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Background  In Italy only recently, for the 2020–21 season, has the flu vaccination been extended to all children.  A quadrivalent live attenuated influenza vaccine (qLAIV) was administered to children aged 2–17 years for the first time.  We registered the number and severity of adverse reactions to (Fluenz Tetra™) and the factors influencing them, evaluated uniformity of access to care and assessed the degree of satisfaction with the vaccination of both parents and health care providers, in order to improve the 2021–22 vaccination program.    Methods  On vaccination day, a questionnaire was given out to collect information about the children and their parents. Between 1 and 3 months later, the parents were contacted to record any adverse reactions following (Fluenz Tetra™) and rate the degree of satisfaction.    Results  We received data of 3226 children from 2152 families.  Adverse events were reported in 24.8% of children: 80.6%  mild , 18.1%  moderate  and 1.3%  significant . The most common were rhinitis (52.5%) and fever (24.4%). Statistical analysis performed with a multiple regression model, showed that children aged 2–5 years have an increased risk of adverse events compared to both 6–10 years old (aRR 1.7, 95% CI 1.5–1.9,  p  < 0. 001) and 11–17 years old (aRR 1.5, 95% CI 1–2.2,  p  = 0.051).  Most families chose to vaccinate their children to protect them and because they were concerned about Covid19.  The main channel through which parents became aware of a new flu vaccination was word-of-mouth (39.8%), which occurred mostly among parents of the same school group, followed by information from the child’s doctor (30.6%), the Internet (26.9%), personal research (15%), newspapers (4%), telecommunications (7.5%) and other (2.6%).  Most parents (83.3%) were very satisfied and intend to vaccinate their children with qLAIV again (83.8%). The majority of operators (93%) considered the experience as  excellent  and are willing to repeat it (94.6%) .Conclusion  (Fluenz Tetra™) proved to be easy to administer and the degree of satisfaction was high among both health workers and parents. Considering its substantial safety profile especially in school-age children and adolescents, all these aspects make the nasal qLAIV optimal for widespread immunization.  Schools offer the best setting to reach more families and physicians should be actively involved.

Nasal spray live attenuated influenza vaccine: the first experience in Italy in children and adolescents during the 2020–21 season