Overview

With coronavirus (COVID-19) around it's more important than ever to get the flu vaccine.

Influenza (flu) is a respiratory virus with similar symptoms to COVID-19. It’s likely flu viruses and the virus that causes COVID-19 will both be spreading this autumn and winter.

The flu vaccine will reduce the risk of your child getting or spreading flu to friends and family who are at greater risk from flu and COVID-19, such as grandparents or people with health conditions.

The more people who are vaccinated against flu, the less likely it is that there will be a spike which would put pressure on the NHS on top of COVID-19.

Childhood immunisations are a high priority. Please bring your child to their immunisation appointment to protect them against flu.

If you need to use public transport to get to your appointment, this counts as essential travel.

If you think you or your child are showing symptoms of coronavirus phone the number on your invitation to rearrange your appointment.

Self-help guide

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Who's being offered the vaccine?

The flu vaccine's offered to all:

  • children in Scotland aged 2-5 years and not yet in school (children must be aged 2 years or above on 1 September 2020 to be eligible)
  • primary school children, normally at school

Children in secondary school aren't currently included in the programme. However, children of all ages with a health condition will still be offered the flu vaccine from 6 months of age.

Benefits of vaccinating your child against flu

Flu is very infectious and can be serious. Flu can lead to complications that may result in hospitalisation or even death.

Even healthy children can become seriously ill from flu and can spread it to family, friends and others. Every year in Scotland, children are hospitalised for the treatment of flu or its complications.

In some cases flu can lead to complications. These can include:

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

For children with health conditions getting flu can be even more serious. Health conditions that make children more vulnerable include:

Chronic respiratory disease (aged 6 months or older)

Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.

Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD).

Children who have previously been admitted to hospital for lower respiratory tract disease.

Chronic heart disease (aged 6 months or older)

Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease.

Chronic kidney disease (aged 6 months or older)

Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephritic syndrome, kidney transplantation.

Chronic liver disease (aged 6 months or older)

Cirrhosis, biliary atresia, chronic hepatitis from any cause such as hepatitis B and C infections and other non-infective causes.

Chronic neurological disease (aged 6 months or older)

Stroke, transient ischaemic attack (TIA).

Conditions in which respiratory function may be compromised, due to neurological disease (for example polio syndrome sufferers).

Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with:

  • cerebral palsy
  • learning disabilities
  • multiple sclerosis and related or similar conditions
  • hereditary and degenerative disease of the nervous system or muscles
  • severe neurological or severe learning disability
Diabetes (aged 6 months or older)

Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet-controlled diabetes.

Immunosuppression (aged 6 months or older)

Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant. HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (eg IRAK-4, NEMO, complement disorder).

Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day.

Asplenia or dysfunction of the spleen

This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction.

The vaccine

The flu vaccine is a quick, painless nasal (nose) spray, not an injection, and is the best available protection against flu.

A tiny amount of the vaccine is sprayed into each nostril.

Your child does not have to sniff or inhale the vaccine and will just feel a little tickle in their nose.  

Child flu spray 2020.jpg
The nasal (nose) flu vaccine spray can protect against flu.

Flu vaccine is safe

All medicines, including vaccines, are tested for safety and effectiveness before they're allowed to be used.

Once they're in use, the safety of vaccines continues to be monitored.

The nasal spray flu vaccine's been used safely since 2014 and millions of doses have been given to children in the UK.

Once they're in use, the safety of vaccines continues to be monitored by the Medicines and Healthcare products Regulatory Agency (MHRA).

What vaccine's used?

The Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal) is routinely used in Scotland.

The flu vaccine won't give your child flu

The virus in the vaccine has been weakened so it doesn’t cause flu. It helps your child build up immunity to flu.

Children who don’t get the vaccine are not at risk of catching flu from children who have had the vaccine.

The only exception to this would be children who are extremely immunocompromised (have a weakened immune system).

Children who can't have the nasal spray vaccine

An alternative injectable form of the vaccine is available for children who cannot have the nasal spray vaccine.

This includes children who:

  • have their immune system suppressed because they're getting treatment for serious conditions, such as cancer, or if they've had a transplant
  • have a serious condition which affects the immune system, such as severe primary immunodeficiency
  • live with or are in close regular contact with very severely immunocompromised people who require isolation
  • are taking regular high doses of oral steroids
  • have had a severe reaction to a previous dose of the vaccine
  • are undergoing salicylate treatment (for example, taking aspirin)

Children with egg allergies

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

An egg-free injectable vaccine which can be used in those from 9 years of age is available. If you're affected, please speak to your immunisation nurse for advice.

