated against the [[Pandemic H1N1/09 virus|H1N1/09]] (later renamed A(H1N1)pdm09<ref name="pdm09" group="note">(H1N1)pdm09 is newer nomenclature for the 2009 pandemic H1N1 virus, not a different strain.</ref><ref name="2009 Composition">{{cite journal | title = Update on influenza A (H1N1) 2009 monovalent vaccines | journal = Morbidity and Mortality Weekly Report (MMWR)| volume = 58 | issue = 39 | pages = 1100–01 | date = October 2009 | pmid = 19816398 | url = https://www.cdc.gov/mmwr/pdf/wk/mm5839.pdf | archive-url = https://web.archive.org/web/20110629132344/http://www.cdc.gov/mmwr/pdf/wk/mm5839.pdf | url-status = live | archive-date = June 29, 2011 |author=Centers for Disease Control Prevention (CDC)}} {{PD-notice}}</ref>) swine flu virus during the [[2009 flu pandemic|2009 pandemic]]. However, uptake is often low.<ref name=Rubin>{{cite journal | vauthors = Rubin GJ, Potts HW, Michie S | title = Likely uptake of swine and seasonal flu vaccines among healthcare workers. A cross-sectional analysis of UK telephone survey data | journal = Vaccine | volume = 29 | issue = 13 | pages = 2421–28 | date = March 2011 | pmid = 21277402 | doi = 10.1016/j.vaccine.2011.01.035 }}</ref> During the 2009 pandemic, low uptake by healthcare workers was seen in countries including the UK,<ref name=Rubin /> Italy,<ref>{{cite journal | vauthors = La Torre G, Di Thiene D, Cadeddu C, Ricciardi W, Boccia A | title = Behaviours regarding preventive measures against pandemic H1N1 influenza among Italian healthcare workers, October 2009 | journal = Euro Surveillance | volume = 14 | issue = 49 | date = December 2009 | pmid = 20003908 }}</ref> Greece,<ref>{{cite journal | vauthors = Amodio E, Anastasi G, Marsala MG, Torregrossa MV, Romano N, Firenze A | title = Vaccination against the 2009 pandemic influenza A (H1N1) among healthcare workers in the major teaching hospital of Sicily (Italy) | journal = Vaccine | volume = 29 | issue = 7 | pages = 1408–12 | date = February 2011 | pmid = 21199700 | doi = 10.1016/j.vaccine.2010.12.041 }}</ref> and Hong Kong.<ref>{{cite journal | vauthors = Chor JS, Ngai KL, Goggins WB, Wong MC, Wong SY, Lee N, Leung TF, Rainer TH, Griffiths S, Chan PK
In a 2010 survey of United States health care workers, 63.5% reported that they received the flu vaccine during the 2010–11 season, an increase from 61.9% reported the previous season. US Health professionals with direct patient contact had higher vaccination uptake, such as physicians and dentists (84.2%) and [[nurse practitioners]] (82.6%).<ref>{{cite web | title=CDC updates flu vaccination recommendations | vauthors = Schnirring L | website=[[Center for Infectious Disease Research and Policy]] (CIDRAP) | date=August 18, 2011| url=http://www.cidrap.umn.edu/news-perspective/2011/08/cdc-updates-flu-vaccination-recommendations | archive-url=https://web.archive.org/web/20191025025948/http://www.cidrap.umn.edu/news-perspective/2011/08/cdc-updates-flu-vaccination-recommendations | archive-date=October 25, 2019 | url-status=live | access-date=October 24, 2019 }}</ref><ref>{{cite journal | title = Influenza vaccination coverage among health-care personnel – United States, 2010–11 influenza season | journal = Morbidity and Mortality Weekly Report (MMWR)| volume = 60 | issue = 32 | pages = 1073–77 | date = August 2011 | pmid = 21849963 | url = https://www.cdc.gov/mmwr/pdf/wk/mm6032.pdf | archive-url = https://web.archive.org/web/20170525220229/https://www.cdc.gov/mmwr/pdf/wk/mm6032.pdf | url-status = live | archive-date = May 25, 2017 |author=Centers for Disease Control Prevention (CDC)}} {{PD-notice}}</ref><ref name="pmid23013720">{{cite journal | title = Influenza vaccination coverage among health-care personnel: 2011–12 influenza season, United States | journal = Morbidity and Mortality Weekly Report (MMWR)| volume = 61 | pages = 753–57 | date = September 2012 | pmid = 23013720 | url = https://www.cdc.gov/mmwr/pdf/wk/mm6138.pdf | archive-url = https://web.archive.org/web/20170624221955/https://www.cdc.gov/mmwr/PDF/wk/mm6138.pdf | url-status = live | archive-date = June 24, 2017 |author=Centers for Disease Control Prevention (CDC)}} {{PD-notice}}</ref>
