Eating food with your hands, rubbing your eyes or wiping your nose could get you sick this time of year.

October is the start of the influenza season, which lasts through May. Proper handwashing and other precautions could keep a person from getting sick.

"A lot of people don't do it long enough," said Michelle Feist, North Dakota Department of Health influenza surveillance coordinator.

People should wash their hands for as long as it takes to sing a childhood song and use warm water, she said. Washing hands before eating or after being in public places can limit the chance of germs entering through the mouth, eyes and nose.

A flu shot is another way to keep influenza at bay. It takes two weeks for the shot to be effective. Flu shots, which are made from killed viruses, are available at doctor's offices, hospitals, public health departments and some employers offer shots.

At Bismarck Burleigh Public Health, they have some of their vaccine order in, and will begin giving shots later this month. Children's vaccine clinics are Oct. 19 and 25. Vaccine clinics for the general public begin Oct. 30 at the Bismarck Civic Center.

The Centers for Disease Control anticipate 75 percent of the vaccine to be available the end of October, Bismarck Burleigh Public Health Wellness Supervisor Vonnie Ereth said.

Flu vaccine is shipped from the manufacturers in multiple shipments instead of all at once to providers to even out distribution, according to the CDC Web site.

It is recommended by Bismarck Burleigh Public Health for children 6 months to 5 years old to get a flu shot, children and teens on aspirin therapy, children with heart and lung disorders, diabetics, people with chronic kidney disease and any condition affecting the respiratory system to get a flu shot. For children under 9 who haven't ever had a flu shot, they need two doses to build up an immunity, Ereth said.

Other groups of people who should consider flu shots are people over 50 years old, pregnant women, health care workers, nursing home and long-term care residents, and people who live with people who are at risk if exposed to the flu.

People between 5 years and 49 years old should consider a flu shot if they have diabetes, heart or lung disease, kidney disease, cancer, HIV/AIDS or an immune system disorder, Ereth said.

The flu is spread by coming into contact with respiratory droplets, Feist said. This comes from coughing and sneezing. A virus can stay active on a surface, like a door knob, and enter if picked up on the hands and transferred to the mouth, eyes or nose. This is why health officials recommend washing hands after being out in public, coughing into the elbow and throwing out tissues after using them.

Hand sanitizers also are recommended by the department of health and public health. The trick is to follow directions.

"You need to rub the sanitizer in like you are washing your hands," Feist said.

If a person does have the flu, they should get plenty of rest, drink fluids and stay home, she said.

The symptoms of the flu include fever, aches, nonproductive cough, sore throat, nasal congestion and headache.

The department of health will track laboratory reports of influenza on its Web site. It began tracking on Oct. 1 and will post its first update Wednesday. The Web site is www.ndflu.com.

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@;bismarcktribune.com.)