Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine)

Should the nasal spray flu vaccine be given to patients with chronic diseases?

LAIV is not recommended for people with some kinds of chronic health conditions because the safety and effectiveness of this vaccine in people with those conditions has not been established.

See Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) – United States, 2015-2016 Influenza Season – August 7, 2015 for a list of contraindications and precautions for the nasal spray vaccine.

Should pregnant and postpartum women avoid contact with people who were recently vaccinated with the nasal spray vaccine?

Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with the nasal spray influenza vaccine. However, the nasal spray influenza vaccine should not be given to women who are pregnant. Postpartum women can receive an influenza shot or the nasal spray influenza vaccine.

Are there any contraindications to giving breastfeeding mothers the nasal spray vaccine?

Breastfeeding is not a contraindication for the nasal spray vaccine. Breastfeeding mothers younger than 50 years can get the nasal spray influenza vaccine as long as they do not have any contraindication to getting that vaccine. See Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) – United States, 2015-2016 Influenza Season – August 7, 2015 for a list of contraindications and precautions for the nasal spray vaccine.

Can the nasal spray flu vaccine be given to patients when they are ill?

The nasal spray influenza vaccine can be given to people with mild illnesses (e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, nasal congestion might limit delivery of the vaccine to the nasal lining. Delaying vaccination with LAIV until the nasal congestion is reduced or use of an age-appropriate injectable vaccine instead of LAIV should be considered. People with moderate or severe illness, with or without fever, should generally wait to be vaccinated until they have recovered. Your health care provider can provide advice about when to get vaccinated if you are feeling ill.

Can nasal spray flu vaccine give me influenza?

Influenza vaccines do not cause influenza illness. The nasal spray influenza vaccine does contain live viruses. However, the viruses are attenuated (weakened), so that they will not cause influenza illness. The weakened viruses are also cold-adapted, which means they are designed to only multiply at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist.

While an influenza vaccine cannot give you influenza illness, there are different side effects that may be associated with getting an influenza shot or a nasal spray influenza vaccine.

These side effects are mild and short-lasting, especially when compared to symptoms of bad case of influenza.

What are the side effects that could occur?

The viruses in the nasal spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. In children, side effects from the nasal spray may include:

  • Runny nose
  • Wheezing
  • Headache
  • Vomiting
  • Muscle aches
  • Fever (low grade)

In adults, side effects from the nasal spray vaccine may include:

  • Runny nose
  • Headache
  • Sore throat
  • Cough

If these problems occur, they begin soon after vaccination and usually are mild and short-lived. People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears. Rarely, people can experience a severe allergic reaction after an influenza vaccine (or any vaccine); there are about 1-2 cases of severe allergic reactions per million influenza vaccine doses administered and these reactions can be treated with medication. People who think that they have been injured by an influenza vaccine can file a claim with the National Vaccine Injury Compensation Program (VICP)external iconexternal icon.

More information about the safety of influenza vaccines is available at Influenza Vaccine Safety.

Note: There is no recommendation for pregnant women or people with pre-existing medical conditions to get special permission or written consent from their doctor or health care professional for influenza vaccination if they get vaccinated at a worksite clinic, pharmacy or other location outside of their physician’s office. For more information, visit Misconceptions about Seasonal Flu and Flu Vaccines.

A young girl receives the intranasal flu vaccination.

By Dr. Samira Mubareka

As healthcare providers, we know that the best protection against the influenza virus is to get the flu shot. For children, there are two options for influenza vaccination: the intranasal live attenuated vaccine (the nasal spray) or the inactivated vaccine (the shot).

However, deciding which method to use in children has recently become more confusing. The Centers for Disease Control and Prevention (CDC) in the U.S. announced that, based on the data they had collected, the nasal spray was not effective last flu season. As a result, many parents have been asking their healthcare providers whether they should be giving the nasal spray flu vaccine to their children.

