Is a Preservative-Free Flu Vaccine Safer?

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A preservative-free flu vaccine is a type of flu vaccine that does not contain the antiseptic and antifungal agent known as thimerosal. The mercury-based compound is added to some vaccines to prevent the growth of bacteria, fungus, or other microorganisms that might contaminate a vial when a needle is inserted.

Some people seek out preservative-free vaccines because they have heard that vaccine preservatives may cause autism, a claim that remains unsupported by the body of scientific research. The side effects of flu vaccines containing thimerosal are the same as those that are preservative-free.

Side Effects of the Preservative-Free Flu Vaccine
Verywell / Cindy Chung

History and Controversy

Thimerosal is used in multi-dose vials of the flu vaccine for delivery to multiple people. This helps ensure the purity of the vaccine from one person to the next.

Prior to the introduction of thimerosal, there were cases where a multi-dose vial was contaminated with bacteria between uses, leading to illness and even death. Preservatives became a requirement for multi-dose vaccines in 1968, although they were in use well before then.

Despite the proven safety of thimerosal, there were many who remained unconvinced. In 1998, a group of scientists in Great Britain published a study claiming that the measles, mumps, and rubella (MMR) vaccine caused children to develop autism.

Although the study was published in one of the leading medical journals, The Lancet, it soon drew the ire of scientists who noted numerous flaws in the study model. By 2020, The Lancet issued a full retraction of the article and its findings.

Nevertheless, the study set off a firestorm of misperceptions that led many parents to abandon vaccines altogether as well as the preservatives perceived to be "harmful."

As a result, thimerosal has only been used in multi-dose vaccines since 2001—and for no other reason than to counter these unwarranted fears. All other single-dose vials in the United States are preservative-free.

To date, there has been no evidence that thimerosal can or has ever caused autism in children. According to the Centers for Disease Control and Prevention (CDC), "the number of children diagnosed with autism has not gone down since thimerosal was removed from vaccines."

Safety and Side Effects

The CDC, U.S. Food and Drug Administration, National Institutes of Health, American Academy of Pediatrics, Advisory Committee on Immunization Practices, and National Academy of Sciences' Institute of Medicine have all declared that the use of thimerosal in vaccines is safe and effective.

The safety profile of traditional and preservative-free flu vaccines are considered equal. Common side effects include:

  • Pain and swelling at the injection site
  • Low-grade fever
  • Fatigue

Side effects are typically mild and resolve within a day or two.

However, if you develop rash, vomiting, confusion, dizziness, rapid heart rate, difficulty breathing, or swollen lips, tongue, or throat, call 911 or go to your nearest emergency room. These could be the signs of a rare and potentially life-threatening allergic reaction known as anaphylaxis.

Indications

According to the CDC, you should get your flu shot (whether traditional or preservative-free) before the end of October. Children under 9 receiving the vaccine for the first time would need a second shot four weeks after the first.

Approximately 85% of the vaccine supply produced for the 2019 to 2020 flu season was thimerosal-free.

The preservative-free formulations contain the same four strains of killed influenza virus as other injectable quadrivalent flu vaccines. Preservative-free flu vaccines are also delivered at the same time and in the same dose as the traditional flu vaccines.

Flu shots, whether traditional or preservative-free, are contraindicated for use in:

  • Children younger than six months
  • People with severe, life-threatening allergies to the flu vaccine or any ingredient in the vaccine

Considerations

Unless flu vaccination is contraindicated for you, there is no safety-related reason to avoid getting a traditional flu vaccine.

With that said, if you would prefer to avoid thimerosal, ask your healthcare provider if they have a preservative-free flu vaccine available. Alternatively, you can ask your doctor if FluMist nasal spray vaccine is a reasonable option, which is also thimerosal-free.

Be aware that most clinics and pharmacies will only have one or two types of vaccine on-hand—typically the traditional multi-dose vial and FluMist—and would have to place a special order for you.

Because it takes two weeks for the body to produce enough defensive antibodies, the vaccination should be done early in the season to avoid infection.

While the FluMist vaccine is preservative-free, it contains a live weakened virus and cannot be used in people with a compromised immune system, children under 2, the elderly, or people with a severe egg allergy.

A Word From Verywell

Although there is no evidence that thimerosal causes harm when used in vaccines, there are other options to choose from if you'd rather avoid it.

Ultimately, what's most important is that you get vaccinated against the flu, especially if you are at high risk for flu-related complications. And, despite what some people might tell you, the flu vaccine does not cause the flu.

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