Giving polio to children through the flu vaccine – getting parental consent.

Dear Parent/Guardian
Your child’s annual Flu immunisation (Flu Spray) is now due.
All Primary school-aged children in Reception Year to Year 6 (aged 4 to 10 years old on 31st August
2021) will be offered the vaccine.
All Secondary school-aged children in Year 7 to Year 11 (aged 11 to 15 years old on 31st August 2021)
will be offered the vaccine.
Children who attend specialist schools will be offered the Flu Nasal Spray from Reception up
to their 18th Birthday.
This vaccination programme is in place to help protect your child against flu.

Flu can be an unpleasant
illness and sometimes causes serious complications. Vaccinating your child will also help protect more
vulnerable friends and family by preventing flu from spreading. The vaccination is free and recommended for
young children, and will be given by a quick and simple spray up the nose. Our immunisation team will be
responsible for ensuring children receive the Fluenz nasal spray in schools.

Please complete the attached consent form, (one for each child) detach from the letter and return
the completed consent form to the school within one week to ensure your child receives their vaccination.
Last year, most children offered the Flu spray in schools had the immunisation. Clinics will be available for
children to access if they do not receive the Flu spray on the day we are in school.
If you wish to receive the Inactivated Porcine-free Vaccination, please contact the Immunisation
Team for the alternative Flu consent form.
If you have any queries, contact the Immunisation Team. Frequently asked questions and answers can be
seen on the next page.
The NHS Friends and Family Survey is a way of gathering your feedback about your experience and helps to
drive improvement in our service. To complete the online survey please use the following link:
http://www.shropscommunityhealth.nhs.uk/fft-survey.
Yours sincerely,
D J
Immunisation Lead

If your child becomes wheezy or has their asthma medication increased after you return this form,
please contact the Immunisation Team via school on the day.
If you decide you do not want to vaccinate your child against flu, please return the form indicating No consent.
This will help us plan and improve the service.
08/21 DJ/

►► Why should children have the flu vaccine?
Flu can be a very unpleasant illness in children causing fever, stuffy nose, dry cough, sore throat,
aching muscles and joints, and extreme tiredness. This can often last several days.
Some children can get a very high fever, sometimes without the usual flu symptoms, and may need to
go to hospital for treatment. Serious complications of flu include a painful ear infection, acute
bronchitis, and pneumonia.

►► My child had the flu vaccination last year. Do they need another one this year?
Yes; the flu vaccine for each winter helps provide protection against the strains of flu that are likely to
circulate this year and which may be different from last year. For this reason we recommend that even
if vaccinated last year, your child should be vaccinated again this year.
►► How will the vaccine be given?

For most children, it is given as a nasal spray.

►► Who will give my child their vaccination?
Children aged two and three years will be given the vaccination at their general practice usually by the
practice nurse.
Children in Primary schools from Reception to Year 6 will be offered the vaccination in school.
Pupils in Secondary schools from reception to Year 7 to 11 will be offered the vaccination in
school.
Children who attend specialist schools will be offered the Flu Nasal Spray from
Reception up to their 18th Birthday.

►► How does the nasal spray work?
The nasal spray contains viruses that have been weakened to prevent them from causing flu but will
help your child to build up immunity. When your child comes into contact with flu viruses they will then
be less likely to get ill.

►► Are there any side-effects of the vaccine?
Serious side-effects are uncommon. Children may commonly develop a runny or blocked nose,
headache, general tiredness and some loss of appetite. This may last a few days.
The vaccine is absorbed quickly in the nose so, even if your child sneezes immediately after having the
spray, there’s no need to worry that it hasn’t worked.

►► Are there any children who shouldn’t have the nasal vaccine?
Children should not have the nasal vaccine if they:
• Are currently wheezy or have been wheezy in the past three days (vaccination should be
delayed until at least three days after the wheezing has stopped)
• Are severely asthmatic, i.e. being treated with oral steroids or high dose inhaled steroids
• Have a condition, or on treatment, that severely weakens their immune system or have
someone in their household who needs isolation because they are severely immunosuppressed
• Have severe egg allergy. Most children with egg allergy can be safely immunised with nasal flu
vaccine. However, children with a history of severe egg allergy with anaphylaxis should seek
specialist advice. Please check with your GP
• Are allergic to any other components of the vaccine

