This information is for health professionals. More information about the program is also available for parents and carers.
You can support the rollout of the nasal spray influenza vaccine and promote it by sharing resources on the Winter Respiratory Vaccination Toolkit.
Patients can learn more about influenza prevention, symptoms and treatment, by reading the Influenza fact sheet.
Find out more about influenza
The following guide has been developed to support the implementation of the new NSW Nasal Spray Influenza Vaccination Program.
The guide is for health professionals administering the nasal spray influenza vaccine (brand name FluMist®). Health professionals must administer FluMist® in line with this guide and the:
The new NSW Nasal Spray Influenza Vaccination Program offers FluMist®, a live attenuated influenza vaccine that is administered to each nostril, to children aged 2, 3 or 4 years. Sufficient stock of FluMist® was purchased to explore whether the needle-free alternative can increase the influenza immunisation coverage from 24% (as reported by NCIRS in children aged 6 months to < 5 years in 2025) to 40%, and so reduce influenza and influenza-associated hospitalisations.
National Immunisation Program funded inactivated influenza vaccine (IIV) that is administered intramuscularly will still be available for children aged 6 months to under 2 years, children aged 2, 3 or 4 who do not receive FluMist® and other eligible at-risk children.
A single dose of FluMist® (administered as a divided dose of 0.1 mL nasal spray per nostril – see more in Dosage, presentation and administration) should be offered to all healthy children aged 2, 3 or 4 who do not have a contraindication to the live vaccine. A second dose of FluMist® is available for eligible children with a medical at-risk condition receiving influenza vaccine for the first time. This is free under the NSW Health program from April 2026.
The following table outlines the number of influenza vaccine doses required for children aged 6 months to less than 9 years receiving influenza vaccine for the first time:
Registered nurses, midwives and enrolled nurses can prepare and administer FluMist® under a medication order from a medical practitioner or nurse practitioner. The medical practitioner or nurse practitioner must be available for supervision or advice if required.
Authorised nurse immunisers can independently administer FluMist® as detailed in the Authority for Authorised Registered Nurse/Midwife Immunisers to Supply Poisons and Restricted Substances and Vaccination Standards.
NSW pharmacist immuniser can also independently administer FluMist® as detailed in the NSW Pharmacist Vaccination Standards and Pharmacist Vaccine Authority.
FluMist® is funded by NSW Health for children aged 2, 3, or 4. Immunisation providers have been provided with an allocation of FluMist®. Pharmacists will be reimbursed for privately purchased vaccines administered to children in the same age group in this limited program. Further communication about the reimbursement process will be communicated to community pharmacies soon.
FluMist® will also be available on the private market for those aged 2 to under 18 years.
An AEFI is defined in the Australian Immunisation Handbook as “any untoward medical occurrence that follows immunisation. It does not necessarily have a causal relationship with the vaccine". AEFIs are notifiable conditions under the NSW Public Health Act (Schedule 1) and must be notified to your local public health unit (PHU).
All AEFI notifications are required to be reported to the TGA via your local PHU. To report a suspected AEFI, download the National Adverse Events Following Immunisation (AEFI) Reporting Form and contact your local public health unit on 1300 066 055. Further information regarding AEFIs is available on Adverse events following immunisation (AEFI).
In addition to reporting to the TGA, all AEFIs occurring at the time of immunisation, which occur in NSW Health facilities, e.g. anaphylaxis, must be reported in the NSW Health incident management system IMS+.
The AIR has been updated to accept records of FluMist®. All influenza vaccination encounters must be reported to the AIR.
Immunisation providers are required to check an individual's vaccination status on the AIR prior to administering any vaccine.
FluMist® is a live attenuated influenza vaccine (LAIV). It 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.
Many religious authorities and representatives of Islamic or Jewish communities have issued guidance that the use of porcine-derived gelatine in vaccines is permissible:
Families who prefer to avoid LAIV due to porcine gelatine can opt for traditional intramuscular IIV as an alternative.
A single dose of FluMist® should be offered to all 2–4-year-olds who do not have contraindications to the live vaccine each winter season. This is free under the NSW Health program from April 2026.
FluMist® is also registered for use for those aged 5 to under 18 years; however, it will only be available on the private market for this age group.
FluMist® must be stored in a purpose-built vaccine refrigerator between +2°C to +8°C at all times and the temperature continuously monitored in accordance with the current edition of the National Vaccine Storage Guidelines: Strive for 5.
The dose of FluMist® is 0.2 mL, which is administered as a divided dose of 0.1 mL nasal spray per nostril. FluMist® is not to be administered orally, intramuscularly, intravascularly, intradermally, subcutaneously or otherwise parenterally.
The dose does not need to be repeated if the child sneezes or blows their nose after receiving FluMist®.
The vaccine is a colourless to pale yellow (clear to opalescent) suspension. Small white particles may be present.
FluMist® is for nasal use only. Further detail on the use of the nasal applicator can be found in the product information guide.
Healthcare professionals can also access the Flumist® administration video upon registration with their AHPRA ID. There are no recommendations regarding personal protective equipment for the administration of FluMist®.
FluMist® can be co-administered at the same time as, or separate to, most other vaccines, including dTpa, RSV and pneumococcal vaccines. For further information on co-administration see the Australian Immunisation Handbook - Influenza. Individuals can receive FluMist®, even if they have received another live vaccine, e.g. measles, mumps, rubella or varicella vaccine, within the last four weeks.
LAIV has been administered to over 20,000 children and adolescents in controlled clinical studies over multiple years, in various regions and using different vaccine strains. In the UK, the vaccine has been administered to millions of children since 2013 as part of the childhood vaccination program. Data from the UK also suggests that when LAIV vaccination coverage is high among children, there are indirect benefits to adults who were not targeted for vaccination.
Estimates of LAIV vaccine effectiveness generally range between 50% and 65%1, similar to that of IIV. LAIV also prevents up to 50% of influenza hospitalisations in young children.1 These estimates 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 clinical trials assessing the effectiveness of LAIV found LAIV to be as effective as traditional IIVs.1
A summary of FluMist® product efficacy and safety is available at NCIRS - Influenza FAQs.
The most common side effects reported in FluMist® studies were:
The TGA and ATAGI continue to monitor routine pharmacovigilance, including submissions of safety update reports for FluMist®.
There is no difference in the incidence of serious adverse events following LAIV and IIV.
LAIV is safe in children with asthma or wheeze. Early studies of LAIV did raise concerns about wheezing in young children and possible asthma exacerbation. An early trial found a higher rate of “reactive airway" illness in children aged 18–35 months, and another showed an increase in wheezing among unvaccinated children aged 6–23 months, compared with IIV.1 However, numerous studies since then - including a 2025 review of 24 studies involving more than 1.2 million people - have confirmed that LAIV and IIV have comparable safety for children with asthma or recurrent wheeze.2 LAIV vaccination was tolerated well among children who were mildly immunocompromised, specifically children with cystic fibrosis, HIV infection and those receiving cancer treatment.
FluMist® is contraindicated in people who:
Vaccination with FluMist® should be postponed in individuals suffering from an acute febrile illness. If a child has a runny or blocked nose, vaccination should be deferred as this may hinder absorption of the vaccine, or else IIV administration should be considered.
If further information regarding immunisation is required, please contact your local public health unit on 1300 066 055.