So, why are we still offering the nasal spray flu vaccine in Canada? And how should we respond when parents inevitably ask why we aren’t following the U.S.’s lead in only offering the needle this year?

Flu strains change

First, it’s important to mention that researchers continue looking at vaccine effectiveness every year, and that the findings from Canadian data are different from the U.S. Using data from previous flu seasons, researchers work hard to predict which flu strain will be most prominent during the next flu season, months in advance. This means there may be year-to-year variation in how well the vaccine and circulating flu virus strains match. Still, significant protection against getting the flu is provided even during years where the vaccine isn’t a perfect match.

Because the flu strain you’re being protected against is constantly changing, you should get the flu vaccine every year, and you should encourage your patients to do the same.

Influenza can cause serious illness and death, particularly among the elderly, very young children, pregnant women and those with chronic medical conditions. As such, the flu vaccine is universally recommended in Canada.

It bears repeating that not everyone can get the flu vaccine, including babies younger than six months old (who are too young to receive it), making it essential that people who spend time with these vulnerable groups get the flu shot – including moms of infants.

Differences in data

Canada isn’t the only country that continues to recommend the nasal spray. In fact, the U.S. is one of only a few countries that are not recommending it this flu season.

The difference comes down to different findings in studies conducted on either side of the border. In the data that’s been collected in Canada and other countries, such as Finland and the United Kingdom, we haven’t seen the low level of effectiveness of the nasal spray that American studies have found. In fact, a recent Canadian study showed no difference between the two types of vaccine in terms of protection from influenza.

While we can’t ignore the U.S. data, we must also keep our own data in mind. Though it can be difficult to understand how one country can make a recommendation that differs from another, the fact remains that the evidence was not strong enough for Canada to remove its recommendation of the nasal spray.

What should parents do?

Deciding between the nasal spray or flu shot can be difficult, particularly for a parent who has to make a decision about which to give to their child. Speak with your family physician about which vaccine method is best for your child.

In addition to getting the vaccine, parents and children should be reminded of other ways to prevent the spread of the flu. It’s important to clean hands before and after using the washroom or handling food, covering coughs and sneezes with tissue (and disposing of the tissue immediately in the garbage) and then cleaning your hands. Practice healthy habits to keep the immune system strong, like having a balanced diet and getting enough sleep, and stay home from work, daycare or school when sick. These are all good habits to adopt, and will increase your chances of staying healthy through the flu season.

I made sure my own children were vaccinated this year, one way or another. While one of my kids got the flu shot, the other got the nasal spray – he simply wouldn’t do it any other way. Sometimes, the decision comes down to how your child reacts to needles!

As a parent, I’ll be keeping a closer eye on new data about the effectiveness of the nasal spray versus the shot. However, the most important thing is that my kids received an influenza vaccine this year.

Dr. Samira Mubareka is a microbiologist and infectious diseases consultant at Sunnybrook Health Sciences Centre.

Five misconceptions about the flu

There are many misconceptions about the flu, even among those of us who work in healthcare. Here are five of the top flu misconceptions you may hear people talk about this season:

  1. “It’s really just a bad cold”

The flu is not just a bad cold. Generally, people who have come down with the flu will say they’ve been “hit” with the flu — and that’s no exaggeration. Knowing the difference can make all the difference for everyone. Fever and chills are common flu symptoms, along with severe muscle pain and weakness. A sore throat, chest congestion and persistent cough are also signs that you’re suffering from the flu, not just a cold.

  1. “I don’t need the vaccine. I never get the flu. Even if I were to get it, I’d get through it.”

Chances are this individual, if healthy and hit with the virus, would likely recover with no complications. They would also likely spend time with family, relatives and friends — social circles that include the two most flu-vulnerable groups: very old and very young, and in some families, pregnant women. Transmission from an infected individual can cause serious complications and result in hospitalization for these vulnerable groups.

