Children understand shots. Getting them to understand nasal spray, well, it's something to be experienced.

During flu season, parents have the option of getting their children a shot or a nasal spray of the influenza vaccine. Recently, the Flu Mist vaccine was approved for children as young as 2 years old.

"It looks like a syringe," Dr. Rafael Ocejo said about Flu Mist. "Children get scared. They think they'll get a needle up the nose."

Instead of the needle prick they expect, they get a squirt up each nostril of a fine mist. About a dozen of Ocejo's patients received the vaccine Wednesday morning. He is a pediatrician at Medcenter One. Patients who had Flu Mist last year are coming back this year, opting for the nasal spray over the shot, he said.

Flu shots and the nasal spray vaccine are available through doctor's offices, the public heath unit of each county and some pharmacies. Medcenter One offers the vaccine through its clinics, including walk-in clinics, and St. Alexius Medical Center has flu vaccine available. MidDakota Clinic, which is affiliated with St. Alexius through Prime Care, offers the vaccine through its clinics.

October is the time of year when flu vaccination campaigns begin in many communities.

"Absolutely, this is prime time," for vaccinations, said Bismarck Burleigh Public Health nurse Naomi Friesz .

Public health has started walk-in clinics for the flu shot at a cost of $20. The nasal spray vaccine, which is not available at public health, is about the same cost.

Last year, 2,369 people statewide were confirmed sick with the flu. In North Dakota, the season tends to peak after the new year, said Michelle Feist, influenza surveillance coordinator for the state Health Department. This flu season, two cases have been reported as of Saturday. One case was in Morton County and the other was in Stutsman County. Last year, there were four cases by this time.

The nasal spray vaccination is different from the flu shot in more ways than the way it is given. It is a modified live influenza virus and creates an immunity to the flu through the mucous membrane in the nose. The flu shot is a killed vaccine that builds immunity through the bloodstream.

The effectiveness of the shot is about four months, compared to about eight months for the nasal spray, Ocejo said. This difference could allow people between 2 and 49 years old to be vaccinated earlier without it losing effectiveness when the flu season hits a peak in February or March.

The Centers for Disease Control and Prevention recommends flu vaccination for children and the elderly because they are most likely to get the flu and be hospitalized or die. The nasal spray is not for people with compromised immune systems, pregnant women and children under 5 who have asthma.

People who do get the nasal spray vaccination should wait seven to 10 days before having contact with people who are susceptible to the flu. This precaution is taken because it is an active virus, and it takes seven to 10 days for it to be absorbed through the nose, Ocejo said. The flu virus is modified so that it is live in cold temperatures, but killed at body temperature.

Flu Mist is made by MedImmune Inc. The Centers for Disease Control and Prevention reported 132 million doses of vaccine, including 7 million doses of Flu Mist, are available.

Flu shots are readily available, according to Bismarck Burleigh Public Health and local hospitals. People should check with their physicians on the availability of the nasal spray vaccine.

Symptoms of the flu include fever, sore throat, cough and body aches. It is recommended that people who have the flu stay home, Friesz said.

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