New intradermal flu shots

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kayakgirl
kayakgirl Member Posts: 172
edited October 2015 in Lymphedema

The new flu shot this year is intradermal and the CDC recommends in be given in the deltoid (arm). Since I have had a bilateral mastectomy with lymph nodes removed on my right, I have asked for the previous Flu shot that were given intramuscularly be given in my buttocks. But where do I ask for this intradermal vaccine to be given?

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited October 2012

    Our employee health nurse has noticed a fair number of local (upper arm) reactions to the new intradermal version, including 2 of my younger co-workers who had warm, pinkish red, slightly sore areas around the area of the shot. It has a nice/fine needle for people sensitive to the thought of an IM injection. The nasal mist which is a "live" vaccine is another possibility.

    Go ahead and get the regular kind like you used to. I had it done on my unaffected side a few weeks ago and was fine. 

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  • Jennifer1295
    Jennifer1295 Member Posts: 244
    edited October 2012

    I have decided to get the older/normal version of the flu shot. My doctors offices didn't have any in a few weeks ago but I will be checking again soon. The do my flu shot in my thigh. I get a local reaction and some sorness for a few days but I have had nodes removed on both sides so I do not want to risk my non lymphedma arm.

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  • LindaLou53
    LindaLou53 Member Posts: 929
    edited October 2012

    I have been getting a Flu shot for more than 25 years and since developing LE in 2006, I always get the shot in my thigh.  Today I got the new Intradermal Flu vaccine for the first time.  I was informed by the nurse that there would be more local symptoms than the standard flu shot, the amount of vaccine is less (0.01ml vs 0.05ml) and the needle is very tiny (90% smaller than standard vaccine needle) but the intradermal vaccine has approximately the same effectiveness as the standard method.

    I did experience stinging when the vaccine was injected and an immediate "wheal" or small swollen nodule developed, very similar to the swelling seen from a PPD (TB) skin test.  The area quickly became reddened and itchy which the nurse had said was typical.  The itchyness went away after about 15 minutes but the redness and induration has persisted.  This morning I have an approx 2 inch diameter reddened, indurated area on my upper thigh.  It is not painful, but is warm to touch and a definite area of mild inflammation.

    I mention this only to warn other persons with "at risk" limbs that the inflammatory process with the intradermal shots appears to be much higher than the standard flu shot.  I would definitely not allow anyone to use an "at risk" limb for the injection.  After looking at the detailed literature from the Fluzone website I found the following table comparing adverse reactions between the new Intradermal injection and the standard Fluzone injection for adults aged 18-64:

    As you can see there are significantly more local inflammatory reactions with the Intradermal than the standard Fluzone injection.  I think persons who truly hate needles might prefer the intradermal method, but in the long run you may be dealing with more local discomfort anyway.  I especially think that no flu injection should ever be given in an at risk LE limb, and the intradermal injection may be an even a higher LE risk than the standard. The one "good" thing about the intradermal is there are many locations it can be given since it does not involve concerns about avoiding deep blood vessels or nerves as the Intramuscular injections do.  Any area of the skin on a non-involved or non-at risk limb should be useable for the intradermal injection even though current literature refers only to the upper arm area.

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  • Binney4
    Binney4 Member Posts: 8,609
    edited October 2012
    Yikes! Thank you, LindaLou. So, can we request the standard Fluzone injection instead, or is the intradermal just the way it is this year?Frown
    Bonnie
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  • MiniMacsMom
    MiniMacsMom Member Posts: 595
    edited October 2012

    Just a word on the flu mist.  Our son gets it, since his peds said it has a broader coverage of viruses than the shots.  BUT since its a live virus and I am only 6 mo out of chemo he said to pass on the mist for myself this year, our son D can get it after I get my flu shot.  He said next year I "should" be fine to get the flu mist, but that as far as he knows there really isn't a study on when its ok to get a live virus after chemo.  I haven't yet looked myself.  Its good to know about the side effects, I might try to pass on the new one if possible this year and stick to the old style shot in my non MX side :)

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  • RosesToeses
    RosesToeses Member Posts: 721
    edited October 2012

    I just got my flu shot today and the nurse's form, under the "where did you administer," had thigh as an option, so if that works for you it's an option. Good luck!

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited October 2012

    Nice chart LindaLou! Those statistics seem to agree with what is being observed in wider population usage.

    The new intradermal injection is one of 3 options, the others being the "traditional" shot and the nasal form. (There is also a special high dose version for elderly people whose immune response needs additional stimulation).