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[[File:Reassortment.svg|thumb|[[Schematic]] of influenza vaccine creation]]
Research continues into the idea of a [[Universal flu vaccine|"universal" influenza vaccine]] that would not require tailoring to a particular strain, but would be effective against a broad variety of influenza viruses.<ref name="pmid31693060">{{cite journal | vauthors = Abbasi J | title = The Search for a Universal Flu Vaccine Heats Up | journal = JAMA | volume = 322 | issue = 20 | pages = 1942–1944 | date = November 2019 | pmid = 31693060 | doi = 10.1001/jama.2019.16816 | s2cid = 207903441 }}</ref> No vaccine candidates had been announced by November 2007,<ref name=NPR2007>{{cite AV media | vauthors = Greenfieldboyce N | title=New and Old Ways to Make Flu Vaccines | publisher=[[NPR]] | date=November 8, 2007 | url=https://www.npr.org/templates/story/story.php?storyId=16105360 | archive-url=https://web.archive.org/web/20191024052018/https://www.npr.org/templates/story/story.php?storyId=16105360 | archive-date=October 24, 2019 | url-status=live | access-date=October 23, 2019 | medium=Radio broadcast
In a 2007 report, the global capacity of approximately 826 million seasonal influenza vaccine doses (inactivated and live) was double the production of 413 million doses. In an aggressive scenario of producing [[pandemic influenza]] vaccines by 2013, only 2.8 billion courses could be produced in a six-month time frame. If all high- and upper-middle-income countries sought vaccines for their entire populations in a pandemic, nearly two billion courses would be required. If China pursued this goal as well, more than three billion courses would be required to serve these populations.<ref>{{cite web |url=https://path.org/resources/influenza-vaccine-strategies-for-broad-global-access/ |title=Influenza Vaccine Strategies for Broad Global Access | website=Path | date=October 2007 | access-date=September 16, 2009 |url-status=live |archive-url=https://web.archive.org/web/20191014212233/https://path.org/resources/influenza-vaccine-strategies-for-broad-global-access/ |archive-date=October 14, 2019 }}</ref> Vaccine research and development is ongoing to identify novel vaccine approaches that could produce much greater quantities of vaccine at a price that is affordable to the global population.{{citation needed|date=June 2019}}
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===Other methods of manufacture===
Methods of vaccine generation that bypass the need for eggs include the construction of influenza [[virus-like particle]]s (VLP). VLP resemble viruses, but there is no need for inactivation, as they do not include viral coding elements, but merely present antigens in a similar manner to a virion. Some methods of producing VLP include cultures of ''[[Spodoptera frugiperda]]'' [[Sf21|Sf9 insect cells]] and plant-based vaccine production (e.g., production in ''[[Nicotiana benthamiana]]''). There is evidence that some VLPs elicit antibodies that recognize a broader panel of antigenically distinct viral isolates compared to other vaccines in the [[hemagglutination-inhibition assay]] (HIA).<ref>{{cite journal | vauthors = Bright RA, Carter DM, Daniluk S, Toapanta FR, Ahmad A, Gavrilov V, Massare M, Pushko P, Mytle N, Rowe T, Smith G, Ross TM
A gene-based DNA vaccine, used to prime the immune system after boosting with an inactivated [[H5N1 vaccine]], underwent clinical trials in 2011.<ref>{{cite web |url=http://www.nih.gov/news/health/oct2011/niaid-03.htm |title=Priming with DNA vaccine makes avian flu vaccine work better (NIH News) |date=October 3, 2011 |url-status=live |archive-url=https://web.archive.org/web/20120927233909/http://www.nih.gov/news/health/oct2011/niaid-03.htm |archive-date=September 27, 2012 }}</ref><ref>{{ClinicalTrialsGov|NCT00776711|Vaccine for Prevention of Bird Flu}}</ref><ref>{{ClinicalTrialsGov|NCT01086657|An Open-Label, Randomized Phase{{spaces}}I Study in Healthy Adults of the Safety and Immunogenicity of Prime-Boost Intervals with Monovalent Influenza Subunit Virion (H5N1) Vaccine, A/Indonesia/05/2005 (Sanofi Pasteur, Inc), Administered Alone or Following Recombinant DNA Plasmid (H5) Vaccine, VRC-AVIDNA036-00-VP (VRC, NIAID)}}</ref>
