Add post about supporting the nasal flu vaccine (#223)

Author: frankieroberto

app/images/record-a-vaccination/2025/09/one-nostril-or-two/fluenz-check-and-confirm.png

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+---
+title: "One nostril or two? "
+date: 2025-09-02
+description: Changes we’ve made to support the nasal flu vaccine for 2 to 3 year olds
+image:
+  src: vaccine-type-flow-diagram.png
+  opengraphImage: true
+  alt: Flow diagram showing a fork whether the top fork is labelled 'Injection' and leads to a screen with the question 'Where did you give the injection?' and the bottom fork is labelled 'Nasal spray' and leads to a screen with the question 'Did you give a full dose of the vaccine?'. Arrows from both screens then recombine at the label 'Check and confirm'
+---
+
+From autumn 2025, the nasal flu vaccine for 2 to 3 year olds [will be available in some pharmacies for the first time](https://www.gov.uk/government/publications/vaccine-update-issue-362-august-2025-flu-special/vaccine-update-issue-362-august-2025-flu-special#pharmacy) (rather than just at a GP surgery).
+
+To support this, RAVS has made a change to our interface for recording these vaccinations.
+
+## What we did
+
+Previously we always asked the question ‘Where was the injection given?’ as all our vaccine products were injections. However this question is not relevant for nasal sprays, and can be skipped.
+
+![Screenshot with a red cross through it showing the question 'Where did you give the injection?' with the answers 'Left arm', 'Right arm' or 'Somewhere else'](injection-site.png)
+
+However, for the nasal spray there was an additional requirement to capture whether a full dose was given or not.  The nasal spray applicator is designed to be used in both nostrils, with a 0.1ml spray given in each nostril for a total 0.2ml dose.
+
+But there are circumstances where a full dose is not given, for example if the child is too upset after the first spray.
+
+The vaccine manufacturer advises that if only a single spray is given, there is no need to repeat the immunisation as each half dose contains enough viral particles to induce an immune response.  However, this should be recorded and will be monitored by the [UK Health Security Agency (UKHSA)](https://www.gov.uk/government/organisations/uk-health-security-agency).
+
+To record this, we designed a new question. The wording focuses on whether a full or half dose was given, rather than the specific dose amounts in millilitres.
+
+![Screenshot showing the question 'Did you give a full dose of the vaccine?' with 2 possible answers: 'Yes, both nostrils' or 'No, 1 nostril only'](nasal-dose-amount.png)
+
+The Check and confirm page has also been updated to reflect this new question, with 'Dose' shown instead of 'Injection site':
+
+![Screenshot showing a 'Check and confirm' heading and a summary of the vaccination recorded. The bottom row has the label 'Dose' and the value 'Bost nostrils (full dose)'.](fluenz-check-and-confirm.png)
+
+## Next steps
+
+This change will go live for the Autumn 2025 flu vaccination campaign.