Influenza vaccines – frequently asked questions (FAQs)

General questions about influenza vaccines

• What is influenza?
• What is the difference between influenza and the common cold?
• Who can get influenza, and how common is it?
• What are the complications of influenza?
• What types of seasonal influenza vaccines are available in Australia?
• Who is recommended to receive an influenza vaccine?
• Why are influenza vaccines funded for certain groups but not others?
• Why do healthy infants and young children need an influenza vaccine?
• When is the optimal time to receive an influenza vaccine?
• How should people protect themselves from influenza if they are travelling overseas or returning to Australia?
• How many doses of influenza vaccine are recommended for each influenza season?
• Does getting a second dose improve protection against influenza, especially in seasons that last longer than usual?
• For those requiring a second dose, does the same vaccine need to be administered?
• Should a person receive an influenza vaccine if they have already had influenza?
• How is the safety of influenza vaccines monitored?
• Is taking paracetamol recommended before getting an influenza vaccine, and does it reduce the effectiveness of vaccination?
• Can a person with an egg allergy receive an influenza vaccine?
• Can a person with a latex allergy receive an influenza vaccine?
• What is the difference between trivalent and quadrivalent influenza vaccines?
   

Questions about inactivated influenza vaccines (IIV)

• What is an inactivated influenza vaccine (IIV)?
• Who is recommended to receive an IIV?
• Who is eligible to receive a free IIV under the NIP?
• How can people access an IIV if they are not eligible for a free NIP-funded vaccine?
• How effective is IIV in preventing influenza illness?
• What is an ‘enhanced’ influenza vaccine, and how is it different from other influenza vaccines?
• Should pregnant women receive an IIV – and if so, when is the optimal to do so?
• Is it safe for breastfeeding mothers to receive IIV, and will it have any impact on milk supply?
• Can IIVs cause influenza?
• What are the common side effects after receiving an IIV?
• Are there any rare side effects after receiving an IIV?
• Who should avoid receiving an IIV due to contraindications, or receive it with caution?
• Can IIV be given at the same time (co-administered) as other vaccines?
   

Questions about intranasal live attenuated influenza vaccine (LAIV)

• What is an intranasal influenza vaccine?
• How does the intranasal influenza vaccine work?
• How is intranasal LAIV given and how many doses are needed?
• Is LAIV safe?
• Is LAIV effective?
• Can intranasal LAIV cause influenza?
• Who is eligible for free LAIV in Australia?
• What are the considerations for choosing between the injectable and intranasal influenza vaccine?
• Who should avoid receiving LAIV due to contraindications, or receive it with caution?
• Can LAIV be given at the same time as other vaccines?
• Can influenza virus be passed from a child who received the LAIV to close contacts?
• Can a child with asthma or wheeze receive LAIV?
• Can LAIV be given to a child who is using intranasal medications?
• Can a child receive LAIV while taking antiviral medications for influenza, and do these medications affect vaccine effectiveness?
• Can intranasal LAIV be given to a child who has a runny or blocked nose?
• Can intranasal LAIV be given to a child who is susceptible to nosebleeds?
• Can LAIV be given to a child with a cochlear implant?
• Can LAIV be given to a child with unrepaired craniofacial malformations?
• What if the full dose of LAIV is not administered?
• What if a child sneezes or blows their nose after receiving LAIV?
• What should be done if LAIV is inadvertently administered to a child who is immunocompromised?
• What should be done if a child less than 24 months of age receives intranasal LAIV?
• What should be done if LAIV is administered by a wrong route (i.e. other than intranasal)?
• Should pregnant or breastfeeding women receive LAIV?
• Do healthcare workers who frequently administer LAIV need to take any precautions?
• Can an influenza PCR testing be performed after LAIV vaccination?
• What advice is available regarding faith-related concerns about the porcine gelatine content in LAIV?

What is influenza?

Influenza is an acute respiratory illness that occurs after an infection with an influenza virus. It is often called ‘the flu’. 

Common symptoms include: 

• fever
• dry cough
• nasal congestion
• headache
• sore throat
• general symptoms such as feeling unwell, muscle aches, and pains and fatigue.
   

Influenza virus is mainly spread through large droplets from sneezing and coughing; these may be airborne and can be transmitted via inhalation and touching surfaces. 

What is the difference between influenza and the common cold?

A cold may cause some symptoms similar to those caused by influenza, but these symptoms are not caused by influenza viruses. Usually, influenza is more severe and lasts longer than a cold. 

Who can get influenza, and how common is it?

