A Case of Seasonal Influenza: Getting Ahead of The Suspect At Large
Last September, I told you flu season was sneaking up on us. Well, here we are again!
The flu is a repeat offender. It comes back every single fall, and every year it shows up in a slightly different disguise. So appropriate for the month of Halloween, I suppose! But that's what makes it so tricky, and honestly, it's why this year's post isn't just me saying "go get your flu shot" again (although, yes, please go get your flu shot).
There's some genuinely new information this year. The vaccine has been updated to go after the strain that made so many of you miserable last winter, there's a brand-new type of flu shot on the market, and (this is the part I'm most excited about) members can now get their flu shot right here in our office! So let's dig in.
The Short Answer
When: September or October, ideally before the end of October. If you haven't gotten yours yet, now is the time.
Who: Everyone 6 months and older, with very rare exceptions.
Which one: It depends on your age and health. Adults 65+ should get a high-dose, adjuvanted, or recombinant shot, and a new mRNA option is available for adults 50+.
Where: Right here! I recently learned of an ordering option that doesn’t require a bulk purchase and True Insight members can get flu shots in the office at just $24. Your local pharmacy works too– but really, who wants to wait in those lines?!
What's Different About This Year's Flu Shot?
Every year, the experts update the flu vaccine based on which strains they expect to circulate. This year, all three strains in the vaccine were updated. The big one to know about is a mutated version of H3N2, nicknamed subclade K. It spread widely last season and was behind the vast majority of the H3N2 cases CDC tracked.
Why did it catch so many people off guard? Flu viruses mutate constantly, a little at a time. The strains for each year's vaccine have to be picked months in advance, so when a new variant pops up after that decision is made, it can get a head start on us. Subclade K did exactly that. The good news is that this year's vaccine was built with it in mind.
How Bad Was the Last Flu Season?
If you were sick last winter, you had plenty of company. (It was the club no one actually wants to be part of! CDC estimates somewhere between 32 and 57 million people had the flu last season, and between 390,000 and 800,000 people ended up in the hospital.
Interestingly, the flu was pretty quiet through the fall last year. Then it came roaring in during January and February, and it didn't just bring the usual upper respiratory symptoms. A lot of people got hit with GI symptoms too, like diarrhea, on top of the congestion and cough. And it wasn't a quick in-and-out. For many of my patients, symptoms hung on for a couple of weeks.
One of my patients went through it while her husband was out of town. She hunkered down at home and battled diarrhea for days, all on her own, and she didn't tell me until it was all over! I could've smacked her (lovingly, of course). I could have swung by her house after leaving the office one evening, dropped off some meds, and helped her recover faster. That's the beauty of DPC!
So consider this your official reminder: if you're sick, tell me. That's what I'm here for!
And for some people, it goes much further than a rough couple of weeks. "It's just the flu" is something I hear every year, and sometimes it really isn't. Every winter, otherwise healthy people end up in the hospital, and some end up in the ICU. I don't say that to scare anyone. I say it because it's preventable, and I want you on the right side of it.
Why I Recommend the Flu Shot to Everyone
I recommend the flu shot to every one of my patients, and after last year, I feel even more strongly about it.
Is it 100% guaranteed? No, and no vaccine is. You can still catch the flu after getting your shot. But it does two really important things: it lowers your chances of getting sick in the first place, and if you do get sick, it's usually much less severe.
Here's how I explain it. The vaccine gives your immune system a sneak peek at the flu, so it recognizes the invader. Then when the virus shows up, your body takes one look at it and says, "Woah, wait a second. We’ve met before and you’re not a nice guy!" Instead of wondering if the invader is safe or not, it acts right away.
The vaccine still helps in years when it isn't a perfect match. It’s as though your immune system looks at the virus and says “Hey, I know your brother and he’s bad news. I can’t trust you either. Get outta here!” A strong family resemblance is usually enough for your body to recognize the troublemaker!