Children with severe asthma

The nasal spray vaccine may not be suitable for some children with severe asthma who regularly need oral steroids for asthma control. If you’re affected, please speak to your health professional for advice.

Consent forms

If your child is at school, please make sure you list all of your child’s medications on the consent form. All consent forms will be checked by a health or immunisation team before the immunisation session to make sure your child can have the nasal spray.

More information about the consent form and its completion and return.

Pork gelatine

The nasal spray vaccine contains a highly processed form of gelatine (pork gelatine) which is used in many essential medicines.

The gelatine helps keep the vaccine viruses stable so the vaccine provides the best protection against flu.

Many faith groups, including Muslim and Jewish communities, have approved the use of vaccines containing gelatine.

However, it's your choice whether or not you want your child to get the nasal spray vaccine.

The nasal spray vaccine is a much more effective vaccine than the injected flu vaccine and is the preferred option.

If your child is in primary school, and you do not want your child to get the nasal spray vaccine for religious reasons, you may request the injectable alternative by ticking the box on the consent form (your child won't automatically be offered the injectable alternative – you'll need to tick the box every year).

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 isn't possible to predict exactly which strains will circulate each year.

Children aged 2-5 years old

All children aged 2–5 years as of 1 September 2020 and not yet in school will be offered the nasal vaccine from autumn onwards.

The flu vaccine should start to protect most children about 10 - 14 days after they get their immunisation, so the earlier your child can get the vaccine, the better.

You'll be sent a leaflet and letter about how to arrange your child's vaccination appointment.

What if my child's ill on the day?

Your child should not have the vaccine if they’re very unwell (for example with a fever, diarrhoea or vomiting). If this happens, phone the number on your invitation letter to rearrange your child's appointment.

If your child’s asthma is worse than usual in the 3 days before their vaccination, meaning they are wheezing more or have had to use their inhaler more than they normally do, tell the healthcare worker at their appointment.

There is no need to delay their immunisation, and they should be offered an alternative injectable form of the vaccine.

What if my child misses their immunisation?

If your child misses their appointment, phone the number on your invitation letter to reschedule your child's appointment.

Does my child need a second dose?

Almost all children will only need one dose of the vaccine.

However, if your child is under 9 years old they'll need a second dose (4 weeks after the first) if they:

  • have a health condition and this was their first time getting the flu vaccine - this will make sure their immunity has fully built up
  • were given the injectable vaccine and this was their first time getting the flu vaccine - even if they don't have a health condition

Your health professional will advise you if your child needs a second dose.

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

No, your child will need to get the flu vaccine every year. Flu viruses are constantly changing and a different vaccine has to be made every year to ensure the best protection against flu. This is why the flu vaccine is offered every year during autumn/winter.

Improving how vaccines are offered in Scotland

To improve how vaccinations are offered to you or your child, you may notice:

  • you're invited to a new location to receive your immunisations instead of your GP practice
  • the health professional giving your immunisations changes

You'll still receive clear information about the location, date and time of your appointment.

Primary school children

The flu vaccine is offered to all primary school children in Scotland. It's normally given at school between October and December. If your child has a health condition they're also offered the vaccine in school and no longer need to get it from your GP.

Your child will be sent home with a letter, leaflet and consent form. You should complete the consent form and send it back to school with your child. Your child can only get the nasal vaccine if you have sent back a completed and signed consent form.

You can view consent form guidance for full instructions on how to complete the consent form.

You and flu

This video introduces flu and the concept of immunisation in a fun and engaging way and shows how the nasal spray vaccine is administered.

What if my child's ill on the day?

Your child should not have the vaccine if:

  • they’re very unwell (for example, with a fever, diarrhoea or vomiting)
  • their asthma is worse than usual, meaning they are wheezing more or have had to use their inhaler more than they normally do in the 3 days before their vaccination

Otherwise there is no reason to delay getting the vaccine.

What if my child misses their immunisation?

If your child misses their immunisation in school, please contact your local NHS Board to find out about local arrangements for getting their vaccine at another time.

Does my child need a second dose?

