Formulary
Influenza vaccine (live): Indications, Dosing, Side Effects and Interactions
For influenza vaccine (live) The live influenza vaccine is a nasal spray containing live attenuated strains; it protects people at high risk from influenza...
MedNext Academy | 5 min read
Influenza vaccine (live): Indications, Dosing, Side Effects and Interactions
For influenza vaccine (live) The live influenza vaccine is a nasal spray containing live attenuated strains; it protects people at high risk from influenza...
Drug action
For influenza vaccine (live) The live influenza vaccine is a nasal spray containing live attenuated strains; it protects people at high risk from influenza and reduces transmission of infection. For information on the inactivated vaccines, see influenza vaccine (inactivated) .
Indications and dose
**Annual immunisation against seasonal influenza for influenza vaccine (live)**
- **Child 2-17 years** (By intranasal administration): 0.2 mL for 1 dose, to be administered as 0.1 mL into each nostril.
**Annual immunisation against seasonal influenza (for children in clinical risk groups, or who are household contacts of others in clinical risk groups, and who have not received seasonal influenza vaccine previously) for influenza vaccine (live)**
- **Child 2-8 years** (By intranasal administration): 0.2 mL for 1 dose, followed by 0.2 mL for 1 dose, after at least 4 weeks. Dose to be administered as 0.1 mL into each nostril.
Cautions
For all vaccines, general Acute illness; minor illnesses Cautions, further information Illness UKHSA advises vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. Predisposition to neurological problems UKHSA advises: when there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended ; advice on the management of fever should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended ; children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and peri-natal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule; when there is a still evolving neurological problem , including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable. Impaired immune response and drugs affecting immune response Immune response to vaccines may be reduced in immunosuppressed patients, UKHSA advises consider seeking specialist advice. Cautions For all vaccines, live Cautions, further information Impaired immune response and drugs affecting immune response There is a risk of generalised infection with live vaccines. UKHSA advises seek specialist advice for immunosuppressed patients, including those who are: taking high doses of corticosteroids (dose equivalents of prednisolone: adults , at least 40 mg daily for more than 1 week or at least 20 mg daily for more than 14 days; children , 2 mg/kg (or more than 40 mg) daily for more than 1 week or 1 mg/ kg (or more than 20 mg) daily for more than 14 days); taking immunosuppressive drugs; receiving treatment for malignant or non-malignant conditions with chemotherapy or generalised radiotherapy. UKHSA advises live vaccines should be postponed until at least 3 months after stopping high-dose systemic corticosteroids, or non-biological oral immune modulating drugs; and at least 6 months after stopping other immunosuppressive drugs, or generalised radiotherapy; and at least 12 months after discontinuing immunosuppressive biological therapy. Cautions For influenza vaccine (live) Nasal congestion Cautions, further information Nasal congestion Vaccination should be postponed in children with heavy nasal congestion due to the potential for reduced vaccine delivery, but may proceed if there are mild symptoms of a cold without congestion. M
Contraindications
For all vaccines, live Contra-indications, further information Impaired immune response UKHSA advises severely immunosuppressed patients should not be given live vaccines (including those with severe primary immunodeficiency). Contra-indications For influenza vaccine (live) Active wheezing; concomitant use with antiviral therapy for influenza; concomitant use with salicylates (in children); severe asthma Contra-indications, further information Concomitant use with antiviral therapy for influenza UKHSA advises avoid immunisation for at least 48 hours after stopping the influenza antiviral agent. Administration of influenza antiviral agents within two weeks of Fluenz administration may reduce the effectiveness of the vaccine.
Side effects
For all vaccines, general Common or very common Abdominal pain; appetite decreased; arthralgia; diarrhoea; dizziness; fatigue; fever; headache; lymphadenopathy; malaise; myalgia; nausea; skin reactions; vomiting Uncommon Hypersensitivity Side-effects For all vaccines, live Common or very common Abdominal pain; arthralgia; diarrhoea; fever; headache; myalgia; nausea; skin reactions; vomiting Uncommon Dizziness Side-effects For influenza vaccine (live) Common or very common Nasal complaints Uncommon Epistaxis; face oedema Frequency not known Guillain-Barre syndrome
Pregnancy
For all vaccines, live UKHSA advises live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection, but where there is a significant risk of exposure to disease the need for vaccination may outweigh any possible risk to the fetus. Termination of pregnancy following inadvertent immunisation is not recommended. Pregnancy For influenza vaccine (live) Avoid-limited information available. M
Breast feeding
For all vaccines, live Although there is a theoretical risk of live vaccine being present in breast milk, vaccination is not contra-indicated for women who are breast-feeding when there is significant risk of exposure to disease. Breast feeding For influenza vaccine (live) Avoid-limited information available. M
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Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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