Tag Archives: immunisation

Nasal flu vaccine

Live attenuated influenza vaccine (LAIV).  Now available in quadrivalent form, Fluenz Tetra in Europe, Flumist in US.  Transmission to another person has only ever been documented once, and it was asymptomatic!

The extra B hopefully makes it better than 2014/15 where poor coverage.  Live attenuated is more effective and has less systemic effects than injected vaccines.

Current annual programme in Scotland is for all 2-5yr olds to be offered vaccine by public health, whereas all primary and secondary school children will be offered vaccine at school.
Cut off for 2yr olds is age 2 on 1st September.
For infants between 6 months and 2, previous hospital admission for lower respiratory tract infection (which would include all our bronchiolitis babies!) is a clinical risk indicator, along with asthma, chronic heart/kidney/neuroresp disease, or indeed anything else where you thing getting flu is likely to exacerbate the underlying condition.

If you miss your school appointment, up to the family to request another via NHS Lanarkshire vaccine helpline 01698 687456.

Although GPs aren’t much involved anymore in vaccine programme, they should still offer it if a family prefers it, or if a family are keen to get it earlier than they might otherwise as part of the schools programme.

Most kids will be offered nasal live flu vaccine (Fluenz Tetra).  Contraindications to nasal flu vaccine are:

  • under 2yrs of age,
  • wheezing or extra bronchodilator within the previous 72 hours,
  • severe immunodeficiency (esp cellular) or immunosuppression eg leukaemia/lymphoma, high dose oral steroids
  • aspirin use (eg Kawasaki) – theoretical risk of Reyes [reported with wild type influenza and aspirin]

Kids on high dose inhaled steroids no longer require consultant approval to get nasal vaccine.

Kids previously in PICU for asthma, or who require regular oral steroids for asthma, require consultant approval to get nasal vaccine. Otherwise they should get injectable.

If you can’t have nasal, then should get injectable (inactivated) vaccine.  Can be given from age 6 months.

A second dose is needed after 4 weeks minimum if you are in a clinical risk group, and under 9yrs, and this is the first time you are getting flu vaccine.  This applies whether you get nasal or injectable flu vaccine.

For egg allergy, advice, as before, is that children with egg allergy – including those with previous anaphylaxis to egg – can be safely vaccinated with nasal vaccine in any setting (including primary care and schools). The only exception is for children who have required admission to intensive care for previous severe anaphylaxis to egg, who should be offered nasal flu vaccine in hospital [lack of data, not definite risk!].

If a kid with egg allergy has a contraindication to nasal flu vaccine (eg immunosuppressed) and needs injectable vaccine, then it should be either an egg free (cell based) injectable vaccine (the one from Seqirus is licensed from age 2) or low egg content (“split virion inactivated vaccine”), viz less than 0.12mcg/ml (equivalent to 0.06 µg for 0.5 ml dose).