On September 17, 2020, the [[Committee for Medicinal Products for Human Use]] (CHMP) of the [[European Medicines Agency]] (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for Supemtek, a quadrivalent influenza vaccine (recombinant, prepared in cell culture).<ref name="Supemtek: Pending EC decision">{{cite web | title=Supemtek: Pending EC decision | website=[[European Medicines Agency]] (EMA) | date=September 17, 2020 | url=https://www.ema.europa.eu/en/medicines/human/summaries-opinion/supemtek | access-date=September 21, 2020 | archive-date=September 23, 2020 | archive-url=https://web.archive.org/web/20200923005908/https://www.ema.europa.eu/en/medicines/human/summaries-opinion/supemtek | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref> The applicant for this medicinal product is Sanofi Pasteur.<ref name="Supemtek: Pending EC decision" /> Supemtek was approved for medical use in the European Union in November 2020.<ref name="Supemtek EPAR">{{cite web | title=Supemtek EPAR | website=[[European Medicines Agency]] (EMA) | date=September 15, 2020 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/supemtek | access-date=November 27, 2020 | archive-date=January 10, 2021 | archive-url=https://web.archive.org/web/20210110092717/https://www.ema.europa.eu/en/medicines/human/EPAR/supemtek | url-status=live }}</ref><ref>{{cite web | title=Supemtek Product information | website=Union Register of medicinal products | url=https://ec.europa.eu/health/documents/community-register/html/h1484.htm | access-date=March 3, 2023 | archive-date=March 5, 2023 | archive-url=https://web.archive.org/web/20230305052137/https://ec.europa.eu/health/documents/community-register/html/h1484.htm | url-status=live }}</ref>
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==Cost-effectiveness==
The cost-effectiveness of seasonal influenza vaccination has been widely evaluated for different groups and in different settings.<ref>{{cite journal | vauthors = Jit M, Newall AT, Beutels P | title = Key issues for estimating the impact and cost-effectiveness of seasonal influenza vaccination strategies | journal = Human Vaccines & Immunotherapeutics | volume = 9 | issue = 4 | pages = 834–40 | date = April 2013 | pmid = 23357859 | pmc = 3903903 | doi = 10.4161/hv.23637 }}</ref> In the elderly (over 65), the majority of published studies have found that vaccination is cost saving, with the cost savings associated with influenza vaccination (e.g. prevented health care visits) outweighing the cost of vaccination.<ref>{{cite journal | vauthors = Postma MJ, Baltussen RP, Palache AM, Wilschut JC | title = Further evidence for favorable cost-effectiveness of elderly influenza vaccination | journal = Expert Review of Pharmacoeconomics & Outcomes Research | volume = 6 | issue = 2 | pages = 215–27 | date = April 2006 | pmid = 20528557 | doi = 10.1586/14737167.6.2.215 | s2cid = 12765724 }}</ref> In older adults (aged 50–64 years), several published studies have found that influenza vaccination is likely to be cost-effective, however the results of these studies were often found to be dependent on key assumptions used in the economic evaluations.<ref>{{cite journal | vauthors = Newall AT, Kelly H, Harsley S, Scuffham PA | title = Cost effectiveness of influenza vaccination in older adults: a critical review of economic evaluations for the 50- to 64-year age group | journal = PharmacoEconomics | volume = 27 | issue = 6 | pages = 439–50 | year = 2009 | pmid = 19640008 | doi = 10.2165/00019053-200927060-00001 | s2cid = 20855671 | doi-access = free }}</ref> The uncertainty in influenza cost-effectiveness models can partially be explained by the complexities involved in estimating the disease burden,<ref>{{cite journal | vauthors = Newall AT, Viboud C, Wood JG | title = Influenza-attributable mortality in Australians aged more than 50 years: a comparison of different modelling approaches | journal = Epidemiology and Infection | volume = 138 | issue = 6 | pages = 836–42 | date = June 2010 | pmid = 19941685 | doi = 10.1017/S095026880999118X | s2cid = 29939376 | doi-access = free }}</ref> as well as the seasonal variability in the circulating strains and the match of the vaccine.