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It's coming - the flu will be here before we know it. But this season, federal health officials are urging flu vaccination for all kids 6 months of age and older (instead of just the youngest).

Offering immunizations to millions more kids will, hopefully, make this season less brutal than the last. More kids immunized means fewer who might spread the virus to those most at risk for serious complications, like babies, toddlers, and the elderly.

Although young tots (from 6 months to 5 years old) are still considered the group of kids who need the flu vaccine the most, the updated guidelines from the Centers for Disease Control and Prevention (CDC) recommend that all older kids and teens get it, too. That is, as long as enough is available.

That's because the CDC's new recommendations say the vaccine should be given to older children "beginning in the 2008-09 influenza season, if feasible, but no later than the 2009-10 influenza season." The goods news, though: The CDC is projecting 146 million doses of the vaccine - the most ever made available during a single season in the United States.

Getting kids of all ages vaccinated against the flu is even more crucial now as federal health officials are reporting a dramatic increase in the number of flu deaths linked to bacterial infections. According to a new report by the CDC , five times more kids who died of the flu in 2006-2007 also had a Staphylococcus aureus (or staph) infection than in the past three flu seasons. In 2004-2005, only 6% of the kids who died had a staph infection, too. But the numbers skyrocketed to nearly 35% for the 2006-2007 season - and 64% of those infections were due to the antibiotic-resistant "superbug" MRSA (or methicillin-resistant Staphylococcus aureus ).

A specific strain of the common bacteria Staphylococcus aureus , MRSA causes a type of "staph" infection that's been cropping up among otherwise healthy people mostly as skin infections, such as abscesses. Staph bacteria live on most people's skin or in their noses without causing any problems. But a staph infection can happen when the germ enters the body through broken skin such as a cut, scrape, or rash. MRSA can sometimes cause more serious infections, such as bone infections or pneumonia. MRSA pneumonia is rare, but it's more of a risk for kids already sick with the flu.

Flu deaths in kids are rare in the United States - 166 children died from flu complications from 2004 to 2007 (the average age was 5). But the flu can become serious for any child, no matter how well he or she was before getting sick. In fact, studies show that most of the kids who died of the flu in the past few years were perfectly healthy before they came down with the illness. And many of the kids developed complications quickly - nearly half died within just 3 days of getting sick. Yet the vast majority of the kids who died and could've been vaccinated hadn't been.

Flu Vaccine FAQs

As the flu season starts to sneak up on us, parents often have a ton of questions about the ins and outs of getting their kids vaccinated.

Here are some of the most frequent inquiries and concerns:

What's the big deal? Isn't the flu just a really bad cold?

Although the common cold and the flu are often confused, symptoms of the flu can be a lot worse. Granted, most healthy people infected with the flu virus can weather the infection without any problems. But the flu can cause serious sickness in some, especially those considered high risk (like children under 2, senior citizens 65 and older, and anyone with chronic conditions such as asthma or diabetes).

In fact, each year, the highly contagious seasonal bug kills 36,000 people and sends another 200,000-plus (including more than 20,000 kids under age 5) to the hospital. Yet a mere 1 in 5 babies and toddlers (who are especially at risk) receives the annual vaccine, according to the CDC.

If your child has cold-like symptoms along with achiness, fever, chills, and fatigue, don't be too quick to deem it just another cold - it could be the flu or a bacterial infection (like strep throat or pneumonia) that can look like the flu or a cold.

Why did so many people who'd gotten the flu vaccine last season still get sick?

Many of the flu cases reported in the 2007-2008 flu season weren't caused by the exact strains that last season's vaccine targeted. Each year the vaccine is created to combat the three most current strains of the virus - though other strains may crop up at any time (which is what happened last season). Because the vaccine provides protection from only a few of the strains that can cause flu-like symptoms, it isn't a guarantee against getting sick.

So if the flu vaccine isn't entirely effective why should anyone get it?

Even though last season's vaccine didn't prove to fend off the flu nearly as much as health officials had hoped, the flu vaccine still greatly reduces the average person's chances of catching the flu. And getting vaccinated can still help prevent complications and can make symptoms far more mild - and that's regardless of whether or not you come down with a strain of the virus that isn't part of this year's vaccine.

Does the flu vaccine contain thimerosal?

You've probably heard the controversy about the mercury-containing preservative thimerosal, which was once widely used in many childhood vaccines. Despite the lack of scientific evidence that it causes any harm (specifically, autism), manufacturers began removing thimerosal from kids' vaccines in 1999 to reduce childhood exposure to mercury and other heavy metals.

