Flu 2019/20 - Childhood flu vaccination programme
Which children are eligible?
- 6m - 2 years in a clinical “at risk” group
- 2 years – 10 years with or without a clinical risk
- 11yr - 17 yr in a clinical “at risk” group
All those aged 2-3 years (but not four years or older) on 31st August 2019 (i.e. date of birth on or after 1st September 2015 and on or before 31st August 2017) are eligible for flu vaccination in general practice under the childhood immunisation programme and not under the DES.
All children in primary school born between 1st September 2008 and 31st August 2015 would normally be vaccinated at school. Practices can vaccinate at risk children only and other children will need to attend their school.
With the schools programme it will take some time to vaccinate all children. Parents of any child at risk because of an underlying medical condition can choose to have their child vaccinated at their GP surgery.
What about those children who are not in a clinical risk group?
They should be offered a single dose of LAIV.
The Joint Committee on Vaccinations & Immunisations JCVI has considered this issue and has recommended that as a second dose of the vaccine provides only modest additional protection.
What about children who are in the clinical risk group?
Children in clinical risk groups aged 2 to less than 9 years who have never had a flu vaccine before should be offered 2 doses at least 4 weeks apart.
Please refer to your local PGD and Public Health guidelines on the administration, contraindications and precautions when administering a flu vaccine to children.
What are the types of vaccines available for children?
There are two types of vaccine available for children in 2019/20
- Live nasal vaccine LAIV
- Inactivated injectable flu vaccine (QIVe)
Both the live and inactivated flu vaccines are quadrivalent vaccines – they contain two subtypes of Influenza A and both B types.
LAIV has been shown to more effective compared to QIVe in children, it replicates natural infection and better long-term protection. It has a good safety policy in children over 2 years of age. Slides 23-25 in the national childhood flu immunisation programme training slides.
LAIV should be offered unless contraindicated. For further information about the childhood flu immunisation programme 2019/20, please refer to the annual flu letter from DH/PHE/NHS England: Childhood flu vaccination programme
LAIV is based on a form of gelatine derived from pigs. Some faith groups do not accept porcine gelatine in medical products . Only those who are in clinical risk groups should be offered inactivated injectable vaccine as an alternative.
A child who is not in a clinical risk group whose parents decline LAIV will continue to derive benefit from the programme by virtue of reduction of transmission amongst peers. They will not be eligible for an inactivated vaccine (QIVe)
How is the vaccine administered?
Administration of the vaccine is via a nasal applicator which delivers just 0.1ml (around 1/50th of a teaspoon) of fluid into each nostril. Clear diagrams showing administration are provided in the SmPC and NHS Education for Scotland has made a video for health professionals on how to administer the vaccine.
Can other people present be at risk of catching the vaccine as it is ‘sprayed’?
There is not a ‘mist’ of vaccine virus in the air when children are being vaccinated and therefore others in the room should not be at risk of “catching” the vaccine virus. The room or school in which administration of nasal influenza vaccine has taken place does not require any special cleaning afterwards.
Health care workers who are immunocompromised and those who are pregnant can safely administer the vaccine. As a precautionary measure, however, very severely immunocompromised healthcare workers should not administer LAIV
Do you have to defer the vaccination due to acute illness?
Acute severe febrile illness
If the child has an acute severe febrile illness, LAIV administration should be deferred until recovered. Minor illnesses without fever or systemic upset are not valid reasons to postpone vaccination.
Heavy nasal congestion
If the child is at risk. As heavy nasal congestion might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration until resolution of the nasal congestion or use of an appropriate alternative intramuscularly administered flu vaccine should be considered
LAVI should not be administered at the same time or within 48 hours of cessation of treatment with the above.
Antiviral flu agents should not be administered within 2 weeks of a child having been given LAVI as this can impact on the effectiveness of the vaccine. There is no data on
What if you think you have administered an incomplete dose of the LAVI vaccine?
It is not necessary to repeat the dose of vaccine if at least 0.1ml of the vaccine has been given intranasally as each half dose (0.1ml) contains enough viral particles to induce an immune response.
If the vaccine is accidentally squirted into the child’s eye, it may cause some slight irritation to the eye and eyewash/normal saline should be used to wash out the eye. The child/parent should be advised to seek medical advice if any irritation occurs and persists beyond what might reasonably be expected.
What to do if the child refuses the second half of the vaccine dose after the first half has been given?
As each half dose (0.1ml) contains enough viral particles to induce an immune response, it is not necessary to offer an inactivated vaccine or a repeat live vaccine on another occasion as each half dose (0.1ml) contains enough viral particles to induce an immune response
What if you inadvertently give LAIV to a child who is aged less than 24 months?
Please refer to the Childhood Flu Programme (pg. 21).
