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The flu vaccine and children: Here is everything parents need to know

“The flu vaccine is one of the safest vaccines we have, it’s one of the oldest vaccines we have,” a GP said.

THE FLU VACCINE will be free of charge for children aged two to 12 years in Ireland from October to December.

The vaccine is not compulsory but parents or guardians who want their children to be vaccinated can arrange this with their GP or pharmacist.

At-risk groups aged from six months to 69 years will also be able to get the vaccine for free, as part of measures announced in May. People aged 70 and over already have access for free and this will continue.

Some misinformation related to the vaccine and children in particular has been spreading online recently. in August debunked a false claim that children who didn’t get the flu vaccine would be banned from attending school, for example.

The HSE has advised people that “some online content can contain misinformation that is completely false, not fully accurate or not supported by experts”.

Dublin-based GP Maitiú Ó Tuathail said the flu vaccine is one of the safest vaccines a person can get and while this is the first time the vaccine is being rolled out for free to children in Ireland, children with underlying conditions have received it for years.

“It’s one of the safest vaccines, the reason why there is so much talk about it in Ireland is because we haven’t done it before, but the reality is that if you look at the United Kingdom and the United States, this has been the norm for many, many years, so it’s not like the flu vaccine for kids was invented this year, it’s been around for years and years and years.

“The flu vaccine is one of the safest vaccines we have, it’s one of the oldest vaccines we have. The components of the flu vaccine change year-on-year but it is a safe vaccine.”

The flu virus itself mutates and changes every year, so experts predict the most likely strains that the vaccine should target, based off the most common flu strains that circulate in the southern hemisphere – this year it’s Guangdong, Hong Kong, Washington and Phuket.

Ó Tuathail said vulnerable children have received the flu vaccine in Ireland for years.

“We give the flu vaccine to lots of kids. We give the flu vaccine to kids who have heart disease, liver disease, kids who’ve cancer, kids who’ve gone through chemotherapy, kids who’ve got diabetes. So actually children who are unwell with underlying medical problems have always got the flu vaccine, that’s the first misconception.

“So the most vulnerable and the sickest children in society have always got the flu vaccine. It’s just that what we’re doing now is actually giving the flu vaccine to children who are well, who don’t have underlying medical conditions.”

Covid-19 pressure

Ó Tuathail said one of the main reasons the flu vaccine is being made free for children this year is “purely economic”. He said the government has decided to invest in it this year because of the Covid-19 pandemic and the fact hospitals will already be under immense pressure this winter.

“We want to limit the amount of flu circulating within the community because as a society and a health service we can’t cope with both the flu and Covid,” he said.

Ó Tuathail said people should get the flu vaccine as early as possible, noting that another common misconception is that the flu vaccine actually gives people the flu.

“It takes two weeks for the flu vaccine to work and there’s no way that it can give you the flu, that’s one of the commonest misconceptions.”

He said some people get the flu vaccine too late and actually develop the flu in the two-week period before the vaccine takes effect.

Flu vaccines usually reduce the risk of infection by 40-60%. If a person gets the flu after they have the vaccine, it’s likely to be milder and they will recover more quickly.

The flu vaccine is being rolled out to children from mid-October until the end of the year. Ó Tuathail said this isn’t ideal as people should get the vaccine from mid-September to mid-October if possible to ensure they are protected.

He said the timing is “a little bit late” but is the result of delays caused by a global increase in demand for the vaccine.

“The plan was to deliver again in mid-September, but it’s very difficult as a country to get our hands on the vaccine because everybody in the world wants it.”

A spokesperson for the HSE said deliveries of the flu vaccine to GPs, pharmacies, hospitals and nursing homes began on 17 September, and they are confident it will receive adequate supplies in the coming weeks. The flu season runs from September until the end of April.

The HSE has set a target uptake of 75% for those aged 65 years and older and for healthcare workers, in line with the World Health Organization’s target. The target uptake for the nasal flu vaccine for children aged two to 12 is 60%.

Data from Public Health England shows uptake of flu vaccine for children has increased each year with a national uptake of 60.8% for school-aged children and 44.9% for pre-school children in 2018/2019.

Ó Tuathail said “during a bad flu season, up to 2,000 people die” in Ireland. He said it’s a “no brainer” for both adults and children to get it to prevent the flu virus from circulating in the community.

“No one wants to their child to be sick and this is something you can do to prevent your child getting sick but I think, more importantly, not only are you trying to protect your child, you’re actually protecting yourselves, and the entire population.

“And if you want to be very selfish, we’re looking at a huge amount of disruption this winter. The guidelines around school are quite rigid and so if your child has a temperature or a cough, that means they will be sent home from school and it’s very difficult to differentiate the flu and Covid.

“If you want to limit the amount of disruption in your life, then just remove the flu as part of that. So if you vaccinate your child against influenza, at least you know you’re limiting the disruption to your child’s education and your own life, it’s a total no brainer.”

Here, we’re breaking down the information parents or guardians should know about the vaccine and answering some common questions.

What is the flu?

Influenza (flu) is a very infectious illness caused by the flu virus.

Flu spreads easily and infects both children and adults, but children are more likely than adults to get severe complications of flu which could result in them missing days in school or crèche.

What are the symptoms of the flu?

Flu symptoms are similar in both adults and children, but most children who get the flu have mild symptoms.