Influenza is the most common vaccine preventable disease in Australia – and anyone can get it. 

The number of affected people varies from year to year based on circulating virus strains and the level of immunity in the population. 

In 2024, 361,625 laboratory-confirmed influenza cases and 500 influenza-associated deaths were notified to the National Notifiable Disease Surveillance System.

What are the complications of influenza?

A small proportion of people infected with influenza may experience pneumonia, myocarditis and neurological complications. These complications can lead to hospitalisation and death. 

While people with pre-existing medical conditions are at highest risk of complications from influenza, complications can also occur in healthy individuals.

What seasonal influenza vaccines are available in Australia?

The following seasonal influenza vaccines are available in Australia for the 2026 influenza season.

• Injectable inactivated influenza vaccines (IIVs) including:
  • standard dose vaccines that are egg-based (e.g. Influvac, Vaxigrip, Fluzone) or cell-based (Flucelvax)  
  • enhanced adjuvanted (Fluad) or high-dose (Fluzone High-Dose) vaccines (see question What is an ‘enhanced’ influenza vaccine, and how is it different from other influenza vaccines?).
• Intranasal live attenuated influenza vaccine (LAIV, FluMist).
   

All seasonal influenza vaccines available in Australian from 2026 are trivalent vaccines. 

The Australian Technical Advisory Group on Immunisation statement on the administration of seasonal influenza vaccines in 2026 includes a table that details all seasonal influenza vaccines registered and available each year and whether they are funded under the National Immunisation Program (NIP).

Further information on the different types of influenza vaccines used globally can be found here.

Who is recommended to receive an influenza vaccine?

All people aged 6 months and over are recommended to receive an annual influenza vaccine to prevent serious illness and hospitalisation associated with influenza infection. 

Some groups are at a higher risk of influenza-associated complications and are especially recommended to receive an influenza vaccine. For these high-risk individuals, the vaccine is available for free under the NIP. (See question Who is eligible to receive a free IIV under the NIP?) 

From 2026, an intranasal influenza vaccine is available for free for certain children aged 2 to less than 18 years under some state programs. (See question Who is eligible for free LAIV in Australia?) 

Why are influenza vaccines funded for certain groups but not others?

The Australian Government Department of Health and Aged Care decides which vaccines to fund under the NIP and for which population groups. 

The Pharmaceutical Benefits Advisory Committee provides advice and recommendations to the Department of Health and Aged Care to inform these decisions.

For further information, see National Immunisation Program (NIP) vaccine listing process.

Why do healthy infants and young children need an influenza vaccine?

Influenza vaccination is recommended and funded under the NIP for all children aged 6 months to less than 5 years. Children in this age group – including those without pre-existing medical conditions – are more likely to get severe influenza infection resulting in hospitalisation. 

In 2025, about 1 in 400 to 500 children were diagnosed with laboratory-confirmed influenza. Healthy children infected with influenza can become severely ill and develop influenza-associated complications such as pneumonia and encephalitis.

When is the optimal time to receive an influenza vaccine?

An influenza vaccine is recommended before the start of the influenza season – which is typically around May in Australia. Optimal protection lasts for 3–4 months following vaccination. 

Immunisation providers should start administering influenza vaccinations as soon as the vaccine is available. 

The timing of peak influenza activity in Australia can vary each year. It typically occurs between May and September, but infections can occur year-round; the vaccines are therefore also available outside of the influenza season. 

It is never too late in the influenza season to get an influenza vaccine. 

How should people protect themselves from influenza if they are travelling overseas or returning to Australia?

Influenza vaccination is recommended prior to overseas travel, especially if it is known that influenza is circulating in the destination region.

A northern hemisphere formulation of influenza vaccine may be preferred prior to travel to the northern hemisphere during its influenza season (usually from October to May), but this is generally unavailable in Australia. The southern hemisphere formulation is considered an acceptable alternative. 

Individuals who received a current southern hemisphere influenza vaccine earlier in the year may receive a second dose of influenza vaccine before travelling to the northern hemisphere during its influenza season – ideally, 2 weeks before departure. Individuals should discuss their personal situation and risk factors with their healthcare provider.

For people who have recently returned to Australia from living or travelling overseas, influenza vaccination with the currently available local vaccine is recommended, regardless of the time of the year.

More information can be found in the Australian Immunisation Handbook Influenza (flu) and Vaccination for international travellers chapters.

How many doses of influenza vaccine are recommended for each influenza season?

Most people only require 1 dose of influenza vaccine each year for full protection.

