A quick stick in the arm or a spray in the nose...OR

A week of headaches, coughing, sneezing, chicken soup and misery, while your unit works shorthanded. Not that hard a choice to make. Influenza is a contagious respiratory disease that can have serious, even fatal, effects. It threatens military readiness, with the potential to put many service members on sick call instead of on duty. Therefore, all military members are required to be vaccinated against the flu each year.

"The Centers for Disease Control and Prevention estimated an average of 36,000 Americans died annually in the 1990s due to influenza-related complications. Each year 5 to 20 percent of the United States population gets the flu, resulting in about 200,000 people being hospitalized. Vaccination is your best protection against influenza infection," said Army Lt. Col. Patrick M. Garman, deputy director for scientific affairs at the Department of Defense Military Vaccine Agency.

"DoD will offer its beneficiaries influenza vaccinations during the flu season in accordance with national guidelines. Certain groups take priority, such as active duty or individuals with chronic diseases like diabetes, and after these groups are adequately taken care of the vaccine will be available to any beneficiary who wishes to be vaccinated," Garman added.

Flu immunizations are mandatory for all active duty, National Guard and reserve personnel. The Department of Defense has established a goal of having 90 percent of these people vaccinated by Dec. 31.

Vaccinations also are mandatory for civilian health-care personnel who provide direct patient care in DoD medical treatment facilities, and for emergency-essential DoD civilian personnel. The vaccine is available by injection or intranasal spray.

"Influenza viruses change from year to year. Protection that develops after a person is infected or is immunized against the circulating viruses of one season does not provide adequate cross-protection when a new influenza strain develops," Garman said.

When the vaccine is well matched to the circulating virus strain, immunization of healthy adults has been 70 to 90 percent effective in preventing influenza illness.

"We stress that influenza vaccination should continue until the supply is exhausted or until the expiration date is reached for the vaccine. The highest incidence of disease is usually in February, but influenza can be contracted year round," Garman said.

More information about influenza and influenza vaccinations is available on the Internet from the Military Vaccine Agency at www.vaccines.mil/flu and from the Centers for Disease Control and Prevention at www.cdc.gov/flu/protect.

Influenza is spread through aerosolized respiratory droplets during close contact with an infected person or animal, or through contact with a contaminated object. In addition to vaccination, experts recommend frequent handwashing and avoiding close contact with people who are sick.

Also, people who are sick should avoid others if possible, wash hands often and cover the mouth and nose when coughing or sneezing to prevent the virus from spreading. Most people who receive influenza vaccine experience no serious problems.

Side effects of the injectable vaccine such as soreness, redness or swelling at the injection site, fever, weakness, headache or muscle aches may last one or two days. More serious problems such as severe allergic reactions are rare. Side effects of the intranasal vaccine can include runny nose, headache, fever, cough and sore throat.

People in a few categories, such as children less than 6 months old, those with sensitivity to eggs or egg products, or those with a history of Guillain-Barre Syndrome, should not receive the influenza vaccine.

While providing flu vaccinations, health-care providers should screen immunization records to see if patients need other vaccines or boosters as well. Military commanders are responsible for ensuring immunization data is entered into electronic immunization tracking systems.

"Find out the hours of operation of your local DoD immunization clinic. Most organizations schedule walk-in clinic hours, so appointments may not be necessary," Garman said.

Or be prepared for that week of misery.