Now, the flu vaccine is the only one used in kids 2 and under that contains any of the preservative. Although some of the flu vaccines do have thimerosal in them, most of those available for children have only trace amounts and are technically considered thimerosal-free.

And study after study has found no scientific evidence that autism is caused by any single vaccine, combination vaccines (like the measles, mumps, rubella vaccine called MMR), or thimerosal itself. If you're still concerned, talk to your doctor and ask if you can get a "thimerosal-free" or "preservative-free (trace thimerosal)" vaccine for your kids.

Do I need to get the flu vaccine, too?

To help fend off the flu in your entire household, it is wise for you - and anyone else taking care of your kids in or out of the home - to get the flu vaccine, especially if you:

• are or will be pregnant during the flu season
• live or work with babies, toddlers, and preschoolers or anyone else in any of the high-risk groups
• have a chronic medical condition
• work in the health care or assisted living fields and have direct contact with patients

And if you're breastfeeding, no worries - you can still get the flu vaccine, too.

Are there certain people who should not get the flu shot?

Those who should skip both the flu shot and the flu nasal spray include:

• infants under 6 months old
• anyone who's severely allergic to eggs and egg products. Ingredients for flu shots are grown inside eggs, so tell your doctor if your child is allergic to eggs or egg products before getting the flu vaccine.
• anyone who's ever had a severe reaction to a flu vaccination
• anyone with Guillain-Barré syndrome (GBS), a rare medical condition that affects the immune system and nerves
• anyone with a fever

What's the nasal flu spray?

For shot-shy tots - and parents - who are uneasy about the thought of a needle, there's a pain-free flu immunization option, too. The pain-free FluMist is now available for squeamish kids and adults from 2 to 49 years old.

But FluMist isn't for everyone - it can't be used on high-risk kids and adults (including the same groups listed above either - or pregnant women, anyone with wheezing or a chronic medical condition like asthma, kids younger than 2 years, or adults older than 50.).

And, because the nasal spray flu vaccine is made from live viruses, it may cause mild flu-like symptoms - including runny nose, headache, vomiting, muscle aches, and fever.

What This Means to You

It's best to try to have your family vaccinated between September and mid-November, before the flu officially rears its ugly head. Getting the vaccine early on gives the body enough time to build up immunity to, or protection from, flu viruses before infection rates start to climb in the cold months (usually from late December to early March).

Another reason to not wait until the season is in full swing: It can take 1 to 2 weeks for the flu shot to become effective. Plus, kids under 9 who get a flu shot for the first time will need to receive it in two separate shots at least a month apart, so they should, ideally, get the vaccine as soon as the immunization becomes available.

At the beginning of the season, you can usually find the vaccine at doctor's offices and public, employee, and university health clinics, as well as through some universities, pharmacies, hospitals, supermarkets, and community groups.

If you have an HMO insurance plan, check with your primary care doctor before having your kids vaccinated outside the office. Most HMOs will pay for vaccines only if they're given through their plan. Flu shots are generally covered by insurance for people in high-risk groups. Otherwise, they can cost anywhere from $10 to $50. And if you opt for the FluMist, check to see if your insurance plan covers it.

Whether you get the flu vaccine or not, these simple precautions can help keep the pesky bug away from your household:

• Avoid large crowds whenever possible, especially if you have a young infant or a child with a chronic condition.
• Make sure everyone washes their hands well - and often.
• Discourage young kids' nose-picking. And if they do let their fingers venture upwards, make sure they wash their little digits right afterward.
• Keep hand sanitizers around (but out of reach of little ones since the alcohol in them can be dangerous to young kids if ingested).
• Never pick up used tissues.
• Neve r share cups or eating utensils.
• Stay home from work or school if sick with the flu.
• Cover your mouth and nose with a tissue - not your hands! - when you cough or sneeze. If you don't have a tissue, cough or sneeze into the elbow or shoulder of your shirtsleeve.

Instead of waiting until your child's next checkup or sick visit, call your doctor today to find out when the flu vaccination is expected to come in and schedule an appointment.

And, by all means, encourage extended family members (especially grandparents and anyone who regularly takes care of your kids) to get the flu vaccine as soon as possible, to protect their health and your children's.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2008

Source: "Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008," Morbidity and Mortality Weekly Report ( MMWR ), CDC, Aug. 8, 2008.