However, certain population groups are recommended to receive 2 doses of influenza vaccine (4 weeks apart for adequate response) during the influenza season. These include:  

• children aged 6 months to less than 2 years receiving influenza vaccine for the first time
• children aged 6 months to less than 9 years with medical risk conditions receiving influenza vaccine for the first time
• people who have had a haematopoietic stem cell transplant, solid organ transplant or CAR T-cell therapy and are receiving influenza vaccine for the first time after the transplant.
   

People who received 1 or more doses of influenza vaccine in a previous season only need 1 dose in the current season and future seasons. This includes young children, even if they did not receive 2 doses in their first season of vaccination in a previous year.

See Dose and route requirement for each influenza vaccine in the Australian Immunisation Handbook Influenza (flu) chapter.

Does getting a second dose improve protection against influenza, especially in seasons that last longer than usual?

A single dose of influenza vaccine is recommended for most people.

There is currently not enough evidence to support a recommendation for the general population to receive a routine second dose of influenza vaccine during a single influenza season, even if an influenza vaccine was given early in the season, or the season lasts longer than usual.

See Dose and route requirement for each influenza vaccine in the Australian Immunisation Handbook Influenza (flu) chapter.

For those requiring a second dose, does the same vaccine need to be administered?

Individuals who require 2 doses of influenza vaccine within a season may receive a different vaccine product for each dose, provided both are age-appropriate and there are no medical reasons (i.e. contraindications) to avoid them. 

Influenza vaccines with different brands, types (such as cell-based or egg-based) and methods of administration (such as a nasal spray or an injection) can be used interchangeably.

Should a person receive an influenza vaccine if they have already had influenza?

Yes, influenza vaccination is still recommended following a recent influenza infection. Vaccination can lower the risk of becoming ill from other strains of the virus. People who have been unwell with influenza should wait until they have recovered from acute illness before receiving influenza vaccination.

All people aged 6 months and over are recommended to receive an influenza vaccine in each new influenza season, even if they had influenza in a previous season. This is because strains of influenza change each year and new-season influenza vaccines are reformulated to more closely match circulating strains.

How is the safety of influenza vaccines monitored?

The Therapeutic Goods Administration (TGA) assesses the quality of every batch of vaccine, including influenza vaccine, before it is distributed in Australia. It also collects, analyses and reports data on vaccine side effects once a vaccine is in use. 

Individuals and healthcare providers can also report side effects directly to the TGA. 

Additionally, programs such as AusVaxSafety collect information from individuals regarding side effects experienced after vaccination, including influenza vaccination. Experts analyse this information to detect any safety problems as soon as possible.

Is taking paracetamol before getting an influenza vaccine recommended, and does it reduce the effectiveness of vaccination?

Taking paracetamol before receiving an influenza vaccination is not routinely recommended. However, there are no current data that suggest the effectiveness of the influenza vaccine will be impacted if paracetamol is administered before influenza vaccination.

Can a person with an egg allergy receive an influenza vaccine?

People with an egg allergy can be safely vaccinated with any influenza vaccine (including egg-based vaccines – which usually contain less than 1 μg [microgram] of egg protein per dose – and the cell-based vaccine). 

Reactions such as hives, skin reactions or anaphylaxis (severe allergic reaction) are rare side effects following influenza vaccination, regardless of known egg allergy. 

Australasian Society of Clinical Immunology and Allergy (ASCIA) guidelines offer additional information on influenza vaccination of individuals with an allergy to eggs, including regarding risk, dosage and observation period.

Can a person with a latex allergy receive an influenza vaccine?

Influenza vaccines used in Australia are latex-free and are safe for use by people with a latex allergy or sensitivity. 

What is the difference between trivalent and quadrivalent influenza vaccines?

Trivalent vaccines protect against 3 influenza strains (2 influenza A strains and one influenza B strain), whereas quadrivalent vaccines include one extra influenza strain, B/Yamagata. 

Both vaccine types are equally effective against the shared strains, but quadrivalent vaccines provide additional coverage against the B/Yamagata strain. 

As B/Yamagata strain has not circulated globally since 2020, the World Health Organization (WHO) and the Australian Influenza Vaccine Committee (AIVC) recommend it no longer be included in seasonal influenza vaccines. 

All influenza vaccines available in Australia from 2026 will be trivalent. See more in the ATAGI statement on the transition from quadrivalent to trivalent seasonal influenza vaccines in Australia [PDF].

What is an inactivated influenza vaccine (IIV)?

