It's time to line up for flu vaccine, and health officials again are urging seniors to take advantage of low-cost community clinics.

But this year, the focus is no longer just on seniors.

The U.S. Centers for Disease Control and Prevention now recommends that all children ages 6 to 23 months get vaccinated. In the past, the centers recommended flu vaccine only for children with chronic illnesses, said Nancy Bancroft, public health nurse with Stanislaus County.

Though manufacturing delays each of the past two years had doctors rationing the season's earliest inoculations, the vaccine is widely available this year.

Also new this year, some Americans will get to choose a squirt up the nose instead of a shot in the arm.

But the new nasal-spray vaccine, called FluMist, will cost more than twice as much as an inoculation. It also cannot be used by those who need protection against influenza the most: babies and toddlers, people 50 or older and those with asthma or other chronic illnesses.

Counties won't be offering the nasal spray. Some private providers may carry it.

"Probably there are some physicians' offices that will provide it, but people will have to pay out of pocket," said David Jones, spokesman for Stanislaus County public health. Jones said insurance plans are not covering the spray.

At least one local hospital, Emanuel Medical Center in Turlock, has decided not to provide FluMist -- for now.

"There seemed to be more questions about it than answers," said Stephanie Lambert, infection control nurse at Emanuel. "I decided to give it a year and see how other people do."

The spray, she said, is made of the virus itself and could give people a mild case of the flu. Though she thought a spray might encourage more of her staff to get vaccinated, she feared some of them may get a mild form of the flu and spread it to patients.

Still, FluMist's expected advertising blitz could generate new interest in flu protection at a pivotal time. Specialists say far too few Americans get vaccinated, including healthy people who may not be at risk of dying but who spread influenza's misery.

According to the CDC, influenza kills 36,000 Americans in an average year, hospitalizes 114,000 and infects up to 20 percent of the population.

Roughly 70 million people get a flu vaccination every year, less than half the number especially urged to get it, according to the CDC.

Among the highest-risk patients, only a third of adults with asthma are vaccinated, and fewer than two-thirds of the elderly, even though flu shots are free under Medicare.

Though the last two flu seasons have been mild, Dr. William Schaffner of the National Foundation for Infectious Diseases warned, "It would be very unusual to have three mild seasons in a row."

Public health senior flu clinics begin Oct. 13 in Stanislaus County. The cost is $10 a shot, though no one over 60 (the minimum age the state recommends) or those with chronic health problems will be denied. Beginning Oct. 20, shots will be available on a walk-in basis at the public health department, 820 Scenic Drive, from 8 a.m. to 5:30 p.m. Monday through Thursday.

Kelly Austin, public health nurse in the immunization program in San Joaquin County, noted that children ages 6 to 23 months and their family members, who have insurance, should get shots from their private doctors since counties focus on treating seniors and people with chronic health problems first.

"There's enough flu vaccine out there this year that all these kids should be seeing their private doctors to get it," Austin said.

The following high-risk people need flu shots, CDC says:

• Everyone over age 50.
• Anyone with chronic medical conditions such as heart or lung disorders, including asthma, diabetes, kidney disease or weak immune systems.
• Children ages 6 months to 2 years.
• Residents of nursing homes or other long-term care facilities.
• Women who will be more than three months pregnant during the flu season.
• Children of any age on long-term aspirin therapy.
• Caregivers of high-risk people.

Bee staff writer Melanie Turner can be reached at 578-2366 or mturner@modbee.com.

Reprinted by permission of The Modesto Bee.