Flu vaccination via nasal spray: Who is it suitable for?

What is the flu vaccine as a nasal spray?

The flu vaccine as a nasal spray is a needle-free alternative to the traditional injection, developed specifically for children and young people. In Austria, it is known under the trade name Fluenz (or Fluenz Tetra).
Nasal spray or injection: what’s the difference?

The main difference lies in the type of vaccine and how it is administered: Whilst the nasal spray is a live-attenuated vaccine containing viruses with limited replicative capacity and is authorised for children and young people aged 2 to 17, the injection contains an inactivated vaccine consisting solely of inactive viral components. It is the standard vaccine for adults and children aged six months and over.

How does the nasal spray vaccine work compared to the injection?

Unlike the injection, which usually contains an inactivated vaccine with inactivated viruses, the nasal spray is a live vaccine. However, the influenza viruses it contains are so greatly attenuated that they cannot cause actual flu.

It is also worth noting that the viruses can only multiply in the cooler nasal mucosa to trigger an immune response, but not in the warmer lungs. As the vaccine works where natural influenza viruses usually enter the body – in the nose – it builds up protection directly at the site of entry.
How effective is the flu vaccine as a nasal spray?

The effectiveness of the flu vaccine as a nasal spray is very good in children and young people and is generally comparable to that of the traditional injection. Studies show an efficacy of around 75 to 80 per cent in children against the strains contained in the vaccine. In some seasons, the nasal spray has even performed better than the injection in children, as it triggers a broader immune response (including directly in the mucous membranes).

Furthermore, the vaccine can significantly reduce the risk of severe illness. In Austria, the nasal spray is particularly recommended for the first vaccination, as it trains the immune system of children who have never been exposed to influenza viruses particularly effectively.

Who should not use the nasal spray?

The nasal spray vaccine is not suitable for:

• Children under two years of age
• Children with severe, uncontrolled asthma or current wheezing
• Children and adolescents with immunodeficiency (e.g. due to certain medical conditions or immunosuppressive therapies)
• Children and adolescents currently being treated with acetylsalicylic acid (ASA) due to the risk of Reye’s syndrome
• People with severe allergic reactions to any of the ingredients
• Hypersensitivity to active substances or other ingredients such as gelatine

The nasal spray vaccine is not authorised for adults. It is also not recommended during pregnancy.
Important: Anyone who is not eligible for the nasal spray can usually switch to an inactivated vaccine administered by injection.
From what age is the nasal spray authorised?

In Austria, the nasal spray vaccine is authorised for children and young people aged between two and 17 years inclusive.
From the age of 18, the nasal spray vaccine is no longer authorised; in such cases, an inactivated vaccine administered by injection is used instead.

Which strains does the nasal spray protect against?

In line with the recommendation of the World Health Organisation (WHO), the nasal spray will be a so-called trivalent, i.e. triple, vaccine from the 2025/2026 season onwards.

According to the Austrian Ministry of Social Affairs and the WHO, the strains for the current 2025/2026 season (Northern Hemisphere) are:

• Influenza A (H1N1): a strain similar to A/Victoria/4897/2022.
• Influenza A (H3N2): a strain similar to A/Croatia/10136RV/2023.
• Influenza B (Victoria lineage): a strain similar to B/Austria/1359417/2021.

What side effects might occur in children?

The most common side effects are mild and indicate that the immune system is working. These include:

• A blocked or runny nose (very common)
• Loss of appetite (very common)
• General feeling of being unwell (very common)
• Headache (common)
• Fever (common)
• Muscle pain (common)
• Nosebleeds (occasional)
• Temporary rash (occasional)
• Allergic reaction (occasional)

These symptoms usually subside on their own after one to two days. If the reactions persist or if you experience unexpectedly severe symptoms, please seek medical advice. The nasal spray vaccine cannot cause the actual flu.

What are the advantages of a nasal spray over an injection?

The nasal spray offers three key advantages over the traditional injection:

• No needle: There is no prick and therefore no painful injection – this is a relief, particularly for children who are afraid of injections.
• Mucosal immunity: As the vaccine is administered directly into the nose, the body produces antibodies (particularly IgA) in the very place where influenza viruses usually first come into contact with the mucous membrane. It therefore blocks the pathogen right at the point of entry.
• Broader protection for children: The live vaccine often stimulates children’s immune systems more comprehensively. It can still offer some protection even if the circulating viruses differ slightly from the vaccine strains.

When is the best time to get a flu jab?

In Austria, the recommended period for the flu jab is generally between mid-October and the end of November. This gives the body sufficient time to build up effective protection before the peak of the flu season – usually in January or February.

Getting vaccinated later in the season can still be beneficial throughout the season. Children receiving their first influenza vaccination, who require two doses, should start as early as possible in the season.

How long does the nasal spray vaccine provide protection?

The nasal spray vaccine provides protection for around six to twelve months, thus covering an entire flu season.

Who covers the cost of the nasal spray flu vaccination?

In Austria, the cost of the nasal spray flu vaccination is fully covered under the Public Influenza Vaccination Programme (ÖIP). This means that the vaccination is free for children and young people from the age of two up to and including 18.