IIV has been used in Australia for many decades. An IIV is made from influenza virus particles that have been inactivated, meaning they cannot replicate or cause infection. All IIVs available in Australia are injectable via intramuscular (preferably) or subcutaneous routes and are manufactured as either split virion or subunit formulations.

IIV differs from live attenuated influenza vaccine (LAIV), which contains a weakened strain of the virus and is administered intranasally. See FAQs on LAIV for further information.

Who is recommended to receive an IIV?

Annual IIV is recommend for all people aged 6 months and over.

For people who are at a higher risk of influenza-associated complications, IIVs are especially recommended and available for free under the NIP. (See question Who is eligible to receive a free IIV under the NIP?) 

Who is eligible to receive a free IIV under the NIP?

The IIV is available for free under the NIP for:

• children aged 6 months to less than 5 years
• all Aboriginal and Torres Strait Islander people aged 6 months and over
• all adults aged 65 years and over
• pregnant women  
• people with specified medical conditions.  

How can people access an IIV if they are not eligible for a free NIP-funded vaccine?

People who are not eligible for an NIP-funded influenza vaccine can purchase an IIV through an immunisation provider (e.g. pharmacists, general practitioners).

Some states and territories may also provide free influenza vaccination to additional population groups. Check with your state or territory health authority. 

How effective is IIV in preventing influenza illness?

Extensive research has shown the IIV is effective.

In young children and healthy adults aged less than 65 years who have received influenza vaccination, the likelihood of getting influenza is reduced by around 50–60%. This figure varies from year to year.

The effectiveness of the vaccine depends on: 

• the age and health of the person receiving it
• the match between the vaccine influenza strains and influenza strains circulating in the community.
   

People with an underlying medical condition and older people may not respond as well to the influenza vaccine, so their level of protection from the vaccine may be lower. The vaccine does reduce the risk of influenza-associated pneumonia and hospitalisations.

What is an ‘enhanced’ influenza vaccine, and how is it different from other influenza vaccines?

An ‘enhanced’ influenza vaccine is specifically designed to increase the response of the immune system to the vaccine. It can contain: 

• the standard amount of antigen but with an adjuvant (a compound that stimulates a higher immune response to a vaccine) added
• a higher amount of antigen but with no adjuvant added. 
   

Older people do not respond as well to standard-dose influenza vaccines as younger adults, and the level of protection they get from influenza vaccine is usually less than that of a younger person. Enhanced influenza vaccines for people aged 65 years and over offer better protection from influenza infection. 

Two enhanced IIVs are available in Australia for older people:

• Fluad (adjuvanted), which is registered for people aged 50 years and over
• Fluzone High-Dose, which is registered for people aged 60 years and over.
   

While both enhanced vaccines are recommended over standard-dose IIV for people aged 65 years and over, only Fluad is available free under the NIP.

Should pregnant women receive an IIV – and if so, when is the optimal to do so?

Influenza vaccine is recommended in every pregnancy to protect the mother as well as reduce the risk of influenza (by around 50%) in infants less than 6 months of age who cannot yet be vaccinated. IIV is preferred over LAIV for pregnant women and can safely be given at any stage of pregnancy.

Women in their first trimester during the first quarter of the year may consider waiting until the current season’s influenza vaccine becomes available. This advice may vary depending on the situation at the time, such as unusually high influenza activity.

Pregnant women who received the previous year’s influenza vaccine early in the pregnancy should be revaccinated with the next season’s influenza vaccine (when available) before the end of pregnancy. 

Women who received an influenza vaccine before becoming pregnant should be revaccinated during pregnancy to protect the unborn infant.

Influenza vaccine can be given safely at the same time as the respiratory syncytial virus (RSV) and pertussis (whooping cough) vaccines, which are also recommended and NIP-funded during pregnancy.

Further details on influenza vaccination in pregnancy can be found in the Australian Immunisation Handbook Influenza (flu) chapter.

Is it safe for breastfeeding mothers to receive IIV, and will it have any impact on milk supply?

IIV is safe for breastfeeding women and can provide protection to the baby through antibodies transferred through breastmilk. 

Decreased milk supply has not been associated with receiving the IIV; however, being sick due to infection with influenza virus can have a negative impact on milk supply.

Can IIVs cause influenza?

IIVs cannot give a person influenza, because they do not contain a live virus. 

The immune response of the body after vaccination may result in side effects that are similar to early influenza symptoms – however, these generally only last for 1–2 days and are much milder than the symptoms of actual influenza. 