Almost all children will only need one dose of the vaccine.

However, if your child is under 9 years old they'll need a second dose (4 weeks after the first) if they:

  • have a health condition and this was their first time getting the flu vaccine - this will make sure their immunity has fully built up
  • were given the injectable vaccine and this was their first time getting the flu vaccine - even if they don't have a health condition

Please phone your local NHS Board using the number on the letter that was sent to you to find out about local arrangements.

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

No, your child will need to get the flu vaccine every year. Flu viruses are constantly changing and a different vaccine has to be made every year to ensure the best protection against flu. This is why the flu vaccine is offered every year during autumn/winter.

What if I change my mind?

If you change your mind, phone your local NHS Board using the number on the letter that was sent to you.

To withdraw consent, you'll need to confirm this in writing. To give consent, you'll need to fill in a new consent form.

After the vaccine

As with all medicines, side effects of the nasal spray flu vaccine are possible, but usually mild.

These potential side effects are much less serious than developing flu or complications associated with flu.

Most children will not experience any side effects.

Common side effects from the nasal spray

However, if your child had the nasal (nose) spray vaccine, the most common side effects are:

  • a blocked or runny nose
  • reduced appetite
  • weakness
  • muscle aches
  • headache

Common side effects from the injection

If your child had the injectable vaccine, they might experience similar side effects to the nasal (nose) spray vaccine (except the blocked or runny nose).

The most common side effects are at the site where the injection was given:

  • swelling
  • redness
  • tenderness
  • a small hard lump

They usually go away after a couple of days and you don’t need to do anything about them. Less common side effects include a slightly raised temperature, shivering, tiredness or a nosebleed

More information on the possible side effects of the vaccine is available in the Fluenz Tetra nasal spray suspension Influenza vaccine (live attenuated, nasal)Patient Information Leaflet (PIL).

Public Health Scotland's booklet What to expect after the flu vaccine: information for parents (PDF, 320 KB) has more information.

Infant paracetamol

Vaccines protect your baby against the risk of very serious infections and should not be delayed.

Fever can be expected after any vaccination. Fevers are usually mild, so you only need to give a dose of infant paracetamol if your child isn’t comfortable or is unwell. Read the instructions on the bottle very carefully.

Fever is more common when the MenB vaccine is given with the other routine vaccines at 8 and 16 weeks. Infant paracetamol should be given to babies after each of these immunisation appointments.

Public Health Scotland’s booklet What to expect after immunisations: Babies and children up to 5 years has more information.

Caring for an infant with fever

In infants who do develop a fever after vaccination, the fever tends to peak around 6 hours after vaccination and is nearly always gone completely within 2 days.

Ibuprofen can be used to treat a fever and other post-vaccination reactions. Giving ibuprofen at the time of vaccination to prevent a fever is not effective.

Remember, never give medicines that contain aspirin to children under 16.

Information about treating a fever in children.

When to get help

If an infant still has a fever 48 hours after vaccination or if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111.

The diseases vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever.

If you're worried about your child, trust your instincts. Speak to your GP or phone the 111 service.

Flu vaccination, fever and coronavirus

It is quite common for children to develop a fever after a vaccination. This would normally happen within 48 hours of their vaccination and usually goes away within 48 hours.

You don't need to self-isolate or book them a coronavirus test unless they have other coronavirus symptoms (a new continuous cough or a loss of, or change in, sense of smell or taste) or:

  • you have been told by NHS Test and Protect that your child is a close contact of someone who has tested positive for coronavirus
  • you live with someone who has recently tested positive for coronavirus
  • you live with someone who has symptoms of coronavirus

If their fever started 48 hours after the vaccination or continues beyond 48 hours from the time of the vaccination, you should self-isolate and book a test for your child.

Your household should follow the guidance for households with possible coronavirus infection.

Reporting side effects?

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

This can be done by:

  • visiting the Yellow Card Scheme website
  • phoning the free Yellow Card hotline on 0808 100 3352 (available Monday to Friday, 9am to 5pm)

Further information

Vaccine Safety Net Member

Public Health Scotland is a proud member of the Vaccine Safety Net and partners with NHS inform to provide reliable information on vaccine safety.

The Vaccine Safety Net is a global network of websites, evaluated by the World Health Organization, that provides reliable information on vaccine safety.

More about the Vaccine Safety Net