CME | Let's Talk Flu Shots: Clearing the Air on Flu Vaccine Safety

In this episode of CME on the Go, Dr. Jason Marker, Dr. Tamaan Osbourne-Roberts, and Dr. Lauren Brown-Berchtold discuss the importance of influenza vaccination. They share personal experiences, outline vaccine recommendations for various age groups, and address common safety concerns and myths about the flu vaccine. They emphasize the role family physicians play in preventing hospitalizations and deaths through effective vaccination campaigns. Listeners are encouraged to incorporate practical strategies for discussing vaccines with patients and to stay informed on the latest vaccine guidelines.

This CME podcast is supported by an educational grant to the AAFP from Seqirus.

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Learning Objectives:

1. Discuss common misconceptions about vaccine safety and the actual risk profile of commonly administered vaccines.

1. Highlight evidence-based recommendations for influenza vaccinations, recommendations, and updates for children, adults, and older adults, including vaccine safety, best practices for shared decision-making, and encouraging timely vaccination against influenza.

Key evidence-based recommendations

Universal recommendation

Annual vaccination for everyone ≥6 months each season (unless specific contraindication). AAFP

Timing

Aim for September–October for most people; earlier (July–August) for some groups can be reasonable, but avoid too-early vaccination in older adults if coverage through season is a concern. September–October balances getting protected before circulation starts and maintaining protection through the season. CDC+1

Children

Kids 6 months–8 years who are receiving influenza vaccine for the first time (or who previously received only 1 dose) need 2 doses at least 4 weeks apart.

FluMist (LAIV) is approved for ages 2–49 but has exclusions (certain medical conditions, recent wheeze/asthma in young children, pregnancy). Use age- and condition-appropriate vaccine choice for kids. CDC+1

Adults & special groups

Pregnancy: Inactivated or recombinant influenza vaccines may be given in any trimester; vaccination protects pregnant person and provides newborn protection by transplacental antibodies. CDC+1

Egg allergy: People with egg allergy may receive any age-appropriate flu vaccine (egg-based or non-egg-based). Severe egg allergy is not a reason to avoid flu vaccine, but observe basic precautions (clinic equipped for allergic reaction). CDC+1

Older adults (≥65 years)

Preferential recommendation: use high-dose (e.g., Fluzone High-Dose), adjuvanted (e.g., Fluad), or recombinant (e.g., Flublok) vaccines because they show improved protection and reduce hospitalizations compared with standard-dose unadjuvanted vaccines. If unavailable, any age-appropriate vaccine is acceptable. CDC+1

Safety & myth-busting

"You cannot get influenza from the inactivated vaccine — the seasonal shot contains killed virus or recombinant proteins; it can cause soreness or low-grade fever for a day or two, but serious reactions are rare." CDC

"Large studies show no increased risk of miscarriage or stillbirth after influenza vaccination in pregnancy; the vaccine is safe at any trimester." CDC

"If you're allergic to eggs, you can still get the flu vaccine; egg allergy alone is not a reason to skip vaccination." CDC

Shared decision-making — practical, 30-second clinician scripts

Use a presumptive + offer approach, then personalize briefly:

Presumptive opener (10–15s): "Today I recommend the flu vaccine for you/your child — it's the best way to reduce risk of serious flu, hospital visits, and to protect infants and older relatives."

If hesitant (10–20s): Ask one focused question: "What worries you most about the flu vaccine?" Listen 15s.

Targeted response (15–30s): Address their specific concern with a brief fact: e.g., "If you're worried about safety in pregnancy — large studies show it's safe and helps protect your baby for several months." Then close: "Would you like to get it now, or talk more about options (high-dose/LAIV/etc.)?"

If true medical uncertainty (e.g., some immunocompromised patients, transplant recipients): use shared decision-making to weigh individual risks and vaccine type (prefer inactivated or recombinant for immunocompromised). (See resources in show notes.) CDC+1

Quick patient-facing lines to encourage timely vaccination

"The best time to get protected before flu starts circulating is now — by late September or October — so schedule your vaccine this month." historyofvaccines.org

"Getting your flu shot protects you and helps protect babies under 6 months who cannot be vaccinated." CDC

"If you're 65 or older, ask for the high dose/adjuvanted/recombinant option for extra protection." CDC

https://www.cdc.gov/flu/highrisk/65over.htm

Between 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.

Specific flu shots for people 65 years and older

CDC and ACIP preferentially recommend the use of higher dose flu vaccines (high-dose inactivated and recombinant) or adjuvanted inactivated flu vaccine over standard-dose unadjuvanted flu vaccines for people 65 years and older. This recommendation is based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. If one of these vaccines is not available at the time of administration, people in this age group should get a standard-dose unadjuvanted inactivated flu vaccine instead. There are other flu vaccines approved for use in people 65 years and older. People 65 years and older should not get a nasal spray vaccine.

Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.

People who are 50 years and older also should be up to date with pneumococcal vaccination. This vaccination helps protect against pneumococcal pneumonia and other serious infections.

Disclosure: It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.  All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose. 

Disclaimer: Copyright 2025. AAFP. The views presented in this broadcast are the speaker's own and do not represent those of AAFP.  The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.  AAFP makes no representation as to the accuracy or completeness of the information and is not responsible for results that may arise from its use.  Consult an appropriate professional concerning your specific situation and respective governing bodies for applicable laws. Reference to any specific product or entity does not constitute an endorsement or recommendation by AAFP unless specifically stated otherwise. AAFP and the AAFP logo are registered trademarks of American Academy of Family Physicians.