Sometimes people are infected with influenza or another circulating respiratory virus just before receiving the vaccine, or they become infected after vaccination but before the vaccine has had time to work (up to 2 weeks). This can lead to the mistaken view that the influenza vaccine caused the illness. 

What are the common side effects after receiving an IIV?

Between 1% and 10% of people who have an influenza vaccine experience a fever, headache, general tiredness or muscle aches. These symptoms can last for 1–2 days. 

Around 10% of people who have an influenza vaccine experience swelling, redness or pain at the injection site. 

Further information can be found in the Australian Government Department of Health, Disability and Ageing resource Following vaccination – what to expect and what to do.

Are there any rare side effects after receiving an IIV?

In rare circumstances, infants and children who receive an IIV may experience a type of seizure known as a febrile convulsion. This can happen when an infant’s or child’s temperature rises suddenly (fever). However, influenza infection itself can also cause fever – and results in many more febrile seizures than vaccination. 

Enhanced safety monitoring systems for influenza vaccines, such as AusVaxSafety, have confirmed that influenza vaccination is safe in children under less than 5 years of age; low rates of fever and medical attendance after vaccination have been reported. 

More serious side effects following influenza vaccination are very rare:

• anaphylaxis occurs in around 1 in 1 million people who receive an influenza vaccine
• Guillain-Barré syndrome (GBS) occurs in less than 1 in 1 million doses of influenza vaccine and is more likely to occur from infection with the influenza virus than from an influenza vaccine.

Who should avoid receiving an IIV due to contraindications, or receive it with caution?

The only absolute contraindication to IIV is diagnosed anaphylaxis to a previous dose of any influenza vaccine or any component of an influenza vaccine. 

People who have experienced severe reactions after receiving an influenza vaccine should consult with their immunisation provider. 

Individuals with certain rare medical conditions may be at increased risk of side effects from IIV, including:

• individuals with a history of GBS where the first episode occurred within 6 weeks of receiving an IIV
• individuals receiving more than one immune checkpoint inhibitor for cancer treatment, who may have a higher risk of immune-related adverse events following IIV.
   

These individuals should consult with their provider before receiving an influenza vaccine.

For more information on Contraindications and precautions, see the Australian Immunisation Handbook Influenza (flu) chapter.

Can IIV be given at the same time (co-administered) as other vaccines?

Yes. Anyone aged 6 months and over can receive an IIV at the same time as most other vaccines. 

If only 2 vaccines are co-administered, it is recommended to give one vaccine into each limb. If 2 vaccines need to be administered in the same muscle, there should be a distance of 2.5 cm between injections.

For more information on these considerations, see Co-administration with other vaccines in the Australian Immunisation Handbook Influenza (flu) chapter.

What is an intranasal influenza vaccine?

Intranasal influenza vaccine protects against influenza infection. Unlike traditional injectable vaccines, it is delivered needle-free via a nasal spray.

The intranasal influenza vaccine FluMist is approved by the TGA for use in Australia for children aged 2 to less than 18 years. From 2026, it will be available free for children under some state- and territory-based immunisation programs.

How does the intranasal influenza vaccine work?

The intranasal vaccine is a live attenuated influenza vaccine (LAIV). This means it contains weakened strains of influenza viruses that, when administered, help train the immune system to recognise these viruses and build protection without causing illness. 

LAIV is sprayed into the nostrils and absorbed rapidly. This differs from traditional inactivated influenza vaccines (IIV), which are injectable and do not contain live virus.

How is the intranasal LAIV given and how many doses are needed?

The intranasal vaccine is given as a nasal spray, not by injection. One dose (0.2 mL) consists of 2 sprays: one spray – about half dose – into each nostril. 

Most people only require one annual dose of LAIV. However, certain people may need 2 doses (4 weeks apart) during the influenza season. These include children aged 2 to less than 9 years with a medical at-risk condition (if not contraindicated for LAIV) receiving LAIV for the first time. 

Further details on intranasal administration can be found in the Administration of vaccines section of Australian Immunisation Handbook and the Australian Product Information for FluMist.

See Dose and route requirement in the Australian Immunisation Handbook Influenza chapter.

Is LAIV safe?

The intranasal influenza vaccine has been safely administered to millions of children in the northern hemisphere since 2003.  

Expected side effects of the vaccine include a runny or blocked nose, headache and tiredness. Respiratory symptoms, especially nasal symptoms like runny nose, occur more often with LAIV than with IIV because LAIV is administered intranasally. These symptoms are generally mild, short-lived and self-resolving. Serious side effects are extremely rare. 

