Enhancing Protection Against Influenza and COVID-19 for Pregnant Women and Medically at Risk Children

Inclusion Criteria:

• COVID-19 pregnant women RCT: Pregnant women have received 2 or less doses of arecommended COVID-19 vaccine
• Influenza pregnant women RCT: Pregnant women have not received the influenza vaccineduring pregnancy
• COVID-19 medically at risk children RCT: Medically at risk children aged 5 years to 18years with a cardiac, endocrine, respiratory, gastrointestinal, haematological,musculoskeletal, neurological condition
• Influenza medically at risk children RCT: Children aged ≥6 months and < 18 years withmedical conditions specified in this list: immunocompromising conditions includingmalignancy, chronic steroid use, haematopoietic stem cell transplant; functional oranatomical asplenia including sickle cell disease or other haemoglobinopathies,congenital or acquired asplenia (for example, splenectomy) or hyposplenia; cardiacdisease including cyanotic congenital heart disease, congestive heart failure,coronary artery disease; chronic respiratory conditions including suppurative lungdisease, bronchiectasis, cystic fibrosis, chronic obstructive pulmonary disease,severe asthma (requiring frequent medical consultations or the use of multiplemedicines); chronic neurological conditions including hereditary and degenerative CNSdiseases, seizure disorders, spinal cord injuries, neuromuscular disorders; chronicmetabolic disorders including Type 1 or 2 diabetes, amino acid disorders, carbohydratedisorders, cholesterol biosynthesis disorders, fatty acid oxidation defects, lacticacidosis, mitochondrial disorders, organic acid disorders, urea cycle disorders,vitamin/cofactor disorders, porphyria; chronic renal failure; children aged 5 to 10years receiving long term aspiring therapy; Down syndrome; obesity (body mass index ≥30 kg/m2); children born less than 37 weeks gestation

Exclusion Criteria:

• COVID-19 pregnant women RCT: Pregnant women have contraindications to COVID-19vaccines and already randomised to influenza RCT.
• Influenza pregnant women RCT: Pregnant women have contraindications to Influenzavaccines and already randomised to COVID-19 RCT.
• COVID-19 medically at risk children RCT:
• Known contraindications to COVID-19 vaccine
• Up to date for COVID-19 vaccine (≥ two doses) at the time of enrolment,
• Sibling of a child already enrolled in the trial (only the sibling who iseligible and scheduled to attend a paediatric clinic first will be eligible)
• Previous participation in the influenza nudge RCT
• Influenza medically at risk children RCT:
• Known contraindications to influenza vaccine
• Already received an influenza vaccine during the flu season in 2023
• Sibling of a child already participating in the trial (the sibling who iseligible and scheduled to attend a paediatric clinic first will be eligible)
• Previous participation in the COVID-19 nudge RCT