Here are some things to know about the once-a-year rite of flu vaccination. (Baltimore Sun video)

It's flu shot time, again.

Here are some things to know about the once-a-year rite of flu vaccination:

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WHO NEEDS A SHOT?

Everybody, starting at 6 months of age, according to the U.S. Centers for Disease Control and Prevention.

Flu is most dangerous for people over age 65, young children, pregnant women and people with certain health conditions such as asthma or heart disease.

But it can kill even the young and otherwise healthy. On average, the CDC says flu kills about 24,000 Americans each year, and last year, the toll included 105 children.

Last year, three-fourths of babies and toddlers — tots ages 6 months to 2 years — were vaccinated. So were two-thirds of adults 65 and older.

HOW WELL DOES THE VACCINE PROTECT?

The CDC says people who get flu shots have a 40 percent to 60 percent lower chance of getting seriously ill than the unvaccinated. If someone is infected despite vaccination, generally they have a milder illness than if they'd skipped the shot, said Dr. William Schaffner of Vanderbilt University and the National Foundation for Infectious Diseases.

"I like to tell my patients, 'You're here complaining, that's wonderful — you didn't die,'" he said.

DON'T DELAY

It takes about two weeks for good protection to kick in. Flu season tends to peak around January, but there's no way to know when it will start spreading widely.

Manufacturers say between 151 million and 166 million doses will be available this year. It's already widely available in doctors' offices and drugstores.

WILL THE SHOT MAKE ME SICK?

You can't get influenza from flu shots, specialists stress. But flu vaccine doesn't protect against colds or other respiratory viruses that people can confuse with influenza.

LOTS OF OPTIONS

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The regular flu shot comes in versions that protect against either three or four strains of influenza — including that problematic H3N2 strain, another Type A strain known as H1N1, and one or two strains of Type B flu.

Ask your doctor or pharmacist about other options which are available for certain age groups.

For needle-phobes, there's a skin-deep vaccine that uses tiny needles, and a needle-free jet injector that shoots another vaccine through the skin.

Two vaccine brands target the 65-and-older crowd. They're especially vulnerable to flu's dangerous complications because they tend to have more underlying health problems than younger people — and because standard flu shots don't work as well with age-weakened immune systems. One high-dose version contains four times the usual anti-flu ingredient, while a competitor contains an extra immune-boosting compound.

And for those worried about allergies from eggs used in the production process, two more vaccines are egg-free.

SORRY KIDS, NO NASAL SPRAY OPTION

FluMist, a less ouchy nasal spray vaccine, once was popular with children. But last year, a baffled CDC said it was no longer protecting against certain influenza strains as well as regular flu shots — and told doctors not to use it. That's the same advice this year: Youngsters will need a shot, just like their parents.

And for kids between the ages of 6 months and 8 years who are getting a first-ever flu vaccination, they'll need two doses a month apart.

THE COST

Insurance covers most flu vaccinations, often without a copayment. For those paying out of pocket, prices can range between $32 and $40.

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