Use of LAIV in adults over 18 years old with serious needle phobia

It is important we protect those most at risk this flu season. Please see the clinical guidelines below for the use of LAIV nasal spray in adults with exceptional circumstances, such as serious needle phobia. This population will likely include adults with learning disabilities who experience significant barriers to vaccination or those in a clinical at-risk group who would otherwise go unimmunised if they refuse to have the injected inactivated vaccine.

Please see Flu vaccination programme 2022 to 2023: information for healthcare practitioners for details, an extract is included below.

However, in exceptional circumstances, individual medical practitioners may choose to use their stocks of LAIV ‘off-label’ to vaccinate patients with a needle phobia.

It is envisaged that the type of patient who would be offered this might be someone with learning disabilities who becomes seriously distressed about needles. This is part of the requirement that the NHS has to make reasonable adjustments to accommodate the needs of a person with learning disabilities. See Flu vaccinations: supporting people with learning disabilities for more information.

Others who might also be offered LAIV include people in a clinical risk group with a serious needle phobia who may otherwise go unimmunised if they refuse to have an injected inactivated vaccine.

The legislation does allow for such situations and the Medicines and Healthcare products Regulatory Agency state that ‘there are clinical situations when the use of medicines outside the terms of the licence (that is, ‘off-label’) may be judged by the prescriber to be in the best interest of the patient on the basis of available evidence’ (26). The responsibility for such use rests with the health professional. In this situation, a Patient Specific Direction (PSD) will be required. In these exceptional circumstances, where it has not proved possible to administer the inactivated vaccine, UKHSA has agreed that the national LAIV stock can be used for this purpose.

Please contact our team directly at with any queries.