Although universal annual influenza immunisation has been recommended for several years in north America, in most European countries these vaccines are only widely recommended and somewhat used among the elderly and health care professionals. Paediatric vaccine use is generally restricted to individuals perceived to be at enhanced risk of severe disease following infection. In this context, seasonal flu epidemics of varying size and severity continue to occur with their attendant health and social cost, morbidity and mortality, the latter predominantly among elderly people. Finland was the first European country to introduce universal childhood immunisation using inactivated vaccine but uptake has been moderate to date. In 2013 the UK initiated a unique programme to immunise all children from the age of 2 years with live attenuated intranasal vaccine every year. A single dose was offered to all 2 and 3 year olds and coverage of around 50% was achieved. Additional pilot programmes in other age groups were also conducted in some areas. In 2014 the target age group is to be extended upwards to include older pre-school and the youngest primary school children. The phased introduction of this programme is predicated by the logistical challenges it presents but also provides an interesting opportunity to monitor impact both direct and indirect. Young children may be the engines of flu epidemics. Controlling flu transmission in that age group, if it is achieved, may result in the kind of impact on overall disease and deaths which conventional flu vaccine programmes have failed to deliver.
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