  1. “I’ve got too much work. I’ve got to come in. And besides… it’s just a bad cold.” (see #1)

Good work ethic is admirable and important, but the health of an individual and those around him/her is also important. Have a co-worker who’s got chills/high fever? Aches and pains? Persistent cough? It’s best to advise this individual to head home.

  1. “I’ve heard of people getting the flu from the vaccine”

The flu vaccine contains killed strains of the virus. People often associate the vaccine with a slight chill, sore arm, and not feeling 100 per cent. That’s not because they are coming down with the flu; it’s because they are experiencing an immune response. And that’s a good thing.

The sore arm, however, is from the needle – and for those with a quiet fear of needles, there is the needle-free nasal spray vaccine option. This option contains live virus, so is not recommended for older or very young individuals, or individuals with pre-existing medical conditions or weakened immunity.

No one can get the flu from the vaccine. But an individual can still get the flu even after getting the vaccine. However, evidence shows that being armed with the vaccine results in a less severe hit, should you get the flu.

  1. “The flu vaccine doesn’t work anyway”

Every year, the vaccine covers three strains of the flu virus: an H1N1 strain, an H3N2 strain and an influenza B strain. The nasal spray vaccine contains an additional influenza B strain. The influenza strains in this year’s vaccine have been updated to reflect what has been circulating over the last year. Don’t discount the flu vaccine based on what happened the previous year. The flu vaccine still provides, on average, 60 per cent protection against the flu. Think of it as a 60 per cent discount taken off the flu’s contagiousness – to you!

Flu Shot, Nasal Spray Recommended Equally for Kids for 2019-2020 Season

The American Academy of Pediatrics is giving its recommendation to the nasal spray form of the influenza vaccine for the 2019-2020 flu season, meaning parents will have 2 choices when getting their children vaccinated this fall.
As in previous years, the AAP is also giving its recommendation for the flu shot (inactivated influenza vaccine).
“Every year, we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option,” said Bonnie Maldonado, MD, who chairs the academy’s committee on infectious diseases, in a press release.
Though the AAP has been firm in its recommendation that children be vaccinated against the flu, its stance on the nasal spray form of the vaccination (live attenuated influenza vaccine) has varied from year to year based on its performance and available data. For instance, the nasal spray was found to have underperformed against the A/H1N1 strain of influenza during the 2013-2014 and 2015-2016 flu seasons. As a result, the AAP did not recommend the nasal spray in the 2016-2017 and 2017-2018 flu seasons.

Bonnie Maldonado, MD

However, the academy said the vaccine was altered in 2017 to better fight against A/H1N1, and early indications were that the change had been successful. At a meeting on March 14, the AAP’s Board of Directors was sufficiently satisfied with the latest vaccine data to issue its recommendation.
The AAP plans to issue a formal policy statement on the matter later in the year. They made the announcement this month because this is the time many clinics are ordering their vaccine supplies for the coming year.
Flu vaccinations among children have been on pace this year to beat last year’s vaccination levels. By November 2018, 45% of children had been vaccinated against the flu, up from 37% in November 2017.
The decision to recommend the nasal spray could have a significant impact on vaccination rates among children. A 2017 study by investigators at Penn State University found the availability of the nasal spray had a significant impact on vaccination rates.
They compared vaccinations at a central Pennsylvania pediatric center between the 2015-2016 flu season, when the nasal spray had the AAP’s recommendation, and the 2016-2017 flu season, when the nasal spray wasn’t recommended. They found early season vaccination rates were actually higher the second year, but end-of-season vaccination rates were lower.
The drop was most significant among children who received the nasal spray the first year but then were unable to get it the second year. The authors concluded that convenience is the major factor in determining whether children are vaccinated.
In making its announcement of the new recommendations, the AAP reiterated that vaccination is a critically important preventative health measure.

