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Influenza

Influenza is a seasonal viral infection that is caused by infection with one of two viruses – Influenza A or Influenza B. In the UK it usually peaks during the winter months with the season starting a few weeks after the children return to school in September.

Although vaccines are available to help prevent infection with Influenza there are many different sub-types of the virus and therefore predicting which particular virus is going to cause most infections in a particular year is difficult. This is because the virus is made up of two major proteins; the H protein and the N protein. This is how the different strains of influenza are named, according to the types of H & N proteins that are present on the virus surface. Slight variations in the protein give rise to different types of influenza such as H1N1 or H3N2 . There are many different combinations of these 2 proteins and any vaccine that is produced has to be specific to a particular virus.

Bird flu (also known as Avian Influenza) is a form of Influenza virus that affects the bird (avian) population. It is not currently considered a threat to human populations. The H7N9 avian virus gave rise to human cases in spring 2013 in China. Although control measures have largely regulated the spread of this virus there have been approximately 800 laboratory confirmed cases since the initial outbreak in 2013, however, very few cases have been reported in children and sustained human to human transmission appears to be rare.

Swine flu arises from the H1N1 variant of the influenza virus (although there are other variants such as H3N2) and was responsible for the pandemic declared by the World health organisation between March 2009 & August 2010. This particular virus appeared to have more gastrointestinal affects compared with standard seasonal influenza.

Influenza A virus appears to have a peak transmission from infected patients at 1 – 2 days after the onset of symptoms. In contrast, Influenza B virus appears to peak in terms of transmission at 2 days before the onset of symptoms to 2 days after.

In 2015 influenza infections peaked over the months of January to February with a rapid fall in the spring months.

Influenza is transmitted by secretion droplets such as through coughing, sneezing or by direct touch.

Vaccination in children may help to prevent acquiring the disease and passing it onto others (see section on nasal spray vaccination below). Each year the nasal flu spray protects against four of the flu strains which are most likely to be around. It prevents 50% – 60% of flu cases.

The vaccine contains gelatine, used as a stabiliser. The gelatine comes from pigs, but very sensitive scientific tests have shown that no DNA from pigs can be detected in the nasal flu spray. This may however be important for some parents. (Link to vaccine information) . The vaccine also contains sucrose, potassium and monosodium glutamate. There is no thiomersal (mercury). Patients with severe egg anaphylaxis are contraindicated to receiving the vaccine but the amount of ovalbumin (egg protein) is so small that those with mild egg allergy can receive the vaccine safely at their GP surgeries.

Giving your child a vaccination can be a difficult decision for some parents, we hope that by supplying you with the information we can help you make an informed choice.

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Treatment for Influenza is largely supportive (paracetamol, ibuprofen and fluids) although anti-viral agents such as Oseltamivir (Tamiflu) have been used during the early stages of the disease in some children. This drug is not without it’s own side effects and it’s effectiveness is subject to debate.

The following advice on flu vaccination in children is taken from NHS choices

At what age should children have the nasal spray flu vaccine?

In the autumn/winter of 2016-17, the vaccine will be available free on the NHS for eligible children, including:

  • children aged two, three and four on August 31 2016 – that is, children born between September 1 2011 and August 31 2014
  • children in school years one, two and three
  • in some parts of the country, all primary school-aged children will be offered the vaccine as part of a test programme
  • children aged 2 to 17 with long-term health conditions

Over the next few years the programme will be extended gradually to include older children.

Who will give the children’s flu vaccination?

Children aged two, three and four years will be given the vaccination at their general practice, usually by the practice nurse.

Children that are 5 years old are also eligible for flu vaccination provided they were 4 on the 31 August 2016. These children should be offered flu vaccination at their general practice as they will not be offered it in reception year at school.

Children in school years one, two and three are likely to have their vaccination in school. In some areas it may be offered in other community health settings.

Children at higher risk from flu

Children aged 2 to 17 with long-term health conditions such as diabetes are at higher risk from flu.

It’s especially important that they are vaccinated with the annual flu nasal spray instead of the annual flu jab, which they were previously given.

