Annual Flu Shot: A Quick Refresher for Nurse Practitioners

It's October, your schedule is full, and half your patients have a reason they'd rather skip the flu shot. The flu vaccine is one you recommend all day, so here's a quick refresher on who needs it, which type to use, and how to talk patients into it.

Who should get the flu vaccine

• Everyone 6 months and older, unless contraindicated.
• Highest priority groups:
  • Adults 65 and older
  • Pregnant patients
  • Immunocompromised patients
  • Chronic conditions (asthma, COPD, heart disease, diabetes, CKD, liver disease)
  • Healthcare workers and caregivers

Vaccinate before flu season starts, ideally September through October, but anytime during the season is better than skipping it.

Vaccine types for adults

• Standard-dose, inactivated flu shot: the most common.
• High-dose or adjuvanted flu vaccine: recommended for adults 65 and older for a stronger immune response.
• Live attenuated nasal spray (LAIV): for healthy, non-pregnant adults under 50 (rarely used in primary care).

Contraindications and precautions

• Severe allergic reaction to a previous flu vaccine or component.
• Egg allergy is not a contraindication. Use any age-appropriate flu vaccine.
• Delay vaccination if the patient has a moderate or severe acute illness.

Counseling patients

• Set expectations: mild soreness, low-grade fever, and fatigue may occur.
• Dispel the myth: the flu shot does not cause the flu.
• Motivate hesitant patients: emphasize prevention of hospitalization, especially in older adults and those with chronic illness.

Why it matters in primary care

• Annual flu epidemics cause thousands of deaths and hospitalizations each year.
• Vaccination protects not just patients, but their families and communities.
• A quick flu shot at a wellness visit is powerful prevention.

The short version

• Recommend the flu vaccine to all adults unless contraindicated.
• Use high-dose or adjuvanted options for patients 65 and older.
• Counsel patients proactively to build vaccine confidence.

Frequently asked questions

"The flu shot gave me the flu last year." How do I respond?
The injectable flu vaccine is inactivated and can't cause the flu. Soreness, low-grade fever, and fatigue for a day or two are normal immune responses, not infection.

My patient has an egg allergy. Can they still get it?
Yes. Egg allergy is not a contraindication. Use any age-appropriate flu vaccine and follow your usual post-vaccination observation.

Is it too late in the season to vaccinate?
No. Earlier is better, but any time during the season is better than skipping it. As long as flu is circulating, vaccinating still helps.

If the harder part is keeping every preventive decision straight in a packed day, the Clinical Desk Reference is a $37 quick-reference for everyday primary care, and the Primary Care Clinical Mastery Program is the AANP-accredited deep dive. You can also read the related guides on the Hep B vaccine, the pneumococcal vaccine, the shingles vaccine, and the Tdap and Td boosters guide.

Education only. Use clinical judgment and your local guidelines.

Written by Allison Sowders, MSN, APRN, FNP-BC, a practicing primary care nurse practitioner and founder of Nurse Practitioner Mentor. Reviewed July 2026.