“The flu virus is unpredictable and can cause serious complications even in healthy children,” said Flor M. Munoz, MD, another member of AAP’s infectious disease committee. “Children who have been immunized are less likely be hospitalized due to flu.”
As of mid-March, the US Centers for Disease Control and Prevention reported a total of 76 children had died of influenza-associated causes during the current 2018-2019 flu season.
The article, “AAP Recommends Flu Shot, Nasal Spray Equally for Next Season,” originally appeared on To stay informed on the latest in infectious disease news and developments, please sign up for our weekly newsletter.


Every year, myths about the flu vaccine spread as widely as the flu itself.

Most people seem to know that the flu shot, which uses killed viruses, cannot cause symptoms. But its newer counterpart, the nasal spray FluMist, is slightly different. It uses live but weakened viruses, which can still replicate for as long as three weeks.

Image Credit…Leif Parsons

But that alone is not enough to cause sickness or result in passing the virus to others. In a report published in January, researchers at the Mayo Clinic noted that the amount of virus shed by people vaccinated with the spray is below what is needed to infect an adult. Children are slightly more susceptible. (One researcher was listed as a consultant for MedImmune, which makes FluMist.)

But in several studies of transmission rates, there was only one case in which a vaccinated child passed on the virus. It occurred in a day care center with 200 children, most 3 or younger. The child who contracted the virus from someone else showed no signs or symptoms of flu, apparently because the virus remained weakened and was capable of only limited replication. Over all, studies suggest, the odds of transmitting the virus after receiving the nasal spray are about 2.5 percent.

Get the facts

  • You should not get FLUMIST QUADRIVALENT if you have a severe allergy to eggs or to any inactive ingredient in the vaccine; have ever had a life-threatening reaction to influenza vaccinations; or are 2 through 17 years old and take aspirin or medicines containing aspirin—children or adolescents should not be given aspirin for 4 weeks after getting FLUMIST QUADRIVALENT unless your healthcare provider tells you otherwise
  • Children under 2 years old have an increased risk of wheezing (difficulty with breathing) after getting FLUMIST QUADRIVALENT
  • Tell your healthcare provider if you or your child are currently wheezing; have a history of wheezing if under 5 years old; have had Guillain-Barré syndrome; have a weakened immune system or live with someone who has a severely weakened immune system; have problems with your heart, kidneys, or lungs; have diabetes; are pregnant or nursing; or are taking a medication used to treat influenza like Tamiflu®*, Relenza®*, amantadine, or rimantadine
  • The most common side effects are runny or stuffy nose, sore throat, and fever over 100°F

The American Academy of Pediatrics is recommending children be vaccinated with injectable flu vaccine for the coming season, rather than the nasal spray vaccine FluMist, unless a child will only be vaccinated if he or she can forgo a needle, or if a doctor runs out of flu shots.

“The AAP feels that the flu shot should be the primary vaccine choice for all children,” said Dr. Henry Bernstein, a pediatrician and an ex-officio member of the AAP’s committee on infectious diseases.

That advice puts the AAP’s annual flu vaccine recommendations slightly at odds with those of the Centers for Disease Control and Prevention, which state that any of the flu vaccines available for children could be used for the coming flu season.


Both, however, share an end goal: getting more children vaccinated.

Influenza can be deadly for children. In the past flu season, 180 children under the age of 18 died from the flu, making it the second most deadly flu season — after the 2009 H1N1 pandemic — since the CDC started recording pediatric flu deaths in the winter of 2005-2006.

The CDC recommends everyone over the age of 6 months be vaccinated every year against the flu, unless there is a medical reason to avoid the vaccine.

Yet only about 60 percent of children between the ages of 6 months and 17 years got vaccinated against flu in 2016-2017, the most recent year for which data are available. Roughly eight out of every 10 children who died from flu weren’t vaccinated, said Dr. Lisa Grohskopf, a medical officer in the CDC’s influenza division.