When Should You Get Your Flu Shot in 2026?
CDC recommends getting vaccinated in September or October, ideally before the end of October. So if you're reading this in October, you're still right on time. Just don't wait too much longer!
Already got yours in September? Wonderful! You're all set for the season.
It takes about two weeks for your body to build its protection, and that protection slowly fades over the following months. Get your shot too early (say, in July) and it may be wearing thin by the time flu peaks in the winter. Wait too long, and you're unprotected when flu starts making the rounds here in the Triangle. North Carolina's own public health guidance points to the same September and October window.
If October comes and goes and you still haven't gotten yours, don't skip it. It's still worth getting as long as the flu is circulating. Last year is a perfect example: the flu stayed relatively quiet until it hit hard in January, so even a November shot had plenty of time to do its job.
Young children getting their very first flu vaccine may need two doses, four weeks apart, and pregnant women have their own timing considerations. If either of those is you, just reach out and we'll figure it out together.
Not All Flu Shots Are the Same
This is one of my favorite things to point out, because most people assume a flu shot is a flu shot. It isn't! There are several versions, and depending on your age and health, one may be a better fit than another:
Standard-dose shot. This is the go-to for most healthy adults under 65.
High-dose, adjuvanted, or recombinant shot. If you're 65 or older, these are the ones CDC recommends. Our immune systems don't respond quite as strongly as we get older (I don't love it either), and these versions are designed to give it an extra boost.
Egg-free options. Some versions are made without eggs at all. That said, current guidance says people with an egg allergy can safely get any age-appropriate flu vaccine.
Nasal spray. For people ages 2 to 49 who aren't pregnant and don't have underlying health conditions since it is a live attenuated vaccine. A good option if you (or your kiddo) would rather skip the needle.
mRNA flu vaccine. New this year, for adults 50 and older. More on this one below, because I know it's going to get people talking.
There's no single "best" flu shot. There's the best one for you, and that's where having a doctor who actually knows your history comes in handy.
Let's Talk About the New mRNA Flu Shot
I know. The minute you hear "mRNA," your mind goes straight to the COVID vaccine, and that comes with a lot of feelings for a lot of people. I get it, and those questions deserve real answers. So let's set the headlines aside for a minute and just look at the science, because I think it's a lot less scary than people expect.
In August, the FDA approved mFLUSIVA, the first mRNA flu vaccine in the U.S., for adults 50 and older. In a study of more than 40,000 adults, it was about 27% more effective at preventing the flu than a standard flu shot.
How traditional flu shots are made
Most flu shots are made by growing the actual flu virus (usually in chicken eggs, sometimes in cells), inactivating it, and pulling out the pieces your immune system needs to see. It's a tried-and-true method, but it takes around six months, which is a big reason the strains have to be chosen so far ahead of time.
How an mRNA flu shot works
An mRNA vaccine skips growing the virus altogether. Instead, it hands your cells a short set of instructions. I like to think of it as a recipe card. That recipe tells your cells how to make one harmless piece of the flu virus, a protein from its outer surface, so your immune system can get a good look at it and learn what to watch for.
A few things I want you to know:
There's no flu virus in it. There's no live virus in it, not even a whole dead one. It can't give you the flu.
It doesn't touch your DNA. Your DNA lives in the nucleus of your cells, and mRNA never goes in there. It simply can't change your DNA.
It doesn't stick around. Your body breaks down the mRNA within a few days, just like it breaks down the mRNA it makes on its own every single day. What stays behind is the immune memory, not the mRNA
It isn't brand-new science. Scientists have been studying mRNA for decades. COVID was just the first time most of us heard about it.
There's a really neat bonus, too. mRNA vaccines can be updated in a couple of months instead of six, which means a better shot (pun intended) at matching whatever strain is actually going around.
What about side effects?