Common symptoms include muscle aches, high fever, headache and feeling weak. After a few days, a person may develop a cough. Other symptoms include a sore throat, difficulty sleeping, loss of appetite, diarrhoea or tummy pain, nausea and vomiting.

Children can also get pain in their ear and may be less active than usual.

What are the complications of flu children could experience?

Most children who get the flu have mild symptoms. But every winter some children can get complications such as pneumonia, bronchitis, inflammation of the brain (encephalitis) – but the latter is rare. Children with these complications may need hospital treatment or intensive care.

Children with chronic health conditions are at risk of serious complications from flu.

In the last 10 years, the HSE said almost 5,000 children were admitted to hospital with complications of flu. Almost 200 children had to have treatment in intensive care and 40 children died.

How is the flu vaccine given?

The vaccine will be given to children via a nasal spray – a single spray in each nostril of a child’s nose. The child can breathe normally while getting the vaccine, there is no need to take a deep breath or sniff.

The vaccine is not painful and is absorbed quickly. It will work even if the child has a runny nose, sneezes or blows their nose after the vaccination, the HSE states.

Most children only need one dose of the vaccine each year. Some children with chronic health conditions such as heart or lung conditions may need two doses. The doses are given four weeks apart if they have never had a flu vaccine.

Where can a child get the flu vaccine?

A child can get the vaccine for free at their GP’s surgery or a pharmacy from mid-October to the end of December 2020.

The HSE has ordered 600,000 doses of the nasal drop vaccine for children which should provide for a 75%-80% uptake rate. 1.4 million doses of adult flu vaccine have been secured for this season, this is sufficient for over 90% of the target groups or the at-risk cohort.

There have been some delays in the delivery of the flu vaccine to date, but supplies are expected to arrive in the coming weeks.

Children in Ireland haven’t been given the flu vaccine in the past, why now?

A campaign to encourage people of all ages to get the flu vaccine will be rolled out in the coming weeks to decrease the number of people who get the flu this winter in a bid to prevent hospitals becoming overwhelmed as they also cope with the Covid-19 pandemic. 

The flu vaccine is the best protection against flu in children, the HSE notes.

Younger children are at high risk of developing complications from influenza like pneumonia or ear infections, and, in rare cases, an inflammation of the brain or worsening of a chronic disease like serious heart disease and asthma.

Although it hasn’t been used in Ireland to date, the nasal flu vaccine has been licensed for more than 15 years. It was first licensed in 2003.

Since then it has been given to millions of children in many countries around the world, including the US, Canada, Finland and the UK. The vaccine has been given to children in the US since 2003 and in the UK since 2013.

What are the side effects of the nasal flu vaccine?

The most common side effects are mild and include:

  • a runny or blocked nose
  • headache
  • muscle aches
  • some children get a fever (temperature) after the vaccine; it is usually mild and goes away on its own

If a child has a fever or a headache, the HSE advises the use of paracetamol or ibuprofen.

“Aspirin, or any medicines that contain aspirin, should never be given to children unless prescribed by a doctor. This is especially important in the four weeks after getting the flu vaccine,” the HSE notes.

Serious side effects to the flu vaccine, such as a severe allergic reaction, are rare. There is no evidence that a child can catch the flu from the nasal flu spray.

The nasal flu vaccine is a live vaccine, what does that mean?

The nasal flu vaccine is a live attenuated vaccine.

The HSE states: “The word “attenuated” means that the vaccine is made with influenza viruses that are weakened so that they cannot cause influenza infection.

“All live vaccines contain weakened viruses or bacteria. They don’t cause disease but instead stimulate the body to produce proteins called antibodies that fight infection.”

The HSE notes that live vaccines have been given to children in Ireland since the 1950s, when the oral polio vaccine was first introduced.

Live vaccines that are given to children in Ireland today include the rotavirus vaccine given to babies at two and four months, and the MMR (measles, mumps and rubella) vaccine given to children at 12 months and in junior infants.

Is the flu vaccine safe?

“All vaccines are thoroughly tested to make sure they will not harm you or your child.

“The flu vaccine for children has a good safety record. Millions of children in the US and the UK have been vaccinated safely and successfully,” a HSE spokesperson said.

What ingredients are in the vaccine?

There is no thiomersal, aluminum or mercury in the flu vaccine used in the 2020/2021 campaign.

There is “a very small amount” of gelatin in the nasal flu vaccine, the HSE notes. Gelatin is used as a preservative in the vaccine.

You can read more about the vaccine (Fluenz Tetra) and its ingredients here

What are the reasons a child should *not* get the flu vaccine?

A child should not get the vaccine if they:

  • have had a severe allergic reaction to a previous dose of the flu vaccine or any of its ingredients
  • have severe asthma or if they have been wheezy or needed their inhaler more than usual in the three days before the vaccination
  • are taking medicines called salicylates, which include aspirin
  • have a severely weakened immune system because of certain medical conditions or treatments
  • are living with someone who has a severely weakened immune system – for example, a person who recently had a bone marrow transplant

The nasal spray is not licensed for children under the age of two.

If a child is aged six months to two years and is in a high-risk group for flu, they’ll be offered a flu vaccine injection. If a parent or guardian has questions about this, they should speak to their GP or pharmacist.

Should getting the flu vaccination be delayed for any reason?

If a child does not feel well or has a high temperature, the vaccination can be delayed until they feel better.

If a child has a very blocked or runny nose, it might stop the vaccine from getting into their system. In this case, getting the vaccine should be delayed until their nose is clear.

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