Flu Shot or Nasal Spray?

Medically Reviewed by Carol DerSarkissian, MD on September 10, 2022
4 min read

When it comes to the flu vaccine, the question for almost everyone shouldn't be if you should get it, but how you should get it.

There are two options: the flu shot and the nasal spray FluMist. Most years, both offer about the same level of protection, but some people are better suited for the shot, while others do better with the spray. 

Recommendations on how to get the flu vaccine can change from year to year. 

The bottom line? Your doctor will let you know which type is better for you.

This vaccine is usually injected into your upper arm. It's made from dead influenza virus and can't give you the flu.

Side effects: They're usually minor and only last a day or two. The most common one is soreness in the arm. Less common symptoms are mild fever and achiness.

Who can get the flu shot: Adults and children ages 6 months and up

Who shouldn't get the flu shot:

  • Babies less than 6 months old
  • Anyone who got Guillain-Barre syndrome (when your body’s immune system attacks your nerves) within 6 weeks of getting a flu vaccine
  • People with life-threatening allergies to any ingredient in the vaccine

You may have heard that people with allergies to eggs shouldn't get the flu shot. But the American College of Allergy, Asthma, and Immunology says the vaccine has such a low amount of egg protein that it's unlikely to cause an allergic reaction. If you have a severe egg allergy, talk to your doctor or pharmacist first. There are flu vaccines that have no egg protein.

Other flu shot options are:

Intradermal shots. These use a much smaller needle. It only goes into the top layer of your skin instead of down into the muscle. It may be a good choice for someone who doesn't like needles, but shouldn't get the spray. It's available for those between ages 18 and 64.

High-dose flu shots. These vaccines can better protect people with weakened immune systems. They're recommended for those ages 65 and older.

If you don’t feel well, you should talk to your doctor about delaying your shot until you feel better.

Pros: The flu shot is available for babies 6 months and older. It’s considered safe for a larger age group than the nasal vaccine.

Cons: Many people don’t like to get shots.

You get this flu vaccine sprayed into your nose. It's made from live virus that's weak and can't cause the flu. Still, you may have flu-like symptoms.

Side effects: They're usually minor, although they can be more severe than the side effects of the flu shot. Adults can get a runny nose, headache, sore throat, or cough. In children, side effects also include wheezing, vomiting, fever, and muscle aches.

The nasal flu vaccine can be taken by people between ages 2 and 49 who are in good health and not pregnant. The spray is not recommended for:

  • Children younger than age 2 
  • Adults 50 years and older
  • Pregnant women
  • People with a history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine
  • Children ages 2 to 17 who take aspirin or salicylate-containing medications
  • People with weakened immune systems
  • Children ages 2 to 4 who have asthma or wheezing in the past 12 months
  • People ages 5 and older who have asthma
  • People who have a medical condition such as lung, heart, kidney, liver, neurologic, or metabolic disorders
  • People who have a moderate to severe illness with or without fever
  • People who had Guillain-Barre syndrome within six weeks of a previous dose of the flu vaccine
  • People who have taken influenza antiviral drugs within the previous 48 hours
  • People who care for severely immunocompromised persons who require a protected environment 

The American Academy of Pediatrics did not recommend the nasal spray during the 2016-17 and 2017-18 flu seasons because it didn't work as well against the A/H1N1 viral strain, but with changes in the formulation of the spray vaccine, the AAP is recommending either the spray or flu shot in the 2019-2020 season. The CDC is also recommending either vaccine.

Pros: The nasal spray is easy to take. Children (and some adults) might prefer it to getting a shot. 

Cons: There are more restrictions on who can get FluMist. Also, some research shows it may be less effective in older adults than the flu shot.

The CDC recommends that everyone 6 months and older get immunized against the flu, unless there's a medical reason not to. Why catch the flu and risk complications if you can avoid them?

The CDC says some people must get vaccinated. This includes people who are at high risk or are in contact with those who are, including:

  • Children between 6 months and 18 years old
  • Children on long-term aspirin therapy, who are at higher risk of Reye's syndrome (a condition that causes swelling in the liver and brain) after getting the flu
  • Women who will be pregnant during flu season
  • Adults 50 and older
  • Adults and children with diseases of the lungs (like asthma), heart, kidneys, liver, blood, or metabolism (like diabetes)
  • Adults and children with weakened immune systems
  • People who live in nursing homes or other care facilities
  • People who live with someone at high risk of flu complications
  • Caregivers of children under 6 months older
  • Health care workers