A recent systematic review found that LAIV is just as safe as IIV.

Is LAIV effective?

Studies from several years of LAIV use show it is effective.

In the UK, where LAIV has been used in childhood vaccination program since 2013, estimates of vaccine effectiveness range between 50% and 65%. It has also prevented up to 50% of influenza hospitalisations in young children. These figures vary from year to year, depending on the match between the vaccine influenza strains and influenza strains circulating in the community. 

A recent systematic review of influenza vaccine effectiveness found LAIV to be as effective as traditional intramuscular (injectable) influenza vaccines.

Can intranasal LAIV cause influenza?

Real-world studies and on-going surveillance have found no documented cases of intranasal LAIV causing influenza in people who received it.

The weakened viruses in LAIV are adapted to grow only in cold temperatures. This means they can replicate at the lower temperatures found in the nose but cannot grow well at the warmer temperatures in the rest of the body and cannot cause influenza disease.

The body’s immune response after vaccination may result in side effects that are similar to early influenza infection, especially nasal symptoms such as a runny nose, nasal congestion or a sore throat. These generally only last for 1–2 days and are much milder than the symptoms of actual influenza. 

Sometimes people are infected with influenza or another circulating respiratory virus just before receiving the vaccine, or they become infected after vaccination but before the vaccine has had time to work (up to 2 weeks). When this happens, it may seem as though the influenza vaccine caused the infection. Other viruses can also be mistaken for influenza.

Who is eligible for free LAIV in Australia?

Children aged 2 to less than 18 years are eligible to receive the intranasal influenza vaccine (FluMist) but it is not currently available for free on the NIP.  

At the time of writing, the intranasal influenza vaccine will be available for free ahead of the 2026 flu season through state-funded programs for:

• children aged 2 to less than 5 years in New South Wales and South Australia
• children aged 2 to 5 years (inclusive) in Queensland
• children aged 2 to less than 12 years in Western Australia.
   

LAIV is available on the private market for children who are not eligible for a funded dose.

What are the considerations for choosing between the injectable and intranasal influenza vaccine?

Both injectable and intranasal vaccines are equally effective and safe when used in the right age groups and with suitable health status. The choice depends on:

• eligibility, noting LAIV is available for children aged 2 to less than 18 years only  
• medical factors, such as contraindications to receiving LAIV (e.g. people who are severely immunocompromised) or medical conditions that may delay receiving LIAV (e.g. an active asthma episode or wheezing in the past 72 hours)
• cost of the vaccine, noting LAIV is only available for free to children of certain ages through specific state-funded programs (see question Who is eligible for free LAIV in Australia?)
• personal preference, for instance, LAIV may be preferred for children who have a fear of needles.
   

See Contraindications and precautions for each type of influenza vaccines in the Australian Immunisation Handbook.

Who should avoid receiving LAIV due to contraindications, or receive it with caution?

Intranasal LAIV is contraindicated (i.e. must not be given) for people who:

• had anaphylaxis after receiving a previous dose of any influenza vaccine
• had anaphylaxis after receiving any component of an influenza vaccine
• are moderately and severely immunocompromised
• are taking oral salicylate therapy (e.g. aspirin).
   

The following people should receive LAIV with caution (noting it is only registered for children aged 2 to less than 18 years):

• pregnant or breastfeeding women – an IIV should be used instead
• close contacts of people who are severely immunocompromised should avoid direct contact for 1–2 weeks after receiving LAIV or receive an IIV instead (see following question about precaution for close contacts)
• individuals with a history of GBS where the first episode occurred within 6 weeks of receiving an influenza vaccination
• individuals receiving more than one immune checkpoint inhibitors for cancer treatment who may have at higher risk of immune-related adverse events following influenza vaccination.
   

See Contraindications and precautions for each type of vaccines in the Australian Immunisation Handbook.

Can LAIV be given at the same time as other vaccines?

LAIV can be administered at the same time as most other vaccines, including diphtheria-tetanus-acellular pertussis, RSV, pneumococcal and COVID-19 vaccines. 

Studies of LAIV co-administered with live vaccines, including measles-mumps-rubella, varicella and oral polio, show similar immune responses and safety profiles as when they are administered separately.

For more on these considerations, see Co-administration with other vaccines in the Australian Immunisation Handbook Influenza (flu) chapter.

Can influenza virus be passed from a child who received the LAIV to close contacts?

A child can shed weakened virus a few days after receiving a live vaccine; however, this virus is less able to spread from person to person. The amount of virus shed is not enough to transmit (i.e. pass on) infection to others, and the virus does not survive for long outside of the body. 