<ref>{{cite journal | vauthors = Newall AT, Dehollain JP, Creighton P, Beutels P, Wood JG | title = Understanding the cost-effectiveness of influenza vaccination in children: methodological choices and seasonal variability | journal = PharmacoEconomics | volume = 31 | issue = 8 | pages = 693–702 | date = August 2013 | pmid = 23645539 | doi = 10.1007/s40273-013-0060-7 | s2cid = 8616720 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Newall AT, Scuffham PA | title = Uncertainty and variability in influenza cost-effectiveness models | journal = Australian and New Zealand Journal of Public Health | volume = 35 | issue = 6 | pages = 576; author reply 576–77 | date = December 2011 | pmid = 22151168 | doi = 10.1111/j.1753-6405.2011.00788.x | s2cid = 22402257 | doi-access =
==Research==
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In January 2020, the US [[Food and Drug Administration]] (FDA) approved Audenz as a vaccine for the H5N1 flu virus.<ref>{{cite web | vauthors=Keown A | title=FDA Approves Seqirus' Audenz as Vaccine Against Potential Flu Pandemic | website=BioSpace | date=February 4, 2020 | url=https://www.biospace.com/article/seqirus-wins-fda-approval-of-vaccine-for-potential-flu-pandemic/ | access-date=February 5, 2020 | archive-date=February 5, 2020 | archive-url=https://web.archive.org/web/20200205184348/https://www.biospace.com/article/seqirus-wins-fda-approval-of-vaccine-for-potential-flu-pandemic/ | url-status=live }}</ref> Audenz is a vaccine indicated for active immunization for the prevention of disease caused by the influenza A virus H5N1 subtype contained in the vaccine. Audenz is approved for use in persons six months of age and older at increased risk of exposure to the influenza A virus H5N1 subtype contained in the vaccine.<ref>{{cite web | title=Audenz | publisher=U.S. [[Food and Drug Administration]] (FDA) | date=January 31, 2020 | url=http://www.fda.gov/vaccines-blood-biologics/audenz | access-date=February 5, 2020 | id=STN: 125692 | archive-date=August 6, 2020 | archive-url=https://web.archive.org/web/20200806022227/https://www.fda.gov/vaccines-blood-biologics/audenz | url-status=live }} {{PD-notice}}</ref>
[[Zoonotic influenza vaccine Seqirus]] is authorized for use in the European Union.<ref name="Zoonotic Influenza Vaccine Seqirus EPAR">{{cite web | title=Zoonotic Influenza Vaccine Seqirus EPAR | website=European Medicines Agency (EMA) | date=9 October 2023 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/zoonotic-influenza-vaccine-seqirus | access-date=26 September 2024}}</ref> It is an H5N8 vaccine that is intended to provide [[acquired immunity]] against H5 subtype influenza A viruses.<ref name="Zoonotic Influenza Vaccine Seqirus EPAR" />
===Universal flu vaccines===
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===Oral influenza vaccine===
As of 2019, an oral flu vaccine was in [[clinical research]].<ref>{{cite web|url=https://www.drugtopics.com/vaccination-and-immunization/researchers-exploring-oral-flu-vaccine-and-treatment-options|vauthors=Sederstrom J|title=Researchers Exploring Oral Flu Vaccine and Treatment Options|date=July 19, 2019|access-date=January 27, 2020|publisher=Drug Topics|archive-date=June 8, 2020|archive-url=https://web.archive.org/web/20200608032923/https://www.drugtopics.com/vaccination-and-immunization/researchers-exploring-oral-flu-vaccine-and-treatment-options|url-status=live}}</ref> The oral vaccine candidate is based on an [[adenovirus]] type{{spaces}}5 vector modified to remove genes needed for replication, with an added gene that expresses a small double-stranded [[RNA]] hairpin molecule as an [[adjuvant]].<ref>{{cite journal | vauthors = Jasty M, Bragdon CR, Schutzer S, Rubash H, Haire T, Harris WH | title = Bone ingrowth into porous coated canine total hip replacements. Quantification by backscattered scanning electron microscopy and image analysis | journal = Scanning Microscopy | volume = 3 | issue = 4 | pages = 1051–6; discussion 1056–57 | date = December 1989 | pmid = 2633331 | doi = 10.1016/s1473-3099(15)00252-2 }}</ref> In 2020, [[Phases of clinical research#Phase II|a