I'll be upfront with you here. In the trials, side effects like a sore arm, feeling tired, headache, or achy muscles were a bit more common than with standard flu shots. They were usually mild and gone within a day or two. That's your immune system doing its homework, not the flu. I’d rather have those brief side effects than full-on flu anyday! The internet is full of stories of “perfectly healthy” people ending up incapacitated in ICU. Nope, not risking it– ain’t nobody got time for that! (I hear Ms Brown’s voice everytime!)
So is the mRNA shot right for you? Maybe! It's one good option, not a requirement. If you're 50 or older and curious about it, let's talk. And if you'd feel more comfortable with a traditional flu shot, that's a great choice too.
I believe in vaccines, and I'll always tell you what I recommend. But your body is your body. My job is to give you the evidence, walk you through the risks and benefits, and answer every question you've got. Then the decision is yours, and I'll respect it. As I've said many times, the beauty of DPC is that I have the time to educate you and the freedom to honor your choices.
Will the Flu Shot Give Me the Flu?
Nope! None of the flu shots can cause an infection. What some people feel afterward is their immune system gearing up: a sore arm, maybe a crummy, low-energy day. Other times, someone just happened to catch a cold around the same time and the shot takes the blame. Poor flu shot.
Can I Get My Flu Shot at True Insight? Yes!
In last month's newsletter, I mentioned I was looking into carrying flu vaccines in the office. Well, I have good news!
In the past, I've sent you to the pharmacy for your flu shot. Vaccines usually have to be ordered in big bulk packs, and for a practice our size, that means wasted doses or higher costs landing on you. That just didn't sit right with me. But it turns out I can order flu vaccines in packs of 10! So this year, members can get their flu shot right here in the office at cost– just $24 We’ll have the standard trivalent option.
So if you'd like a flu vaccine, I can hook you up, without the crazy big box store stuff! No long lines, no waiting around. Just send me a message through SigmaMD and we'll get you taken care of.
A few notes for transparency, because that's how I do things:
Insurance covers it at the pharmacy? If your insurance covers your flu shot at no cost at the pharmacy, go there and save yourself some lunch money! No hard feelings!
Need a specific type? If you need a type I don't have on hand, I'll help you figure out exactly what to ask for before you go.
Higher risk? If you're 65 or older, pregnant, managing a chronic condition, immunocompromised, or you've had a reaction to a flu shot before, let's talk before you get vaccinated, wherever you get it. It's a quick conversation that can make a real difference.
Frequently Asked Questions… Let’s Sum It Up!
When is the best time to get a flu shot in 2026?
September or October, ideally before the end of October. If you miss that window, it's still worth getting as long as the flu is circulating.
Is the 2026–2027 flu shot different from last year's?
Yes. All three strains were updated, including a change to protect against H3N2 subclade K, the strain that spread so widely last season.
Which flu shot is best for adults over 65?
CDC recommends a high-dose, adjuvanted, or recombinant flu vaccine for adults 65 and older. The new mRNA flu vaccine is also approved for this age group.
Can an mRNA flu vaccine change my DNA?
No. (Get off the Sci-Fi channel!) The mRNA never enters the nucleus of your cells, where your DNA is stored, and your body breaks it down within a few days.
Does True Insight Direct Care give flu shots?
Yes. This season, True Insight members can get their flu shot in the office at cost. Dr. Barrett can also help you choose the right type if you'd rather go to a pharmacy.
Let's Get Ahead of It This Year
The flu is coming back this fall. It always does. But you don't have to be caught off guard by it. Get your shot this month, pick the one that fits you, and give your immune system the heads-up it deserves.
Already part of the True Insight family? Send me a message through SigmaMD to get your flu shot here in the office, or if you're not sure which one is right for you. I'll point you in the right direction!
Not a member yet? I'd love to meet you! Schedule a free Meet & Greet and see what it's like to have a doctor who actually has time for questions like these (and who can give you your flu shot, too).
Stay well out there,
Dr. B
