Statement about flu vaccines

NRAS recently had an enquiry about the “nasal” spray flu vaccine that is being rolled out in schools to children which prompted us ask some of our medical advisors for some guidance. 

The concern is that the “nasal” vaccine is a live vaccine and of course these are not recommended for children or young people with Juvenile Idiopathic Arthritis. However, we also wanted to be able to reassure adults with RA who may have, or be around, children who have had this nasal vaccine.

NRAS Statement on Flu Vaccination for Children with JIA (Juvenile Idiopathic Arthritis)

As children who are on medication for their JIA may have a weakened immune system, it is advisable to speak with your child’s rheumatologist or nurse about their flu vaccination and also about coming into contact with others who will have had the nasal spray flu vaccination.

The nasal spray is a LIVE vaccine and is the choice for all children eligible year on year. It is this live vaccine that can theoretically give children who are immunosuppressed the flu.

If your child is in school, parents of children with JIA (Juvenile Idiopathic Arthritis) should be aware that they should not have the live nasal vaccination, but should have the injectable form of flu vaccination which ideally needs to be given at least 2 weeks prior to the start of the whole flu vaccination programme in their school and that the injectable form of vaccine is the only choice for any child on JIA medication.

If you are worried about the timings of the school vaccination programme, please speak with your child’s consultant or specialist nurse.

NRAS statement for those with RA who care for or are in close contact with school aged children who are being offered the Nasal Spray Flu vaccination.

For parents, grandparents, teachers, carers the following is the guidance some of our medical advisors have suggested.

This is largely an "evidence free" zone and the advice that tends to be given is both overly conservative: "should not be in contact with anyone who is ‘immune compromised’ for two weeks" which is often impractical. Everyone living with RA is advised to have their flu vaccination as a matter of course anyway so if your child is about to have the live vaccine and you’ve had your own flu vaccine at least 2 weeks prior then this should give you adequate flu protection. However, the nasal flu vaccination spray does contain 4 strains of flu whereas the injectable contains just 3 strains.

Generally, the view is that someone on standard DMARDs (methotrexate, leflunomide, sulfasalazine, hydroxychloroquine) may NOT be regarded as immunocompromised but those on regular steroids of greater than 7.5mg daily or any biologic/biosimilar or small molecule therapy (JAK inhibitors), they should be regarded as "potentially immune compromised" for this purpose, especially also if over 70 years of age.

In summary, being aware and trying to take precautions ahead of being in close proximity to a vaccinated child is suggested. If you have already been in contact with a vaccinated child and are showing symptoms of flu don’t delay seeking medical advice from your GP or rheumatology team. Ideally get your own flu vaccine 2 weeks in advance of the child/children being vaccinated in school.

If you have any concerns, contact your rheumatology team for further advice.