Is a Preservative-Free Flu Vaccine Safer?

Medically reviewed by

on April 14, 2021

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 studies have repeatedly shown has no relationship whatsoever to any vaccine or vaccine ingredient.

This include thimerosal. The side effects of flu vaccines containing thimerosal are ultimately 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 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" of thimerosal, 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.

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 Possible Side Effects

The CDC, U.S. 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 vaccines are 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.

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 6 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 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 2, adults 50 and over, pregnant women, and people with a severe, life-threatening reaction to flu vaccines or any of their ingredients.

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). A special order would need to be placed for you if you would like something different.

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.

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.