There wasn't much flu around last winter – but this year it's different. Last winter, we were all locked down or keeping our distance and flu viruses didn't have much chance to circulate; this year, now that we're meeting and mixing again, experts are predicting flu could come back with a vengeance. That's why all children in England between the ages of 2 (as at 31 August 2021) and year 11 of secondary school are now being offered the nasal-spray flu vaccine free on the NHS.


Not sure if it's worth your child getting the vaccine? Well, I'm not just a GP; I'm a mum of 3 – and my children, aged 6, 9 and 13, are all having their flu vaccines. I've already made sure I've signed their flu vaccination consent forms. Flu's a nasty illness that can seriously affect children – and the families around them – and the needle-free nasal flu vaccine is a quick and easy way to protect them from it.

Here, I'm going to answer your most-asked questions about the nasal flu vaccine that's offered to children and explain why it's so important this year…

Why do children need a flu vaccine?

Flu is more than the common cold; it is a respiratory illness which can have serious complications in children. It commonly causes a high fever, sore throat and dry cough, as well as aches and pains, headaches, fatigue and loss of appetite. But in some cases, it can go on also to cause bronchitis and pneumonia (a serious lung infection) and ear infections. Children under the age of 5 have the highest rate of admissions to hospital related to flu.

Children are also flu superspreaders. Even if they don't get it too badly themselves, they can easily spread it to other people, especially family members, and some of them will be those who may be more likely to become seriously unwell if they catch flu, including elderly people, babies and those with chronic health conditions.

So, especially this year when it's thought there may be a lot of flu around, ensuring that your child gets the flu vaccine not only protects them but helps protect others in your household, social lives or wider family over the Christmas period.

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What is a nasal spray vaccine? Does that mean it's not an injection?

A nasal spray vaccine is as the name suggests; a vaccine which is given via a spray into the nose (actually, into each nostril). The vaccine is delivered with a syringe and plunger (as in the picture above) but no needles are involved – and it's pain-free!

How do I know if my child is the right age to get a free nasal spray flu vaccine?

All children over the age of 2 (as from 31 August 2021) up to, and including, children in year 11 of secondary school in England are eligible for the nasal flu vaccination free on the NHS. This is a different – and wider – age range than last year (when the vaccine was only offered to children up to year 7 of secondary school).

Why is it being offered to children older than 11 this year?

The flu vaccination programme for children was started in 2013 after the independent Joint Committee on Vaccination and Immunisation (JCVI) recommended vaccinating children against flu, both to protect children as well as reduce the transmission of flu in general. This programme has been gradually rolling out since then, with more age groups added each year.

This year, however, due to concerns regarding potential high flu numbers (and this all happening at the same time as Covid-19 is still in circulation), the programme's been extended to even more age groups – right up to year 11 of secondary school – which means that you might have a child who's eligible for the flu vaccine this year but wasn't last year.

My child is under 2. Why can't they have it?

The nasal flu vaccination spray is not licensed for children under 2, so in this age group the nasal flu vaccine is not given. If your child is over 6 months old but under 2, they may be eligible for a flu vaccination (by injection) if they have a chronic health condition or if they have ever been admitted to hospital for a lung infection, such as bronchiolitis. If you think this applies to your child, please talk to your GP.

How do I know the nasal flu vaccine is safe?

The nasal flu vaccine has been used widely in the United States since 2007 and in the UK child vaccination programme since 2013 – with good safety data. Last year, over 4 million children in the UK had the vaccine. My 3 children will be all be having the vaccine this year.

What are the side effects of the nasal flu vaccine?

Most children don't get any side effects but, if they do, they are generally mild – and much less serious than developing flu or the complications of flu. The most common side effects include a headache, muscle aches and pains, a runny, stuffy or blocked nose, fever, feeling weak and tired, and reduced appetite. If any of these side effects happen, they tend only to last a few days, and I'd suggest giving age-appropriate doses of paracetamol for pain or fever, if required.

It's worth noting that some children might sneeze a bit after having had the vaccine: don't worry, the spray is absorbed very quickly, so sneezing doesn't mean the vaccine is sneezed out (no 2nd dose needed!).

nasal flu vaccine

What's in the nasal flu vaccine exactly?

The nasal flu vaccine contains small amounts of attenuated – or weakened – flu virus. In healthy children, this then stimulates immunity to flu but doesn't cause a flu infection.

Other ingredients include water and, used to keep the vaccine stable, sucrose, dipotassium phosphate, potassium dihydrogen phosphate, gelatine, arginine hydrochloride and monosodium glutamate monohydrate. These are only present in tiny amounts – and, despite their long names, are chemicals we already have in our bodies or consume regularly.

The gelatine is a hydrolysed gelatine derived from pork but highly purified so that no porcine DNA remains. If you don't want your child to have the nasal flu vaccine because of this, either for religious reasons (different religious groups may have different rules on this) or because your child is vegan, then the injectable flu vaccination is an alternative.