The differing advice from the CDC and the AAP on AstraZeneca’s FluMist could befuddle parents and pediatricians.

“There’s no question that ideally we would like for the CDC and the AAP to be completely harmonized” when it comes to recommendations, said Bernstein who is also a member of the Advisory Committee on Immunization Practices, which guides the CDC on vaccine decisions.

“Both groups are harmonized in wanting as many children to receive flu vaccine as possible each and every year,” said Bernstein. “When recommendations are not perfectly harmonized, it does pose the possibility for confusion.”

But any confusion might be mitigated by the fact that finding FluMist might not be easy this flu season.

The decision to once again recommend it — effectively giving doctors and pharmacists a go-head to use it again — was made by the ACIP in late February. By that point, though, many flu vaccine orders would already have been placed for the 2018-2019 season.

While dozens of lots of vaccine products made by Sanofi Pasteur, GlaxoSmithKline, and Seqirus have been given the green light for distribution by the Food and Drug Administration, no lots of FluMist had cleared that hurdle as of Aug. 30.

It has been a rocky few years for FluMist, which once was deemed more effective in children than injectable flu vaccine. But just after ACIP gave FluMist a rare preferential recommendation in 2014, performance problems came into view. By the 2016-2017 flu season, the CDC’s vaccine advisers recommended it not be used in the U.S. ACIP retained that position for the following flu season as well.

The problem was vaccine effectiveness studies that are done every year showed FluMist had not been offering much if any protection against the influenza A virus family H1N1.

It wasn’t clear why the vaccine’s performance was so poor in the U.S. during the 2013-2014 and 2015-2016 seasons. To make matters more confounding, other countries that use FluMist — Canada, Finland, and Britain among them — did not see the puzzling lack of effectiveness.

Unlike injectable flu vaccine, FluMist contains live viruses. The viruses in the vaccine, which is puffed up a nostril of the recipient, initiate the infection process, thereby activating an immune response. But the viruses in the vaccine are weakened and don’t induce illness.

In response to its U.S. performance problems, AstraZeneca reformulated the H1N1 portion of the vaccine. There is some evidence that suggests the updated vaccine may be more effective — although the company hasn’t been able to do studies in children to confirm that. H3N2 viruses have dominated in the last two flu seasons here.

“They provided some evidence that appeared promising that the new virus that’s going to go into the vaccine this season in the U.S. is a bit more fit,” said Grohskopf. “It is promising evidence that what is at least believed to be the root cause of the problem has been fixed.”

Bernstein said the AAP was not as convinced by the data as the CDC. He voted against recommending FluMist for the 2018-2019 season at the February ACIP meeting.

Another place the CDC and AAP advice diverges slightly relates to when children should be vaccinated.

The AAP recommendations, published Monday in the journal Pediatrics, suggest pediatricians should start urging parents to vaccinate their children as soon as flu vaccine becomes available. That can be as early as late July or August, which — depending on when flu activity picks up — is often months ahead of when children will face a flu threat. Flu season often peaks in January or February, and influenza B viruses, which are particularly hard on children, often circulate late in the winter.

There are some studies that have shown protection from flu vaccine starts to wear off as the season wears on.

The CDC’s recommendations, published Aug. 24, suggested people should be vaccinated by the end of October, when flu activity can start to tick up.

Grohskopf acknowledged the variability and unpredictability of influenza makes it tough to know when to advise people to get the vaccine. “What we can say is the best time to get vaccinated is probably a couple of weeks before flu starts circulating where you are. But we can never really tell people when that is,” she admitted.

One thing is clear though, she said. Parents of young children should start the vaccination process earlier. That’s because children under 8 years old who haven’t had at least two flu vaccines in their life need two doses of vaccine given at least four weeks apart. The second shot should be by the end of October, the CDC guidance said.

This article was medically reviewed by Shonda Hawkins, MSN, a nurse practitioner and member of the Prevention Medical Review Board, on August 16, 2019.