LAIV is contraindicated in all children aged less than 24 months due to an increase in adverse events in this age group. An increase in wheezing and hospitalisation was observed in clinical trials that included children aged from six to 23 months of age. The decision not to license the vaccine for use in children aged less than 24 months was based on these observations rather than vaccine efficacy in this age group.
Children who have received LAIV at less than 24 months of age do not require a replacement dose. The inadvertently administered vaccine should count as a valid dose as LAIV will provide protection in this age group. However, the child’s parents/carers should be informed of the possible adverse events in the short term and advised to seek medical care if adverse events occur. They should be reassured that no long-term effects from receiving LAIV are anticipated.
Children from six months of age in clinical risk groups who have not received a flu vaccine previously should count the inadvertently administered LAIV as the first dose. The child should also be offered the inactivated flu vaccine four weeks later to complete the two dose schedule (in line with the recommendation that children aged six months to under 9 years who have not received inactivated flu vaccine previously should be offered a second dose at least four weeks after the first dose).
If the child reaches their second birthday in the four weeks between the dose of LAIV and when a second dose of flu vaccine would be due, a further dose of LAIV can be given (if not contraindicated). Healthcare professionals should report the administration error via their local governance system(s) so that lessons can be learnt, and the risk of future errors minimised.
Inadvertent administration of LAIV to a child who is immunosuppressed
If an immunocompromised individual receives LAIV then the degree of immunosuppression should be assessed. If the individual is severely immunocompromised, antiviral prophylaxis should be considered, otherwise they should be advised to seek medical advice if they develop flu-like symptoms in the four days (the usual incubation period) following administration of the vaccine. If antivirals are used for prophylaxis or treatment, then in order to maximise their protection in the forthcoming flu season, the patient should also be offered inactivated influenza vaccine. This can be given straight away.
Healthcare professionals should report the administration error via their local governance system(s) so that the appropriate action can be taken, lessons can be learned, and the risk of future errors minimised.
Contraindicatoins to LAIV
- confirmed anaphylactic reaction to a previous dose of flu vaccine
- confirmed anaphylactic reaction of LAIV (e.g. gelatine) or residue from the manufacturing process (e.g. gentamicin), except egg proteins (see details below on egg allery)
- clinically severely immunocompromised due to a condition or immunosuppressive therapy such as:
- acute and chronic leukaemias
- HIV infection not on highly active antiretroviral therapy (HAART)
- cellular immune deficiencies
- high dose corticosteriods
- recieving salicylate therapy
- known to be pregnant
Also contraindications for children with acute and severe asthma - see next section
Acute and Severe Asthma
New guidance for 2019 from JCVI based on recent data
- children with asthma on inhaled corticosteroids may safely be given LAIV irrespective of the dose prescribed
- LAIV is not recommended for children and adolescents currently experiencing an acute exacerbation of symptoms including
- those who have had increased wheezing and/or
- needed additional bronchodilator treatment in the previous 72 hours
Such children should be offered a suitable inactivated influenza vaccine to avoid a delay in protection
- children who require regular oral steroids for maintenance of asthma control, or have previously required intensive care for asthma exacerbation should only be given LAIV on advice of their specialist
As these children may be at higher risk on influenza infection, those who cannot receive LAIV should receive a suitable inactivated influenza vaccine.
Children with significant asthma and aged under nine years who have not been previously vaccinated against influenza will require a second dose (of either LAIV or inactivated vaccine as appropriate).
- children with egg allergy (including those with previous anaphylaxis to egg) can be safely vaccinated with LAIV in any setting (including primary care and schools)
- chilren who have required admission to intensive care for a previous severe anaphylaxis to egg should be given LAIV in the hospital setting
- children with both egg allergy and a clinical risk factor that contraindicate LAIV (e.g. immunosuppression) should be offered an* inactivated flu vaccine with a very low ovalbumin content (less than 0.12µg/ml)
- children over age nine years with egg allergy can also be given the quadrivalent inactivated egg-free vaccine, Flucevax® Tetra
- egg allergic children with asthma can receive LAIV if their asthma is well controlled (see previous section on severe asthma)
* children in a clinical risk group and aged under nine years who have not previously been vaccinated against influenza will require a second dose whether given LAIV or inactivated vaccine.
For a full set of training slides on the 2019/20 childhood flu immunisation programme, visit https://publichealthengland-immunisati.app.box.com/s/gk0rhxdo2hgi5oni44wyegdx83cpa7wa/file/491162007044
Can the flu vaccine (LAIV) be given with other vaccines?
Although it was previously recommended that, where vaccines cannot be administered simultaneously, a four-week interval should be observed between live viral vaccines. JCVI has now advised that no specific intervals need to be observed between the live attenuated intranasal flu vaccine and other live vaccines.
NHS Flow Chart - Which Flu Vaccine Should Children Have
Click here to print a full size copy of this flow chart