It's also important to know that the vaccine is manufactured using a technology that involves eggs, so there is also a very small amount of ovalbumin present1. The JCVI has said that most children with egg allergy can still safely have the nasal flu vaccine2 but if your child has a severe allergy to eggs or you're worried, please speak to your GP.

There may also be traces of gentamicin in the vaccine, an antibiotic that is used in the manufacturing process to stop the vaccine becoming contaminated with bacteria. So, if your child has an allergy to gentamicin, they will be offered an alternative vaccine.

Are there some children who shouldn't have the nasal flu vaccine?

If your child is severely asthmatic and is treated with oral steroids, they should not have the nasal vaccine. If they are currently wheezy, or have been wheezy in the past 3 days, the vaccine should be delayed until at least 3 days after the wheezing has stopped.

Children who have a condition which severely weakens their immune system, such as blood disorders or certain cancers, or who are on chemotherapy may also be advised not to have the vaccine. If your child lives with or is in close contact with someone with a severely compromised immune system, it may be advisable for your child to have the injectable flu vaccination. Please discuss this with your GP.

Most children with egg allergy can be immunised with the nasal flu vaccine2 (as I explained above) but if they have had a severe allergic reaction (anaphylaxis requiring intensive care treatment), they may be offered the vaccine in a hospital, rather than GP or school, setting. If your child has an allergy to another component of the vaccine such as gelatine or gentamicin, they should not have the nasal flu vaccination. If this is the case, your GP may advise that they have the injectable flu vaccination instead.

What if my child has just had a Covid vaccine? Is it OK to have the flu vaccine so soon after?

It is fine and safe to have the Covid and flu vaccine together on the same day, or close to each other. Parents often ask if having vaccines together will 'overload' or 'overwhelm' the immune system but they won't. We all encounter lots of viruses every day, so our immune systems are used to dealing with more than one thing at a time. And vaccines don't attack the immune system; they train it, so that it can fight these infections in the future.

Can the nasal flu vaccine give my child flu?

No, the virus in the nasal vaccine has been weakened so that it cannot give your child flu. Some children may develop flu-like symptoms, though, as side effects of the vaccine (see above) but having the vaccine decreases your child's risk of catching flu or becoming seriously unwell with it.

That said, there are some situations where you child might still catch flu after having had the vaccine. There are multiple strains of flu virus and the nasal flu vaccine doesn't protect against them all, so it's possible for your child to be unlucky enough to catch a different strain of the flu to those in the vaccine. It is also possible, of course, for your child to be exposed to the flu in the few days before they receive the vaccine, or in the 2 weeks afterwards before they have built up immunity.

Can I or someone else in my family catch flu if my child sneezes near me after having had the nasal flu vaccine?

Children do shed the virus via sneezing or coughing for a few days after they have had the vaccine but, as the virus in the vaccine is weakened, it can't spread like normal flu and the amount shed is so small, it is below the amount normally required to pass on to others.

However, if your child lives with someone or is in close contact with someone with a severely compromised immune system (a bone marrow transplant patient needing isolation, for example), it may be best for your child to have the injectable flu vaccination. Please discuss this with your GP.

Where can my child get the flu vaccine?

Where your child is offered the vaccine will depend on their age...

  • If your children is between 2 years old (on the 31 August 2021) and the start of primary school, they will be offered the nasal flu vaccine through your registered GP surgery, even if they attend nursery.
  • If your child is in primary and secondary school, they will receive the nasal flu vaccine at school – as long as you have signed and returned the parental consent form.
  • If your child is homeschooled, they will be invited for vaccination by your local healthcare team. If you do not receive an invitation, ask at your GP surgery where they should go for the vaccine.
  • If your child is over 6 months and has a health condition that means they're eligible for a flu vaccine but they are not in the groups being offered it at school, you can ask for them to have the vaccine at your registered GP surgery. Your child should have the vaccine every year.

When will my child get the vaccine?

When your child is offered the vaccine will depend on their age...

  • If your child is over 2 (on the 31 August 2021) but not yet in primary school, you will be contacted by your GP to arrange an appointment for the nasal flu vaccine – or you can contact your GP yourself.
  • If your child is in school, then the school will send home a parental consent letter for the flu vaccine for you to sign and return to the school (it might come home in their school bag or via email). Your school will then inform you of the date that the school's immunisation team will be attending your child's school.
  • If your child is over 6 months and has a health condition that means they're eligible for a flu vaccine, your GP should contact you to arrange an appointment – or you can contact your GP yourself. If your child is old enough to be in the groups being offered it at school, you can still ask your GP to give your child the vaccine, if that's what you prefer. Your child should have the vaccine every year.

Where can I find out more?

You can find out more at the dedicated child flu vaccine page on the NHS website.


1 All influenza vaccines available in the UK for the 2021 to 2022 season. Public Health England, June 2021
2 2020/2021 Influenza vaccine recommendations for children with egg allergy and/or asthma. British Society for Allergy and Clinical Immunology, Oct 2020


Pictures: Getty Images

About our expert Dr Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy's, King's and St Thomas's medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.