Child flu

Flu immunisation is offered to children aged 2–5 years old, and not yet in primary school, through their GP practice (children must be aged 2 years or above on 1 September 2015 to be eligible). All primary school children are also offered the vaccine at school.

Questions and answers:

What is flu like for children? 

Children get the same flu symptoms as adults. These symptoms are worse than a normal cold and include:

  • Fever
  • chills
  • aching muscles and joints
  • headaches
  • extreme tiredness.

Symptoms can also include a stuffy nose, dry cough and sore throat. These symptoms can last between two and seven days. Some children have a very high temperature, sometimes without other obvious symptoms, and need to go to hospital for treatment. Complications from flu can include:

  • bronchitis
  • pneumonia
  • painful middle ear infection
  • vomiting
  • diarrhoea.

For children with certain long-term medical conditions (chronic respiratory, heart, kidney, liver or neurological disease; diabetes; immunosuppression; or no fully working spleen) getting flu can be even more serious as it’s likely to make their medical condition much worse. In severe cases, which are very rare, flu can lead to disability and even death.

Why do we need to protect children and adults from flu?

The flu virus spreads quickly. It infects adults and children very easily, causing an unpleasant illness which can be serious. It may lead to days spent ill in bed rather than being at school or doing day-to-day activities. Children who get flu usually pass it on to family members too.

How does flu spread?

The flu virus spreads through the air when people cough and sneeze without covering their nose and mouth. Other people then breathe in the virus directly or pick it up by touching surfaces where it has landed and touch their eyes, nose and mouth. Because young children don’t always cover their mouths when coughing or sneezing, flu is passed on very quickly among this age group. Anyone who is in close contact with a young child should ensure good personal hygiene, for example, washing their hands.

Who is being offered the vaccine?

The vaccine is offered to all primary school children, as well as children aged 2–5 years who are not yet in primary school. Children in secondary school are not currently included in the programme. However, children of all ages with a long-term medical condition will still be offered the flu vaccine from 6 months of age.

Where and when will my child get the vaccine?

Children aged 2-5 years and not yet in primary school

All children aged 2–5 years and not yet in primary school will be offered the vaccine between October and December. You will be sent a letter about contacting your GP practice to arrange an appointment for your child.

Primary school children 

All primary school children are being offered the vaccine in school between October and December. If your child has a long-term medical condition they may previously have received the flu vaccine from your GP, but now all primary school children are being offered the vaccine in school.

How is the vaccine given?

For most children, the flu vaccine is given as a nasal (nose) spray into each nostril. It is not an injection. It’s quick and it’s painless. There’s no need to sniff or inhale the vaccine; only a tiny amount is sprayed into each nostril.

Watch our short film, explaining how the vaccine is given in school.

An alternative form of the flu vaccine may be suitable for children who cannot have the nasal spray. These children will be offered a flu vaccine as an injection in the upper arm.

What if my child is ill on the day?

If your child is very unwell (for example, with a fever, diarrhoea or vomiting), or if your child’s asthma has worsened (with more wheezing or increased use of their inhalers three days before their immunisation) they should not have the vaccine. If you have any concerns and your child is aged 2-5 years and not yet in school, phone your GP practice to arrange another appointment. If you have any concerns and your child is in primary school, speak to your school nurse team. Otherwise there is no reason to delay.

What is my child misses their immunisation? 

If your child is aged 2–5 years and not yet in school, contact your GP.  If your child is in primary school and misses their immunisation at school, please contact your local NHS Board (on the number in the letter that was sent you with the leaflet) to find out about alternative arrangements.

I’ve heard the vaccine is live. Does this mean my child will get flu?

No, the virus in the vaccine has been weakened so that it doesn’t cause flu. It helps your child build up immunity to flu, in the same way as a natural infection (but without the severe symptoms). Flu viruses are constantly changing – the strains may be different each year and are selected to offer the best protection each flu season. The flu vaccine should start to protect most children about 10 to 14 days after they receive their immunisation.

Does my child need a second dose?

Almost all children will only need one dose of the nasal spray vaccine. However, if your child is under 9 years old, has a long-term medical condition and is getting the flu vaccine for the first time, they will need a second dose (4 weeks after the first) to make sure their immunity has fully built up. So the next time your child comes into contact with the flu virus they should be protected and will not get seriously ill.

If your child is under 9 years old, was given the injectable vaccine and this was their first ever flu vaccine, they will require a second dose even if they do not have a long-term medical condition.

If your child is aged 2-5 years and not yet in school, your GP will advise you. If your child is in primary school, please contact your local NHS Board (on the number in the letter that was sent to you with the leaflet) to find out about local arrangements.

Are there any reasons why my child shouldn’t have the nasal (nose) spray vaccine?

There are very few children who cannot have the nasal spray vaccine. The reasons for this are outlined below. These children will be offered an injection in the upper arm.

