Influenza vaccination reduces the risk of hospitalization in children by 70% and immunization can also be done without a needle. What types of vaccines are there for children?

In the 2025-2026 flu season, children can be vaccinated for free, either by injection or nasal spray, depending on age. Even if the flu has already started to circulate, specialists recommend vaccination – protection is installed in about two weeks and reduces the risk of severe forms. Which types of flu vaccines are suitable for children and what parents need to know before choosing.

When returning to the community, children are the main vectors of transmission of respiratory viruses. The flu spreads quickly in kindergartens and schools, and the complications – especially in young children – range from otitis, pneumonia or asthma exacerbations to death. That is why, according to the National Institute of Public Health (INSP), influenza vaccination remains one of the most effective methods of protection for children in the cold season, starting at the age of 6 months, regardless of whether the influenza virus has already started to circulate.

WHO studies show that annual vaccination reduces the risk of pediatric hospitalization by up to 70%. For parents, the dilemma arises when flu season seems to have already begun. The INSP states that the vaccination remains useful throughout the winter, because immunity sets in in about two weeks and protects for the rest of the period of viral circulation.

What flu shots can children receive in the 2025-2026 season

For the current season, the World Health Organization has recommended switching to a trivalent formula (H1N1, H3N2 and B/Victoria). In Romania, two main forms are available:

• Vaxigrip (Sanofi) – injectable vaccine with inactivated virusadministered intramuscularly. It is approved from 6 months and up and is the standard variant for all age groups. Children under 9 years of age who are vaccinated for the first time may need two doses of this vaccine.
• Fluenz Tetra (AstraZeneca) – nasal vaccine (spray), with live attenuated virusrecommended for children between 2 and 18 years. It is administered without a needle, one puff in each nostril. It is contraindicated in moderate/severe asthma, immunosuppression or treatment with salicylates.

Injectable vaccine or nasal spray: how to choose the right option

The choice of influenza vaccine administered to children is made together with the pediatrician or family doctor, depending on the child's age, health status and medical history.

• Injectable influenza vaccine (containing inactivated virus) is the safest option for all age groups and is preferred for children with chronic respiratory or cardiovascular diseases. Adverse effects are minor: redness, discomfort at the injection site, mild fever.

• Influenza vaccine nasal spray (containing live attenuated virus) is a comfortable option for healthy children who are afraid of needles. However, it is not suitable for everyone. The main contraindications are severe bronchial asthma, immunosuppressive treatments and severe allergies to the component substances. These are some excipients that can cause reactions in sensitive children. These include hydrolyzed porcine gelatin, used as a stabilizer, which can trigger severe allergic reactions in people with a known gelatin allergy, and gentamicin, an aminoglycoside antibiotic, which can cause reactions in those allergic to this type of medication. The vaccine also contains monosodium glutamate (MSG) and sorbitol, which can be problematic in rare cases of hereditary fructose intolerance. For this reason, the vaccine is contraindicated for children with severe bronchial asthma, under immunosuppressive treatments or with severe allergies to any of the components, according to the technical sheet approved by the European Medicines Agency (EMA).

In these cases, the doctor will exclusively recommend the injectable version. For parents, the practical difference is more one of tolerance and comfort. In terms of effectiveness, studies show comparable results in preventing seasonal influenza, provided vaccination is given prior to exposure and repeated annually.

Useful questions to address to the pediatrician

When do two doses? In children under 9 years who are vaccinated for the first time, two injectable doses are required, at an interval of at least 4 weeks.

What if he got a cold after the first dose? Vaccination is postponed until acute symptoms have subsided, then the program can be continued.

Can it be done if he has an egg allergy? Mild egg allergy is no longer an absolute contraindication, but should be discussed with the doctor, especially if there has been a previous severe reaction.

Does the nasal spray give you a cold? Not. The virus is attenuated and does not cause the flu, but nasal congestion, sneezing or mild local irritation may occur.

Can the flu vaccine be given with other childhood vaccines? The vaccine can be given on the same day as other vaccines (including MMR) but in different arms. The only exception is simultaneous administration with other live attenuated vaccines (for example, varicella): in this case, the doctor recommends an interval of at least four weeks.

The Ministry of Health and the National Health Insurance House have expanded the vaccination program through pharmacies, so parents can pick up the child's vaccine on a 100% compensated prescription. The steps are simple: the family doctor issues the prescription, the vaccine is picked up from the pharmacy and administered either at the doctor's office or directly in pharmacies authorized for vaccination. Children between 6 months and 18 years benefit from the vaccine for free. Specialists of the National Institute of Public Health emphasize that the protection lasts for one flu season and that the vaccination must be repeated annually.