►► Does the nasal vaccine contain gelatine derived from pigs (porcine gelatine)?
Yes. The vaccine contains a form of porcine gelatine, Nasal Flu remains the most effective vaccine for
this age group, however this year an alternative is available: Please contact The Immunisation Team
on 01743 730028. Please do not complete this form for the alternative vaccine.
FLU IMMUNISATION CONSENT FORM 2021/2022
Immunisation Team
Parent/Guardian to complete both sides please. Phone: 01743 730028
Please return this completed form to school within One Week.
First Name: Last Name: Date of Birth:
NHS No (if known):
GP Name and Address: School Name:
Year:
Class/Form:
Address and Postcode:
Daytime phone number of parent /
guardian:
Important information about this immunisation which is given as a nasal spray
Has your child been diagnosed with asthma?
Yes No
If ‘yes’ and your child is currently taking
inhaled steroids (i.e. uses a preventer or
regular inhaler), please enter the medication
name and daily dose (e.g. Budesonide 100
micrograms 4 puffs daily)
If ‘yes’ and your child has taken steroid tablets
because of their asthma in the past two weeks
please give details:
Please let the immunisation team know if
your child has to increase his or her
asthma medication after you have returned
the form or has been wheezy.
Has your child had a flu vaccination since
September 2021 at a GP’s or another school? Yes No

Date when last given:

Is your child currently having treatment that severely
affects their immune system? (For example; they
are receiving treatment for leukaemia) Yes No

Is anyone in your family currently having treatment that severely
affects their immune system? (For example; they need to
be kept in isolation or are receiving chemotherapy)
If YES please answer questions on the reverse Yes No

Does your child have an egg allergy? (that’s required
hospital treatment) Yes No

Is your child receiving salicylate therapy? (i.e. aspirin) Yes No
Please list any
Allergies/Medicines:
If you answered ‘yes’ to any of the above, please give details.
Please tell us if your child has any other long term medical
conditions i.e. Diabetes:

On the day of vaccination, please let the immunisation team
know if your child has been unwell or required medication such
as Paracetamol (Calpol®).
Information about the vaccination will be entered onto your childs health records, including records at your GP practice
and those held by the NHS.

Consent for immunisation for my son/daughter to receive the flu nasal spray, Complete only one box below.
As the Parent/Guardian with parental responsibility

YES, I consent for my child to receive the flu Spray
Your Relationship to the Child:
Print Name:
As the Parent/Guardian with parental responsibility
NO, I do not consent to my child receiving the flu Spray
Your Relationship to Child:
Print Name:
Signature: Signature:
Date: Date:

The Fluenz nasal spray is a live vaccine and sometimes it is necessary for young children receiving this
treatment not to have contact with family members immediately following vaccination. Please contact the
Immunisation Team if you require further information.

NB. The nasal flu vaccine contains porcine gelatine (derived from pigs). Nasal Flu remains the most
effective vaccine for this age group, however this year an alternative is available: Please contact The
Immunisation Team on ………

Please do not complete this form for the alternative vaccine.
If anyone within the family is currently having treatment that severely affects their immune system (For
example; they need to be kept in isolation or are receiving chemotherapy) please answer the following
questions. There is a theoretical potential for transmission of live attenuated influenza virus to
immunocompromised contacts for one to two weeks following vaccination.
Please state the family member receiving treatment? __________________

How frequently does your child have contact? i.e. Daily; Weekly; Two Weekly: Rarely: ____________
Has the person in isolation or receiving chemotherapy received the Inactivated Influenza
vaccination? Yes No

If yes please state the date they received their Inactivated Flu vaccination:
Please confirm you understand the above information Yes No

If your child has an on-going medical condition not already mentioned or communication difficulties that you
would like to tell us about to assist the immunising nurses, please contact the team.

GDPR For parents: This information will be shared by your child’s Immunisation team for the following reasons:
1. Public Health England (PHE) to provide data to Commissioners for the immunisation service.
2. SSHIS: Staffordshire County Council’s ICT department and Shropshire Health Informatics Service (SSHIS)
work together to record and report data to GP’s.

If you would like (further) details about the way we handle your child’s information please ask for a copy of our Privacy Notice
or access the Privacy Notice by going to https://www.shropscommunityhealth.nhs.uk/content/doclib/10648.pdf
– For Office Use Only: School Aged Immunisation Service.
Registered Nurse Assessment:
Child suitable for immunisation: Yes No

Signature:
Print Name:
Date:
Child not immunised today because:
Not well enough today:
Refused (not given)
Vaccine Batch number/expiry

TAP – Hospitals have been advised that a major outbreak of polio is imminent – to be called myelitis.  As there is currently no polio to report, the only way a major outbreak can occur is through a vaccine.

This is the one according to reports.  If you are not sure about deciding to get your child to develop polio then check out these reports and make sure you know what you are signing up for.

They can be found on the internet via many channels.