People who are severely immunocompromised and living in close contact with a person vaccinated with LAIV have a theoretical risk of transmission of exposure to the live-attenuated virus to during the first 1–2 weeks after vaccination. 

From global experience, serious illness among immunocompromised contacts who are inadvertently exposed to vaccine virus has not been observed. However, if any at-risk contacts are concerned or close contact is unavoidable, IIV – which poses no risk to immunocompromised people – can be given instead. 

Can a child with asthma or wheeze receive LAIV?

A child with asthma or wheeze can receive LAIV. Real-word data confirm that LAIV and IIV are equally safe for children with asthma or recurrent wheeze. 

A child receiving low-dose* systemic or inhaled corticosteroids may receive intranasal LAIV at the same time. If the child’s parent or guardian cannot identify the current dosage of oral or inhaled steroid, an IIV can be offered, or a specialist may be consulted if there is uncertainty.

If the child has severe asthma requiring intensive care or had a recent a wheezing episode, vaccination should be delayed until the symptoms have improved, and the child’s condition is stable.

*According to Australian Asthma Handbook, low-dose inhaled paediatric (age 1–5 years) corticosteroids are defined as 100 micrograms ore less per day of fluticasone (or equivalent).

Can LAIV be given to a child who is using intranasal medications?

A child using inhaled or topical medications for conditions other than asthma, such as allergic rhinitis, can be given intranasal LAIV (see above question for children with asthma). This is suitable provided the medications do not cause immunosuppression and are not listed among the contraindications for LAIV. 

Can a child receive LAIV while taking antiviral medications for influenza, and do these medications affect vaccine effectiveness?

Influenza antiviral agents can reduce the effectiveness of LAIV. If a child has taken influenza antiviral medication, they should wait for 48 hours before receiving LAIV. 

Administration of influenza antiviral agents within 2 weeks of administration of LAIV may reduce the effectiveness of the vaccine and an additional dose may be required.

Can intranasal LAIV be given to a child who has a runny or blocked nose?

Intranasal LAIV should be deferred if a child has a runny or blocked nose, as this may hinder absorption of the vaccine. In such cases, IIV should be considered instead.

Can intranasal influenza vaccine be given to a child who is susceptible to nosebleeds?

Intranasal LAIV can be given to a child who is prone to nosebleed, provided there are no specific contraindications to LAIV. 

Intranasal LAIV may cause mild nasal irritation or congestion. A child who has frequent or severe nosebleeds may experience discomfort or may vigorously rub their nose after vaccination, which could increase the risk of nosebleed. Immunisation providers should monitor and report unusual adverse reactions.

If the child has an active nosebleed at the time of vaccination, the vaccine should be deferred until the bleeding has stopped, or IIV can be given instead.

If the child’s nosebleeds are frequent, severe or associated with an underlying condition (such as a bleeding disorder), consult a healthcare provider and consider using IIV instead.

Can LAIV be given to a child with a cochlear implant?

Intranasal LAIV can be given to a child with a cochlear implant. 

If possible, LAIV should be administered at least one week before cochlear implant surgery. Alternatively, it can be given 2 weeks after the surgery, when the surgical site has healed and there is no active infection or evidence of on-going cerebrospinal fluid leak.

Can LAIV be given to a child with unrepaired craniofacial malformations?

A child with unrepaired craniofacial malformations, including cleft palate, may have an abnormal connection that creates a potential portal of entry to the brain or central nervous system. If such a case is encountered when considering LAIV administration, or when there are concerns about nasal absorption of the vaccine, an IIV should be used instead.

What if the full dose of LAIV is not administered?

If LAIV is inadvertently given into only one nostril or only half dose is delivered (i.e. 0.1 mL), it is not necessary to repeat the dose of vaccine as this contains enough attenuated viral particles to induce an immune response.

What if a child sneezes or blows their nose after receiving LAIV?

Intranasal LAIV is immediately absorbed after administration, and the dose does not need to be repeated if a child sneezes, blows their nose or experiences nasal dripping after receiving it.

Sneezing, nose blowing, nose dripping or nasal discharge after immunisation with LAIV will not affect immunity; the vaccine is still effective if these occur.

What should be done if LAIV is inadvertently administered to a child who is immunocompromised?

If LAIV is inadvertently given to a child who is immunocompromised, the level of immunocompromise should be assessed and, if severe, antiviral prophylaxis considered. The child’s carer or guardian should seek medical advice if the child develops flu-like symptoms a few days after vaccine administration.