Children who are severely immunosuppressed (unable to fight off most infections) should not have the nasal spray vaccine. Children who are severely immunosuppressed include those: 

  • whose immune system is suppressed because they are undergoing treatment for a serious condition such as a transplant or cancer
  • who have any condition which affects the immune system, such as severe primary immunodeficiency
  • who are taking regular high doses of oral steroids.

Also, children should not have the nasal spray vaccine if:

  • They have had a severe reaction to a previous dose of the vaccine, or any ingredients in it
  • They are undergoing salicylate treatment (taking aspirin).

Egg allergy

Children with an egg allergy can safely have the nasal spray vaccine, unless they have had a life-threatening reaction to eggs (or products containing eggs) that required intensive care.

Asthma

The nasal spray vaccine may not be suitable for some children with severe asthma who are taking high doses of inhaled steroids, or if they have recently been prescribed oral steroids. Your GP will advise you about this.

Pork gelatine

The nasal spray vaccine contains a small trace of pork gelatine. Gelatine is a common and essential ingredient in many medicines, including some vaccines. Many faith groups, including Muslim and Jewish communities have approved the use of gelatine-containing vaccines. It is, however, an individual choice whether or not to receive the nasal spray vaccine and we recognise that there will be different opinions within different communities. The nasal spray is a much more effective vaccine than the injection in children. However, those who choose not to have the nasal spray vaccine for religious reasons may request the injectable alternative. 

If your child is aged 2-5 years and not yet at school, please discuss this with your GP or practice nurse.

If your child is in primary school, please tick the box on the consent form if you wish to request the injectable alternative. You will be sent a consent form for your child every year of primary school (you child will not automatically be offered the injectable alternative – you will need to tick the box every year). 

Which vaccine is being used? 

The flu vaccine being used for children in Scotland, is a live attenuated (a weakened form of the virus which cannot cause disease but which protects against flu) nasal spray vaccine. Most flu vaccines contain two influenza A strains, and one B strain, providing protection against three strains. However, the nasal spray vaccine contains two influenza B strains and therefore may provide better protection against the circulating B strain(s) than trivalent (vaccines which contain three strains) flu vaccines.

In cases of contraindication such as immunosuppression or if a child’s asthma has worsened (with more wheezing or increased use of their inhalers three days before their immunisation), pregnancy or salicylate therapy, consideration should be given to the use of inactivated (i.e. injectable) flu vaccine (Fluarix Tetra for children over 3 years old and inactivated influenza vaccine (Split Virion) BP for under 3 years old).

For more information on the inactivated (i.e. injecatble) vaccines for children please follow the links below:

Patient information leaflet – Fluarix Tetra for children over 3 years old

Patient information leaflet – inactivated influenza vaccine (Split Virion) BP for children under 3 years old

Will there be any side effects of the vaccine?

As with all medicines, side effects to the flu vaccine are possible but usually mild and may include a headache and muscle aches. Some, but not all, children may experience a runny or blocked nose following the nasal spray. Less common side effects include a nosebleed after the nasal spray.

The vaccine is absorbed very quickly so, even if your child gets a runny nose or sneezes immediately after the spray, there’s no need to worry that it hasn’t worked.

For more information on the side effects of the vaccine please read the patient information leaflet (external link).

Is the vaccine safe?

Before they are allowed to be used, all medicines (including vaccines) are tested for safety and effectiveness. Once they are in use, the safety of vaccines continues to be monitored.

The nasal spray flu vaccine has been used successfully and safely for several years in the USA and was given safely to hundreds of thousands of children in the last two years in the UK.

Will the vaccine interfere with my child’s natural immune system?

No, the vaccine helps children to build up immunity in the same way as a natural infection with flu, but without the severe symptoms.

Will my child be protected for life when they’ve had this vaccine?

No. Flu viruses are constantly changing and a different vaccine has to be made as time goes on to continue to protect against the new viruses. So next year’s vaccine may protect against different viruses from this year’s vaccine. This is why the flu vaccine is offered every year during autumn/winter.

How effective is the vaccine?

During the last 10 years, the flu vaccine has generally been a good match for the circulating strains of flu, even though it is not possible to predict exactly which strains will circulate each year. Being immunised is the best protection available against an unpredictable virus that can cause severe illness.

What if I change my mind? 

If you change your mind and your child is aged 2–5 and not yet at school, please contact your GP. 

If you change your mind and your child is at primary school, please telephone your local NHS Board on the number given in the letter you were sent with the leaflet. If you want to withdraw consent, you will need to follow this up in writing. If you want to give consent to your child’s immunisation, you will need to fill in a new consent form.

Where can I find more information?

You can talk to your health visitor, practice nurse or GP, or call the health information service NHS inform on 0800 22 44 88 (textphone 18001 0800 22 44 88). The NHS inform lines are open every day from 8am to 10pm and also provides an interpreting service.

Where can I report suspected side effects?

You can report any suspected side effects of vaccines and medicines through the Yellow Card Scheme.

This can be done online by visiting the Yellowcard website or by calling the Yellow Card hotline on 0808 100 3352 (available Monday to Friday, 10am to 2pm).

Last reviewed on 26 November 2015

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