While temperatures are still in the 90s in many parts of the country, flu season isn’t all that far away. That’s why now is the time to at least start thinking about when (and where) you’re going to get your flu shot.

You can technically get the flu any time of year, but flu season really starts to ramp up in October and peaks between December and February, according to the Centers for Disease Control and Prevention (CDC). The vaccine takes a few weeks to give you protection, which is why you start hearing reminders to get your flu shot in early fall—and it’s really important that you do so.

“The flu vaccine is the only means we have of protecting ourselves against influenza,” says infectious disease expert Amesh A. Adalja, MD, senior scholar at the John’s Hopkins Center for Health Security. “The flu vaccine is only moderately protective against getting the flu, but it is protective against having flu complications and being hospitalized. It really can decrease the impact of flu season if we have as high a proportion of the population vaccinated as possible.”

What’s new with the flu vaccine this year?

For the 2019-2020 season, the CDC is recommending the nasal spray vaccine again, along with flu shots. (Just keep in mind there are select groups of people who should not get the nasal spray vaccine.) The flu vaccine changes every year to try to protect against the strains researchers think will dominate this season (which is why you have to get a new shot every year). This year’s vaccine will target the following strains:

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus
  • A/Kansas/14/2017 (H3N2)-like virus
  • B/Colorado/06/2017-like (Victoria lineage) virus

There was a delay in selecting the H3N2 virus so that experts could have more time to analyze data to try to find the best match, the CDC says.

When should I get a flu shot?

The CDC generally recommends that people get vaccinated by the end of October, and definitely before the flu starts spreading in your area. But, if you can only get your flu vaccine earlier or later than that, you should do it. “We want people to get the flu vaccine no matter what during the flu season,” Dr. Adalja says. “It’s important to get it when you can get it.”

Where to get a flu shot for the 2019-2020 season

You actually have a lot of options, and some of them are free as long as you have health insurance. Here are some places to consider:

At your doctor’s office

If you have health insurance, most doctors will cover the total cost of getting the flu shot. That means you won’t have to shell out for a copay either. (Just call ahead to make sure your primary care physician has the flu vaccine in stock before you go.)

At an urgent care center

Many urgent care offices will offer up flu vaccines and will even provide them for free if you can’t make it to your primary care physician to get your shot.

At your office

Some jobs actually offer this on-site, while others may hand out vouchers that you can take to a local pharmacy. Ask your boss or HR rep about it if you’re not sure.

At your school

In college? Many schools will give out free flu vaccinations to students at the campus health center.

At your local hospital

Many hospitals will offer up select days when they give free flu shots to the public. You can either check out the website of your nearest hospital or call to find out more.

At your local pharmacy chain

Walgreens, CVS Pharmacy, and Rite Aid offer up flu shots to the public, and it’s usually at no cost to you with health insurance. Some prefer that you schedule an appointment in advance, so call the store you’re interested in visiting in advance to find out.

At Target, Walmart, and Kmart

These chain stores offer up a free flu shot with most health insurance plans. Last year, Target offered up a $5 coupon for its stores when you get your shot (no word yet on whether they plan to do it again).

At your local grocery store

Some larger chain grocery stores, like Giant, have pharmacies on the premises that give free vaccines with health insurance. Contact your local store to find out more.

If you’re unsure of where to get vaccinated near you, the CDC recommends using to find a location in your area. For those without insurance, prices may fluctuate between $20 and $40, depending on the location.

Whatever you do, it is important that you do get your flu vaccine. “This is the best defense against the flu that we have for now,” Dr. Adalja says.


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Korin Miller Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more.

Beyond that, you should also know that the flu shot is generally more readily available than the nasal spray. Many of the larger pharmacies aren’t carrying the nasal spray this season. (CVS, Rite Aid, and Walgreens all carry only the flu shot, spokespeople tell SELF.) Which brings us to our next point: how you can actually get a free flu vaccine.