    Last year, I got the usual shot in my noninvolved arm just a month after completing chemo and was fine.

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  • LindaLou53
    LindaLou53 Member Posts: 929
    edited October 2012

    Unfortunately, for anyone who plans on getting their flu shot at the local Walgreens, Walmart, or Target flu stations their policy does not apparently allow them to give flu shots in the thigh.  I have spoken with many of the walk-in store type flu stations and have been told that they are not setup or trained to give shots in the thigh.  Now, granted this information was based on the original, standard flu injection which is intramuscular (IM).  Most of these types of walk-in sites do not have a privacy setting for dropping your pants either, although when I asked our local Walgreens that has a Take Care Clinic with an exam room, they still would not provide a flu shot in the thigh.  The first year the H1N1 flu shot came out, I went to the County Public Health office when they were giving free flu shots.  I wore appropriately baggy pants with a long top and they were willing to inject my thigh while in the midst of a assembly line of people getting their shots.  My PMD's office has since setup their own seasonal Flu clinic available to their patients which does have privacy available as needed.  I think there needs to be more awareness, training and accommodations made by immunization centers for people who require alternate injection sites.

    P.S. Binney, several Flu Vaccination centers are still using the standard Fluzone injections or offer all versions.  My husband just got his shot today at his employer and they are not using the Intradermal version.  I guess a person could call ahead to find out what is available. I don't know if the plan is to eventually phase out the IM injections or not.  The current intradermal is only available for age 18-64.  As vlnrph mentions above, there is a high dose intradermal version available for those 65 and older.  I suspect I will continue to get the intradermal in my thigh, especially since it eliminates the issues I have run into in the past where the proper size needle or technique for a safe IM injection was not always practiced. My primary reason for posting was to warn anyone considering using an "at risk" limb, that the increased degree of local inflammation with the intradermal flu shot could be a problem.

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  • Jennifer1295
    Jennifer1295 Member Posts: 244
    edited October 2012

    Well I was able to get my standard flu shot in my thigh at my doctors office. The nurse had me sit down and aside from the stick I didn't even get a site mark. My legs hurt that night but it was muscular and I did go to the mall and walked lot after getting the shot.

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  • Erica3681
    Erica3681 Member Posts: 1,916
    edited October 2012

    For the first couple of years after my BMX, my doctor gave me the flu shot in my thigh. For the last few years, though, I've had it in my buttocks. My doctor chose not to get the new intradermal due to the larger number of local side effects. But I would be interested to know where doctors recommend it be given for those with or at risk for lymphedema.

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  • purple32
    purple32 Member Posts: 3,188
    edited October 2012

    What about the intra nasal method ?

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  • LindaLou53
    LindaLou53 Member Posts: 929
    edited October 2012

    The Flu Nasal method is a Live Attenuated Influenza Vaccine (LAIV) and is recommended only for healthy individuals aged 2 - 49.  Here is an excerpt from the CDC informational sheet on who should not be given the LAIV nasal vaccine.

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  • carol57
    carol57 Member Posts: 3,567
    edited October 2012

    Linda, you are incredibly generous to share all this information!  I was thinking of requesting the nasal version, and now, of course, I'll avoid that one.  Thanks for your help on this.

    Carol

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  • firstcall
    firstcall Member Posts: 499
    edited October 2012

    May I add.....for every 600 flu shots given, one life is saved......not bad....

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited October 2012

    Just one small correction, Lindalou: the higher potency vaccine for older folks is intramuscular, not dermal. Had to smile at your description of having the injection done into your thigh amongst a crowd of people. One of our clinics tried a "drive thru" service a few years ago, probably only for those willing to use their arm... 

    I agree with firstcall that getting the shot is important, especially for those of us who work in health care. Sorry that Carol is not young enough for the nasal!

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  • LindaLou53
    LindaLou53 Member Posts: 929
    edited October 2012

    Thanks Vlnrph!  I didn't realize the High Dose vaccine was IM, but that works for me too.  I have a few years to go before hitting 65 though Smile.  I did find it interesting in a CDC article I just found that neither the CDC or ACIP are currently stating a preference as to which vaccine a person chooses to get.  Apparently, clinical studies have shown that the High Dose causes a greater immune response than the standard Fluzone, but they don't know if a greater immune response results in greater protection against influenza disease.  There is a study going on now to test effectiveness, which should complete sometime 2014-2015.  Here is the link to the full CDC article on the High Dose Flu Vaccine:

    http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm

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  • ksusan
    ksusan Member Posts: 4,505
    edited October 2015

    Thanks, this thread is still helpful!

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