If antivirals are used for prophylaxis or treatment, IIV should be offered to provide protection. No interval is required between antiviral medication and IIV administration.

Immunisation providers should notify relevant regulatory authorities (i.e. the TGA and relevant state or territory health authorities) of the administration error and report any suspected adverse reaction. 

See the Australian Immunisation Handbook for details on how to report administration errors.

Also see Inadvertent administration of live vaccines to people who are immunocompromised in Australian Immunisation Handbook

What should be done if a child less than 24 months of age receives intranasal LAIV?

LAIV is contraindicated in children aged less than 24 months of age because of an increase in wheezing and hospitalisation.

If LAIV is inadvertently given to a child less than 24 months of age, the carer or guardian should be informed and advised about possible adverse events and to seek medical care if they occur.

If the child has medical risk conditions and requires a second vaccine dose, one dose of IIV should be given 4 weeks later. If the child has turned 24 months of age in the interim, a second dose of LAIV can be given.

Immunisation providers should notify relevant regulatory authorities (e.g. TGA and relevant state or territory health authorities) of an administration error and report any suspected adverse reaction. 

See the Australian Immunisation Handbook for details on how to report administration errors. 

What should be done if LAIV is administered by a wrong route (i.e. other than intranasal)?

LAIV must not be injected or given orally. 

LAIV can only be administered intranasally because it contains cold-adapted viruses that only replicate in the cooler environment of the nasal passages, inducing strong local immunity in addition to systemic immunity. If LAIV is injected or swallowed, an adequate immune response will not be triggered. 

If LAIV is inadvertently administered via a wrong route, it should be treated as an invalid dose. Administer a replacement dose using the correct route.

If the vaccine comes into contact with a child’s eye, flush the eye immediately using eyewash or saline. Advise the child’s parent or carer to seek medical advice if any irritation occurs or persists.

Immunisation providers should notify relevant regulatory authorities (e.g. TGA and relevant state or territory health authorities) of an administration error and report any suspected adverse reaction. 

Should pregnant or breastfeeding women receive LAIV?

As a precaution, LAIV should not be given to pregnant women, although there is no evidence of risk associated with LAIV if it is inadvertently administered during pregnancy. 

IIV is recommended for pregnant or breastfeeding women. Notably, LAIV is only approved for use in people aged 2 to less than 18 years.

Further details about influenza vaccination in pregnancy can be found in the Australian Immunisation Handbook Influenza (flu) chapter.

Do healthcare workers who frequently administer LAIV need to take any precautions?

Healthcare workers administering LAIV may, theoretically, be exposed to the vaccine virus if it is accidentally released outside of the child’s nose. So far, no cases of live vaccine virus transmission in health care workers who administer the vaccine or to individuals in close proximity during vaccination have been reported.

Healthcare workers who are immunocompromised or pregnant can safely administer the vaccine. Very severely immunocompromised healthcare workers should not administer LAIV.

Can an influenza PCR test be performed after LAIV vaccination?

Routine influenza PCR testing is not recommended immediately after vaccination with LAIV. Nasopharyngeal PCR tests are highly sensitive and may detect vaccine virus from LAIV instead of wild-type virus from a natural infection for up to 2 weeks after vaccination, leading to false-positive results. 

PCR testing should be avoided for at least 2 weeks after vaccination to minimise the risk of detecting vaccine-derived virus. If a PCR testing is necessary (e.g. for clinical diagnosis), it should be interpreted with caution and consider other clinical factors and contact history. 

What advice is available regarding faith-related issues with the porcine gelatin content in LAIV?

LAIV contains highly processed form of porcine gelatine as a stabiliser to protect the live viruses from the effects of temperature. The gelatine used in live vaccines is highly purified and hydrolysed (broken down by water), so it is different from the gelatine used in foods. 

Many religious authorities and representatives of Islamic or Jewish communities have issued guidance that the use of porcine-derived gelatine in vaccines is permissible:

• Kashrus and Medicines Information Service advises: ‘It should be noted that according to Jewish laws, there is no problem with porcine or other animal derived ingredients in non-oral products. This includes vaccines, including those administered via the nose, injections, suppositories, creams and ointments.’
• The Canadian National Immunisation Office received correspondence from the Imam of the Islamic Cultural Centre of Ireland and the Chairman of the Council of Imams in July 2020 which states that ‘medicines and vaccinations containing a percentage of gelatine made of pork are permissible’.
   

Families who prefer to avoid LAIV due to porcine gelatine can opt for IIV as an alternative.