Here’s where you can get a free flu vaccine right this second.

You may have seen some ads that make it sound like you can roll into any pharmacy for a free flu vaccine. Major pharmacy chains like Walgreens, Rite Aid, CVS, Walmart, and even Costco do offer flu vaccines, but the cost depends on your specific insurance situation. Here’s what to know if…

You have private insurance through a school or employer: The CDC says that most private insurance companies will allow you to get your influenza vaccine without a copayment even if you haven’t reached your deductible yet—as long as you go through an in-network provider. That could be a doctor like your primary care provider, or it could be somewhere like a pharmacy. For example, Rite Aid accepts most major health insurance plans including Cigna and Humana, a Rite Aid spokesperson tells SELF. CVS also takes most insurance plans, and it provides a locator to help you see if there’s a CVS that accepts your specific insurance, a spokesperson tells SELF. It’s a similar situation with Walgreens, which says it provides coverage under most insurance plans and also has a locator so you can find locations near you that will give you a free flu vaccine.

Just in case, it still makes sense to contact your insurance provider or the pharmacy/doctor you want to see to confirm that it’ll be free before heading there for your flu vaccine.

You have an insurance plan through the Affordable Care Act (ACA): All insurance plans obtained through the ACA marketplace include coverage for the flu vaccine (meaning you can get it for free), but sometimes that coverage extends only to certain doctors or pharmacy/clinic locations, according to the U.S. Department of Health and Human Services. To be sure of where you stand, contact your insurance provider or the place where you’d like to go for your vaccine.

You have Medicaid: Many of the larger pharmacies, including Rite Aid and Walgreens, say they accept Medicaid for free flu vaccines. But Medicaid coverage for vaccines varies by state, so even though most state Medicaid plans will pay for your flu vaccine, you should get in touch with your state’s Medicaid agency to find out for sure (and to see whether Medicaid will cover the vaccine only if you go to certain doctors or pharmacy or clinic locations).

You have Medicare: Similarly, many large pharmacies offer free flu vaccines through Medicare, but it’s always smart to call the pharmacy or get in touch with someone at Medicare to double-check. Additionally, you can get a free flu shot from your doctor or health provider as long as they accept Medicare, according to the Centers for Medicaid and Medicare Services.

You don’t have insurance, or you’re having a hard time getting the vaccine covered through Medicaid or Medicare: Federally and state-funded health clinics may have free flu vaccines available. You can find one that might by using the health clinic locator from the United States Department of Health and Human Services. After that, it’s a good idea to contact your local clinic for information about vaccine availability and whether or not you need to make an appointment (this differs by location).

If you’re not able to get the vaccine for free that way, you can still go to a pharmacy. (The CDC offers a locator you can use to find pharmacies that offer flu vaccines near you.) The thing is that, in this situation, getting the vaccine will unfortunately cost money. The price will vary based on which provider you choose. At CVS and Walgreens, for example, the cost of the flu shot is about $40 for people ages 2 to 64 and around $70 for people 65 and older. At Costco, it’s about $20 no matter your age.

Other places you may find free flu vaccines? If you’re in college, check with your campus health center. Some employers offer free flu shots too, as do some public libraries (even without insurance, in some cases!).

Here’s what to expect after your free flu vaccine.

After getting a flu shot, you might experience pain at the injection site, as well as redness and swelling. You might also notice a headache, fever, nausea, and muscle aches, according to the CDC. These are totally normal occurrences that should go away within a few days and don’t mean you’ve actually gotten the flu. In some extremely rare cases, the flu shot can cause more serious side effects like Guillain-Barré syndrome, which happens when the immune system attacks nerve cells in the body, but there are fewer than one or two cases of Guillain-Barré syndrome per 1 million people who’ve gotten flu shots, the CDC says.

