Is a Preservative-Free Flu Shot Safer?

A preservative-free flu shot is a type of flu vaccine that does not contain the antimicrobial agent known as thimerosal. Thimerosal, a mercury-based compound, is an ingredient in some vaccines because it prevents the growth of bacteria, fungus, or other microorganisms that might contaminate a vial when a needle is inserted.

Some people seek out preservative-free vaccinations because they've heard that vaccine ingredients like thimerosal can cause autism, a claim that clinical researchers have repeatedly been debunked.

According to the Centers for Disease Control and Prevention (CDC), the side effects of flu shots containing thimerosal are ultimately the same as those that are preservative-free.

How Safe Is Thimerosal?

Thimerosal is used in multi-dose vials of the flu shot 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 in multi-dose vaccines, there were many who remained unconvinced.

In 1998, the safety of vaccines was cast into further doubt when a group of scientists in Great Britain published a study suggesting 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 2010, 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, as well as the preservatives perceived to be harmful, altogether.

As a result of the "public's perception of risk," as described by the World Health Organization (WHO), thimerosal was discontinued for use in most multi-dose vaccines in 2001. All other single-dose vials in the United States are preservative-free, except for Fluvirin, which contains only a trace amount from the use of thimerosal in its manufacturing process.

How Is Flu Vaccine Safety Evaluated?

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

The safety profile of traditional and preservative-free flu shots is considered equal. Possible side effects of both thimerosal-containing vaccines and preservative-free vaccines 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 wheezing, difficulty breathing, vomiting, rapid heartbeat, loss of consciousness, 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.

When Do I Need a Flu Shot?

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

It is important to note that preservative-free flu vaccines contain the same four strains of killed influenza virus as other injectable so-called quadrivalent flu shots. Preservative-free flu shots 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
  

Do I Need a Preservative-Free Flu Shot?

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

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 healthcare provider if FluMist nasal spray vaccine is an option for you.

While the FluMist vaccine is preservative-free, it contains a live weakened virus and should not be used in people with a compromised immune system, children under two years, adults 50 and over, pregnant women, people with a severe, life-threatening reaction to flu shots or any of their ingredients, and people with other medical conditions.

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

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 shot does not cause the flu.