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Dear Dr. Roach: For the 2015-2016 flu season, we find a trivalent vaccine (three influenza virus), quadrivalent vaccine (four influenza virus) and high-dose trivalent recommended for seniors 65 and older. As a member of the senior group, I would like your opinion on the best choice. Why do they still supply the trivalent when the quad protects against four flu viruses? The high-dose trivalent is only for seniors, but the quad seems to be a better choice. This is confusing; please help us understand.

J.H.

Dear J.H.: Let me preface my answer by saying that any influenza vaccine will provide some protection against flu.

There actually are six different types of FDA-approved flu vaccines available for the 2015-2016 season. In addition to the three you mention (standard- and high-dose trivalent and quadrivalent), there also are two trivalent vaccines made without eggs (particularly useful for those with an egg allergy); an intradermal vaccine that uses a tiny needle (90 percent smaller than regular needles) for people who really don’t like shots; and, unlike all other flu vaccines (which are inactivated virus), a live attenuated vaccine given via a nasal spray, which may be better in children, and is approved only for ages 2-49.

If you do have a choice, I would recommend the high-dose trivalent for those over 65, and the quadrivalent for those under 65, unless you fall into one of the special situations above (fear of shots, egg allergy).

Dear Dr. Roach: I had my spleen removed many years ago, for a rare form of severe anemia. The operation was a success. I have my pneumonia shot every five years. In a previous column, you mentioned a meningitis shot; how often should you get that one? Also, I would like to know where to get a medical alert bracelet for “splenectomy.” I do not have a computer!

H.M.P.

Dear H.M.P.: It sounds like you had a form of autoimmune hemolytic anemia, which has been treated by splenectomy for many years (it was originally suggested as a treatment by a medical student, a fact I enjoyed when I was early in my training). The meningitis vaccine is given as a two-shot series for people age 2 through 55. A booster dose is recommended every five years.

There are several companies that make medical alert bracelets, and your doctor might have information in her or his office. Two large ones are Medical Alert Foundation at 800-432-5378 (800-668-1507 in Canada) and American Medical ID at 800-363-5985.

Dear Dr. Roach: I’m an 80-year-old woman who recently developed an itchy rash and right-sided chest pains radiating to the back. An EKG was fine. I had my gallbladder removed in the 1990s, and a CT scan showed that the surgical clips had migrated. Is this dangerous? Should they be removed?

S.T.

Dear S.T.: I found many case reports of surgical clip migration after surgery, despite the fact that several papers say the phenomenon is rare. It has been reported 14 years after the surgery, and yours seems like it may be even longer. In some cases, the clips caused inflammation of the liver and bile ducts. I doubt this is the cause of your symptoms, but I do think it is worth a visit to your surgeon. Very often, the clips don’t cause any problems, but I can’t answer whether it’s a problem for you.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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