Children between the ages of six months and two years who are at high risk from flu are offered the annual flu jab, usually at their GP surgery.

What are the side effects of the flu vaccine for children?

The nasal spray flu vaccine has very few side effects – the main one is getting a runny nose after vaccination for a few days.

Read more about the side effects of the flu vaccine for children.

How to get the flu vaccine for your child

Your child’s GP or school should contact you about getting them vaccinated before the winter.

Talk to the GP, practice nurse or your child’s school nurse if you want more information about when and how your child will be vaccinated against flu.

If you haven’t heard from their GP by early November 2016, contact them directly to make an appointment.

How is the nasal spray flu vaccine given?

The vaccine is given as a single spray squirted up each nostril. Not only is it needle-free – a big advantage for children – the nasal spray is quick, painless, and works even better than the injected flu vaccine.

The vaccine is absorbed very quickly. It will still work even if, after the vaccination, your child develops a runny nose, sneezes or blows their nose.

Are there any children who should delay having the nasal spray flu vaccine?

Children should have their nasal spray flu vaccination delayed if they:

  • have a runny or blocked nose
  • are wheezy

If a child has a heavily blocked or runny nose, it might stop the vaccine getting into their system. In this case, their flu vaccination should be postponed until their nasal symptoms have cleared up.

If a child is wheezy or has been wheezy in the past week, their vaccination should be postponed until they have been wheeze-free for at least three days.

Are there any children who should not have the nasal spray flu vaccine?

There are a few children who should avoid the nasal spray flu vaccine.

The vaccine is not recommended for children who have:

  • a severely weakened immune system
  • severe egg allergy
  • severe asthma – that is, those being treated with steroid tablets or high-dose inhaled steroids
  • an allergy to any of the vaccine ingredients, such as neomycin

Children unable to have the nasal spray vaccine may be able to have the injectable flu vaccine instead.

Why children are offered flu vaccine

Flu is a very common infection in babies and children. It can be very unpleasant for them.

Children with flu have the same symptoms as adults – including fever, chills, aching muscles, headache, stuffy nose, dry cough and a sore throat lasting up to a week.

Some children develop a very high fever or complications of flu, such as bronchitispneumonia and a painful middle ear infection.

They may need hospital treatment, and very occasionally a child may die from flu.

In fact, healthy children under the age of five are more likely to have to be admitted to hospital with flu than any other age group.

For children with long-term health conditions such as diabetesasthmaheart disease or lung disease, getting flu can be very serious as they are more at risk of developing serious complications.

Learn about the five reasons to vaccinate your child against flu (PDF, 461kb).

Read more about the complications of flu.

How safe is the flu vaccine for children?

The flu vaccine for children has a good safety record. In the UK, millions of children have been vaccinated safely and successfully.

How does the children’s flu vaccine work?

The vaccine contains live but weakened flu viruses that do not cause flu in children. It will help your child build up immunity to flu in a similar way as natural infection, but without the symptoms.

Because the main flu viruses change each year, a new nasal spray vaccine has to be given each year, in the same way as the injectable flu vaccine.

Stopping the spread of flu

The nasal spray flu vaccine will not only help protect your child against flu, the infection will also be less able to spread from them to their family, carers and the wider population.

Children spread flu because they generally don’t use tissues properly or wash their hands.

Vaccinating children also protects others that are vulnerable to flu, such as babies, older people, pregnant women and people with serious long-term illnesses.

Read more about how flu is spread.

How many doses of the flu vaccine do children need?

Most children only need a single dose of the nasal spray.

The patient information leaflet provided with the nasal spray suggests children should be given two doses of this vaccine if they’ve not had flu vaccine before.

However, the NHS vaccination programme has advised that healthy children only need a single dose because a second dose of the vaccine provides little additional protection.

Children aged two to nine years at risk of flu because of an underlying medical condition, who have not received flu vaccine before, should have two doses of the nasal spray given at least four weeks apart.

Dr Tim Ubhi

Review date: January 2019