Lauran Neergaard; The Associated Press

WASHINGTON - Flu-shot season begins next week, and this year marks the first time parents are being urged to get babies and toddlers vaccinated because influenza sends its tiniest patients to the hospital as often as it does the elderly.

But there's a catch: Unlike the one yearly shot most people need, the first-ever inoculation for young children requires two doses a month apart. So experts are urging parents not to delay that pediatrician visit, to be sure their kids get both shots in time.

There's plenty of flu vaccine this year, say federal health officials who estimate 94 million doses will be shipped.

Still, it takes a while to send vaccine to every doctor's office and clinic. The government is calling for people at the highest risk of severe illness during flu season to be first in line in October - and urging healthy people to wait until November to get their shots.

High-risk people include:

• Everyone older than age 50.

• Anyone with chronic medical conditions that make them more vulnerable to the flu, such as heart or lung disorders including asthma, diabetes, kidney disease, or weak immune systems.

• Children ages 6 months to 2 years.

• Residents of nursing homes and other long-term care facilities.

• Women who will be more than three months pregnant during the flu season.

• Children of any age on long-term aspirin therapy.

November offers plenty of time for healthy people to avoid flu's misery, reassures vaccine specialist Dr. Walter Orenstein of the Centers for Disease Control and Prevention. It takes only two weeks after vaccination to reap full protection, and influenza typically doesn't start causing outbreaks until late December or January. But the schedule ensures that if influenza strikes abnormally early, those most at risk of dying will be protected.

Don't feel it's OK to skip the vaccine just because recent flu seasons have been mild, Orenstein cautions. Even in a mild season, up to 20 percent of the U.S. population gets the flu, 114,000 people are hospitalized and 20,000 die. Despite that toll, only about a third of people with asthma or other flu-worsening conditions get vaccinated each year.

"If I were rolling the dice, I would err on the side of getting vaccinated because the likelihood of continuing to have mild seasons is very slim," Orenstein said.

Why this winter's focus on babies? Recent research suggests children younger than age 2 are as likely to be hospitalized with flu complications such as pneumonia as are people older than age 65 - the age group long thought to be at highest risk. The CDC is working to confirm that, but meanwhile decided to encourage vaccinating babies ages 6 months to 2 years.

The vaccine can't be given to younger infants, whose family and caregivers are urged to get vaccinated themselves so they don't spread the virus to newborns.

While the elderly are at high risk of death from flu, hospitalizing babies usually saves them. But it's traumatic and exposes babies to unnecessary antibiotics until doctors confirm they have viral flu, not a bacterial infection, says Dr. Leonard B. Weiner, pediatric infectious disease chief at the State University of New York at Syracuse. Worse, germ-filled hospitals expose already weak babies to other infections.

The American Academy of Pediatrics encouraged pediatricians to stock vaccine for more babies than ever this fall. But it will be next year before flu shots are included in the federal program that provides childhood vaccines for free to the needy, Orenstein says.

"This year some of the poor children will have more difficulty," he acknowledged.

Parents can check local health departments or charity-run vaccine clinics to see if any offer free or reduced-price toddler doses. Flu shots typically cost $20.

Older children can get vaccinated, too, if parents just want to avoid flu's misery and lost school. The two-dose requirement is for any child younger than age 9 who's getting a first-ever flu vaccination, because their response to the initial shot isn't protective enough. Each flu season afterward requires only one shot.

And no, you can't get the flu from the vaccine, which is made from dead virus. But lots of other cold viruses lurk in the fall, which people sometimes mistake for flu.

(Published 12:30AM, September 24th, 2002)