Typical nasal spray flu vaccine side effects are very similar to those from the shot, according to the CDC. Again, these symptoms are usually mild and clear up in a few days. What doesn’t go away after the side effects fade? Your amped-up protection against this season’s flu strains.

If you’ve never had the flu before, it can be hard to convince yourself it’s worth taking the time to get vaccinated. Trust us when we say that it’s a good decision. Even if you think you can brave the season unvaccinated, take one for the team. Seriously, think about your family members, commuter buddies, coffee shop comrades, and coworkers. “Nobody wants to be a dreaded spreader and make other people sick,” Dr. Schaffner says.


  • What Is Herd Immunity, And Why Does It Matter?
  • I Used to Be An Anti-Vaxxer. Here’s What Changed My Mind.
  • Here Are All the Vaccines You Actually Need as an Adult

Originally Appeared on Self

Here’s Where You Can Get a Free Flu Shot Right Now—With or Without Insurance

While you can technically still get the flu shot well into flu season (like, if you forgot about it until January), it’s still wise to get it ASAP—especially when, for most people, it takes less than a minute of your time, and can be totally free. That’s right: With most insurances, a flu vaccine costs a cool $0.

Got some time? Plug your zipcode into the CDC’s Flu Vaccine Finder to find the nearest provider near you. But, to help you out right this instant, we rounded up everywhere you can get a free flu shot, with—and sometimes without—insurance.

RELATED: Why You Should Get the Flu Shot Every Year

Your primary-care doctor

If you’re enrolled in a health insurance plan through the Affordable Care Act (ACA) or almost any private plan, your provider will cover the cost of the flu shot entirely, even if you go to your doctor for the shot. That’s right, no copayment or coinsurance for your appointment, just protection from the flu—whether you’ve hit your yearly deductible yet or not.

Urgent-care centers

Can’t make it to your regular doctor because of the 9 to 5 office hours? Check with local urgent-care centers. Many stock flu shots and provide them gratis if you have insurance, but you’ll want to call ahead of time to make sure the shots are available at the center you choose.

Your job

Many corporations offer free flu shots on site, often without insurance, or provide vouchers you can take to local pharmacies. If you haven’t heard anything from your employer about this, check in with HR—they should be able to tell you what’s up.

RELATED: The 10 Biggest Myths About the Flu

Your college

Some research shows that college students are particularly likely to skip out on getting vaccinated. If you’re still in school, head to your campus health center, where you can typically score the shot.

Walgreens and Duane Reade

Plenty of neighborhood pharmacies offer no-cost flu shots for people with health insurance, including Walgreens, and, in New York City, Duane Reade.

Target and CVS

Inside many Target locations you’ll find a CVS pharmacy, where you can get a no-cost flu shot and a $5 coupon for Target. You can get a no-cost flu shot at CVS pharmacies too, and you may even qualify for a $5 of $25 coupon if you do.


Several larger grocery store chains around the country, including Giant, Stop & Shop, Wegman’s, and Kroeger offer pharmacy services on the premises—and in many cases that means a free flu shot with most health insurance plans.

Rite Aid

Rite Aid is another pharmacy chain giant where you can get a free flu shot with most types of insurance.

RELATED: If You Have an Egg Allergy, Can You Still Get a Flu Shot?


Walmart stores also offer pharmacy services, including free flu shots with most insurance plans.


You can also get no-cost flu shots depending on your insurance coverage at Kmart Pharmacy locations. Members also receive cashback rewards for getting vaccinated.

Sam’s Club and Costco

Yep, you can grab a flu shot when you’re making your weekly bulk-grocery runs to Sam’s Club or Costco—flu shots (and other vaccines) there have a $0 copay with most insurances. The best part? You don’t even need a membership to snag the shot.

Your county health department

According to GoodRX, many county health departments offer free flu shots during flu season—with or without insurance. Contact your county’s health department to see if you can benefit from this service.

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  • By Sarah Klein
  • By Amber Brenza

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