section_path: Prevention/Vaccination
section_name: Vaccination
paragraph_text: Vaccination
  
  Annual vaccination is the primary and most effective way to prevent influenza and influenza-associated complications, especially for high-risk groups. Vaccines against the flu are trivalent or quadrivalent, providing protection against an H1N1 strain, an H3N2 strain, and one or two influenza B virus strains corresponding to the two influenza B virus lineages. Two types of vaccines are in use: inactivated vaccines that contain "killed" (i.e. inactivated) viruses and live attenuated influenza vaccines (LAIVs) that contain weakened viruses. There are three types of inactivated vaccines: whole virus, split virus, in which the virus is disrupted by a detergent, and subunit, which only contains the viral antigens HA and NA. Most flu vaccines are inactivated and administered via intramuscular injection. LAIVs are sprayed into the nasal cavity.
  
  Vaccination recommendations vary by country. Some recommend vaccination for all people above a certain age, such as 6 months, whereas other countries limit recommendations to high-risk groups. Young infants cannot receive flu vaccines for safety reasons, but they can inherit passive immunity from their mother if vaccinated during pregnancy. Influenza vaccination helps to reduce the probability of reassortment.
  
  In general, influenza vaccines are only effective if there is an antigenic match between vaccine strains and circulating strains. Most commercially available flu vaccines are manufactured by propagation of influenza viruses in embryonated chicken eggs, taking 6–8 months. Flu seasons are different in the northern and southern hemisphere, so the WHO meets twice a year, once for each hemisphere, to discuss which strains should be included based on observation from HA inhibition assays. Other manufacturing methods include an MDCK cell culture-based inactivated vaccine and a recombinant subunit vaccine manufactured from baculovirus overexpression in insect cells.