This article appears in Fall Healthy Living 2018.

For the 2018-19 season, a nasal spray has returned to the flu vaccine lineup after a two-year hiatus, at the recommendation of the Centers for Disease Control and Prevention.

Everyone older than 6 months should get a flu vaccine, and for those averse to needles the FluMist spray is recommended for people ages 2 to 49 without certain medical conditions and who are not pregnant, said Dr. Sherif Mossad, an infectious-disease expert at Cleveland Clinic.

Others who shouldn’t get the FluMist vaccine spray include those allergic to eggs or other vaccine ingredients, people who have ever had a life-threatening reaction to a flu vaccine, and people ages 2 to 17 who take aspirin or products with aspirin in them, according to the makers of FluMist.

Whether by shot or by spray, “get the flu vaccine,” Mossad said: “Some protection is better than no protection if you do not get the flu vaccine. The flu vaccine is not 100 percent effective; it varies from year to year.”

The flu vaccine takes three to four weeks to work, so get it as early as you can, before flu becomes widespread in the community, Mossad said. The vaccine does not prevent other flu-like illnesses, including common colds, he said.

Last year’s flu season hit hard.

“The 2017-18 influenza epidemic was a historic one, predominated by influenza A(H3N2) viruses, with morbidity and mortality rates approaching pandemic numbers,” Mossad said. “It lasted 19 weeks, killed more people than any other epidemic since 2010 — particularly in children — and was associated with hospitalization rates almost twice the previous season high in some parts of the United States of America.

“If you come down with a flu-like illness after receiving flu vaccine, seek medical attention. There are medications that have been proven to shorten the duration of illness due to flu,” Mossad said.