=== COVID-19 ===
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===Dogs===
In 2004, [[influenza A virus subtype H3N8]] was discovered to cause [[canine influenza]]. Because of the lack of previous exposure to this virus, dogs have no natural immunity to this virus. However, a vaccine was found in 2004.<ref>{{cite journal | vauthors = Karaca K, Dubovi EJ, Siger L, Robles A, Audonnet JC, Jiansheng Y, Nordgren R, Minke JM
==Notes==
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* {{cite book | title=Immunisation against infectious disease | chapter=Chapter 19: Influenza | date=January 21, 2021 | chapter-url=https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19 | publisher=Public Health England | veditors=Ramsay M | url=https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book | access-date=October 24, 2019 | archive-date=November 12, 2019 | archive-url=https://web.archive.org/web/20191112005859/https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25 | url-status=live }}
* {{cite book | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 12: Influenza | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/flu.html | url = https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | access-date = October 24, 2019 | archive-date = December 30, 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }}
* {{cite book | vauthors = Budd A, Blanton L, Grohskopf L, Campbell A, Dugan V, Wentworth DE, Brammer L
* {{cite web | author=National Advisory Committee on Immunization | title=Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2020–2021 | website=Public Health Agency of Canada | date=May 2020 | url=https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2020-2021/naci-2020-2021-seasonal-influenza-stmt-eng.pdf | id=Cat.: HP37-25F-PDF; Pub.: 200003 | access-date=June 2, 2020 | archive-date=August 3, 2020 | archive-url=https://web.archive.org/web/20200803062906/https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2020-2021/naci-2020-2021-seasonal-influenza-stmt-eng.pdf | url-status=live }}
**{{lay source |template=cite magazine |vauthors=Young K, Gemmill I, Harrison R |collaboration=National Advisory Committee on Immunization |date=May 7, 2020 |title=Summary of the NACI Seasonal Influenza Vaccine Statement for 2020–2021 |periodical=Canada Communicable Disease Report |volume=46 |issue=5 |url=https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2020-46/issue-5-may-7-2020/naci-summary-influenza-2020-2021.html}}
* {{cite book | author=National Advisory Committee on Immunization (NACI) | title=NACI literature review on the comparative effectiveness and immunogenicity of subunit and split virus inactivated influenza vaccines in adults 65 years of age and older | id=Cat.: HP40-213/2018E-PDF; Pub.: 180039 | publisher=Government of Canada | date=May 2018 | url=http://publications.gc.ca/collections/collection_2018/aspc-phac/HP40-213-2018-eng.pdf | isbn=978-0-660-26438-7 | access-date=January 12, 2020 | archive-date=July 18, 2020 | archive-url=https://web.archive.org/web/20200718004211/http://publications.gc.ca/collections/collection_2018/aspc-phac/HP40-213-2018-eng.pdf | url-status=live }}
**{{lay source |template=cite magazine |vauthors=Gemmill I, Young K |collaboration=National Advisory Committee on Immunization |date=June 7, 2018 |title=Summary of the NACI literature review on the comparative effectiveness of subunit and split virus inactivated influenza vaccines in older adults |periodical=Canada Communicable Disease Report |volume=44 |issue=6 |url=https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-6-june-7-2018/article-2-summary-subunit-split-virus-influenza-vaccine.html}}
* {{cite journal |vauthors=Rajaram S, Wojcik R, Moore C, Ortiz de Lejarazu R, de Lusignan S, Montomoli E, Rossi A, Pérez-Rubio A, Trilla A, Baldo V, Jandhyala R, Kassianos G
{{refend}}
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