Health care and public health leaders have ramped up efforts to contain the flu this season, with the coronavirus pandemic already straining health systems.

Massachusetts in August announced a student flu vaccine mandate, and is believed to be the first state to require vaccinations for students. The state's Department of Public Health now is also authorizing pharmacists to administer vaccines to anyone 3 and up, whereas pharmacies like Walgreens had previously given flu shots only to people 9 or older.

Public health experts recommend that individuals receive a vaccination annually by the end of October, since the virus mutates each year.

The Eagle spoke with state and local leaders to answer common questions about getting the flu vaccine this year.

Who should get a flu vaccine?

The Centers for Disease Control and Prevention recommends that all people 6 months or older receive a flu vaccine annually, with rare exceptions mostly for those allergic to vaccine ingredients. The state Department of Public Health suggests that people ask their health care provider about where they can get a vaccine, or visit vaccinefinder.org.

The flu vaccine most years reduces the risk of catching the flu by between 40 and 60 percent, according to studies cited by the CDC.

How are flu vaccine providers taking into account coronavirus safety concerns?

Many flu clinics offer "drive-thru" vaccinations, which allow individuals to receive the vaccine without entering a building.

At mobile health units run by Community Health Programs Berkshires, professionals wearing personal protective equipment walk out to meet people either outside or in their cars, said Dr. Chris Sprowl, interim chief medical officer for CHP.

For indoor vaccinations, additional safety measures have been taken. Walgreens pharmacists employ "safety measures meeting or exceeding CDC guidelines" when administering vaccines, the organization has said.

Is it free to get a flu vaccine?

Insurance providers are required by the Affordable Care Act to cover flu vaccines with no copayment.

For those who are uninsured, public health departments and several health care providers run flu clinics that are open to everyone regardless of insurance status, said Ilana Steinhauer, executive director of Volunteers in Medicine Berkshires.

Can the flu vaccine cause the flu?

No. Vaccines administered with a needle use a "killed" or "inactivated" virus, or a single protein from the flu virus. Nasal spray vaccines contain a live virus, but one that is "attenuated," or weakened, and cannot cause illness, researchers say.

How does COVID-19 figure in the case for getting a flu vaccine?

"While the flu vaccination does not protect you from COVID-19, the fall and winter are the prime times for the spread of respiratory illnesses," said Michael Leary, director of media relations for Berkshire Health Systems, "and if we can make gains in preventing the spread of the flu that can aid in keeping respiratory illnesses at a, hopefully, low level."

A greater number of people are expected to seek flu vaccines this year, but manufacturers have also increased production to make nearly 200 million doses available nationally.

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Are there enough flu vaccines?

The Massachusetts DPH expects "sufficient supplies to meet the demand," said Pejman Talebian, director of the department's immunization division, although early shipments of state-supplied and privately purchased vaccines from some manufacturers were delayed.

Northern Berkshire Pediatrics has held flu clinics for its patients at its North Adams location for two weeks, and it saw more people for flu-only appointments in its first week than for any week in 2019, said practice manager Don LeBreux.

Yet the state is "holding up their end of the bargain," LeBreux said. "We're able to get what we need to get it to the public."

Is there a best kind of flu vaccine?

Whether at a flu clinic, a primary care provider or a pharmacy, those who administer flu vaccines decide which of the approved vaccines to administer based on a patient's age and health history.

The CDC has not indicated a preference for a particular vaccine, but "recommends flu vaccination as the first and most important step."

Some children under 8 who have previously never received a flu vaccine may need two doses. Adults 65 or older may be immunocompromised, and there is a higher-dose shot designed to create a stronger immune response.

What are possible side effects?

The most common flu shot side effects are possible swelling, soreness or redness at the spot where the shot was given, and can last for one to two days. While low-grade fevers, muscle aches and headaches have also been reported, studies have found those side effects to be no more likely from a flu shot than from a salt-water shot.

Nasal spray side effects include cough, runny nose or headaches for adults, as well as sore throat, wheezing, vomiting or muscleaches.

When should people get a flu vaccine?

The CDC recommends that people receive a flu vaccine by the end of October. Some local providers have started offering vaccines earlier this year in anticipation of greater demand. "We'd recommend that people start now as opposed to waiting," Sprowl said. "People should just get them wherever they can. We're happy to make things as available as possible, but there are flu shots all around town. If they can take advantage of that, they should."

Many pharmacies and providers already have flu vaccines available.

Berkshire Health Systems provides public flu clinics through the Berkshire Visiting Nurse Association. BHS Urgent Care also provides walk-in flu vaccinations, or those set up by an appointment through its website.

How will the student flu vaccine mandate work?

All students 6 months or older enrolled in Massachusetts child care, preschool, K-12 schools or colleges and universities are required to receive a vaccination by Dec. 31. There are exemptions for medical or religious reasons, and while while the mandate applies to K-12 students in remote learning programs, it does not for higher education students learning remotely and living off campus.

While enforcement is determined locally, school nurses are required to ensure proper documentation that students have received required immunizations in most districts.

Danny Jin, a Report for America corps member, is The Eagle's Statehouse news reporter. He can be reached at djin@berkshireeagle.com, @djinreports on Twitter and 413-496-6221.