For the first time, the federal government has issued a national adult immunization schedule, to tell people when they should have what shots, with separate schedules for people with various medical conditions.

"We're pretty accustomed to getting our children immunized, but not so with ourselves," Carmona said. "Having these guidelines that tell what we should get and when should make us all healthier."

Devised by the U.S. Centers for Disease Control and Prevention (news - web sites), the guidelines are endorsed by several medical specialty organizations.

Reminding adults of the need for these vaccines is "a great idea" - especially the once-a-decade need for a tetanus-diphtheria shot, said Dr. Elizabeth MacNeill, Pima County's chief medical officer.

"This is probably a necessary thing, in light of the years of tetanus vaccine shortage, when people were not getting those boosters," MacNeill said.

"Well, the shortage is over, and a lot of people are behind on the routine booster, and I'm afraid your doctor is not always going to remind you. People pretty much have to keep track of what they need."

The tetanus-diphtheria shot shortage put people nationwide at risk for two very deadly infections, said MacNeill, noting that thousands died of diphtheria in the late 1990s when Russia's immunization programs fell apart.

"There is no doubt this was a dangerous situation, and we tend to lose our immunity faster against diphtheria than tetanus. But you don't want to risk tetanus. It's a very, very painful disease, it's life-threatening, and it takes a long time to recover from it," she said.

No deaths in Pima County have been blamed on the shortage, MacNeill said. For about a year, the shot was restricted only to severely injured or burned patients in hospitals or trauma centers.

In general, the federal guidelines say the only shots healthy adults 19 to 49 need is the tetanus update every 10 years, and a flu shot if they want to avoid a bad case of the flu.

But the flu shot is actually recommended only after turning 50, or for those at high risk with chronic illness or anyone who lives with a high-risk person.

At age 65, people are urged to seek vaccination against pneumococcal infection if they have not received the shot before, as are the chronically ill. The vaccine protects against the 23 most common bacterial strains that can cause pneumonia, as well as deadly blood and brain infections in people with weakened immune systems.

But because the pneumonia vaccine is needed only once, with its immunity lasting about six years, MacNeill cautioned adults to get it only when it's time - at 65 and not before.

"If you are not a high-risk person, we do not recommend this vaccine any earlier in life, because it may not be effective by the time it really counts, in later years," she said.

MacNeill advises all adults to make or get a small immunization schedule card, recording the dates and types of vaccines they have had and will need. Such cards are available at most pharmacies.

"It's the size of a credit card, and it can keep you on track," she said.

Also on the adult vaccine schedule is the varicella vaccine, to protect against chicken pox. However, the new federal guidelines recommend varicella only for adults who have never had either the disease or the shot, or for those who work in jobs likely to expose them to the virus, such as day care.

But MacNeill warns that most of today's adults likely have had a bout of chicken pox as children, and so are protected - even though it may not have been recognized, because of the mildness of the disease.

"I think it's more cost-effective for most adults to get a blood test, to see if they have antibodies, and so don't need the vaccine. The two-dose vaccine is going to cost more than the test," she said.

"But people do need to know if they are protected, because chicken pox in older people can be very, very serious - life-threatening."

Most of the vaccines on the federal list are covered by standard health plans, according to MacNeill and insurance officials.

"This falls under preventive care, so immunizations are covered in just about all health plans," said Susan McLeod, spokeswoman for Health Net of Arizona.

If an adult obtains the shot without the need for a physician visit, there usually is no co-payment, she said. But if a doctor's visit is included, the co-pay can run from $10 to $20, depending on the plan.

"But the rule is, if a doctor says you need it, it's covered," she said.

Although both flu and pneumonia shots can be obtained through a doctor's office, both are available now in various Tucson supermarkets and pharmacies, MacNeill said.

Unlike the past several years, influenza vaccine this year is plentiful, with supplies at record levels nationwide.

In fact, public health officials now are worried more about leftovers than shortages.

Manufacturing and distribution snafus last year created a situation where only about 25 million doses of flu serum had been distributed by the end of September. This year, about 50 million doses have been shipped, said Dr. Walter Orenstein, director of the CDC's National Immunization Program.

"The concern is that many doctors and other providers caught by the shortages of the past two years appear to have double- or triple-ordered, and once they get their first delivery, are canceling the other shipments," Orenstein said.

"This could not only affect health outcomes later in the season, but send a message to the manufacturers that they ought not produce more vaccine."

Last year, 87 million doses of flu vaccine were made, with 10 million to 12 million doses going unused by the official end of the flu season last spring. This year, 94 million doses are to be produced, with 80 percent of those doses distributed by Nov. 1.

The official advice is to get vaccinated this month if you are elderly, have a medical condition that puts you at high risk or are an infant age 6 to 23 months. People 50 to 65, along with anyone else who wants one, are advised to get the shots in November or later.

Together, flu and pneumococcal disease cause more than 26,000 deaths and more than 280,000 hospitalizations a year. Yet only 60 percent of the elderly get flu shots each year, and only slightly more than half have received the pneumococcal inoculation. Rates are far lower for blacks and Hispanics.

* Lee Bowman of Scripps Howard News Service contributed to this report.