2026 Queensland Nasal Spray Flu Immunisation Program

No

• Children do not need to sniff. The vaccine is absorbed through the mucous membranes in the nose. Even if some appears to run out of the nose this is ok.

No

• Do not repeat the FluMist vaccine.
• FluMist 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.

Yes

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

Not recommended

• Nasal spray flu vaccination should be deferred as absorption may be impared.
• Consider offering injectable influenza vaccine to avoid delayed protection.

Unlikely

• People who are severely immunocompromised and living in close contact with a child vaccinated with FluMist have a theoretical risk of transmission of exposure to the live virus vaccine during the 1-2 weeks following vaccination. However, from global experience, serious illness in immunocompromised close contacts who have been inadvertently exposed to vaccine virus has not been observed.
• 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 infection to others, and the virus does not survive for long outside of the body
• If concerned, avoid direct contact for 1-2 weeks after receiving FluMist or offer injectable influenza vaccine instead.
• Exposure of pregnant women to people who have received FluMist should not be a reason to avoid vaccinating another person in close contact with a pregnant woman.

Yes

• The amount of ovalbumin (egg protein) contained in the FluMist is so minimal that it is safe to give to children with an egg allergy, including anaphylaxis to egg.

No

• FluMist is contraindicated in children aged less than 24 months of age.
• It has been associated with increased wheezing and hospitalisation in this age group.
• If FluMist is inadvertently given to a child less than 24 months of age, the carer or guardian should be informed about possible adverse events and advised to seek medical care if they occur.
• If the child has medical risk conditions and requires a second vaccine dose, one dose of injectable influenza vaccine should be given 4 weeks later.
• If the child has turned 24 months of age in the interim, a second dose of FluMist can be given.

Yes, noting recommendations

• A child with asthma or wheeze can receive FluMist.
• A child receiving low-dose* systemic or inhaled corticosteroids may receive FluMist at the same time.
• If the child's parent or guardian cannot identify the current dosage of oral or inhaled steroid, an inactivated influenza vaccine 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 or less per day of fluticasone (or equivalent).

Yes

• FluMist can be given at the same time as, or at any interval before or after other currently used vaccines, including any live or inactivated vaccines currently available for use in Australian children and adolescents.
• Studies of FluMist 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.

No

• Routine influenza PCR testing is not recommended immediately after vaccination with FluMist.
• Nasopharyngeal PCR tests are highly sensitive and may detect vaccine virus from FluMist 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 PCR testing is necessary (e.g. for clinical diagnosis), it should be interpreted with caution and consider other clinical factors and contact history.

See recommendations

• FluMist contains a 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.
• Council of Imams, Queensland have issued a letter which states the use of such a vaccine would be considered permissible.
• The Australian Islamic Medical Association provides useful resources on influenza vaccination and follows guidance [PDF] from the British Fatwa Council, stating that the ‘nasal flu vaccine containing porcine gelatine is permissible (halal) to use.’
• 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.’
• Families who prefer to avoid FluMist due to porcine gelatine can opt for inactivated influenza vaccine as an alternative.