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Pharmacist Jordan Morrison prepares to give a flu shot to Bettye Clark at the Access Family Pharmacy.
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Here is a look at some of the 2013-2014 flu season vaccine options. It's important to ask your doctor or pharmacist before deciding on one, due to potential allergy and safety indications by distributors.

* Quadrivalent Vaccine. These new vaccines prevent four strands of the virus rather than the traditional three. All FluMist sprays will be quadrivalent, but those are only approved for ages 2 to 49. Quadrivalent shots can be taken by anyone over 6 months of age.

* Cell-Culture Vaccines. Last year the Food and Drug Administration approved the first seasonal influenza vaccine using cultured animal cells rather than fertilized chicken eggs. And this could be good news for people will severe egg allergies who have in the past been warned against vaccines. Flucelvax is approved for those ages 18 years and older.

* Recombinant protein vaccine. This vaccine, called FluBlok, is produced in insect cells and can also be used by those with severe egg allergies. The company that produces it, Protein Sciences, says that most vaccines are produced with 1950s technology. FluBlok is made with a small piece of the virus called the hemagglutinin or HA protein. The cultured cells are grown in large stainless steel tanks and machines make hundreds of copies of the HA protein. The vaccine is approved for those ages 18 to 49.

*High-dose vaccines. Those 65 years or older, who are at higher risk if they catch the flu, should talk to their doctor about getting a higher dose of the vaccine. High-dose shots have four times the immunity-producing antigens. However, those shots can also have harsher side-effects, like soreness at the location of the shot. * Intradermal shots. These shots appeal to those who dread the needle and the aftermath of a flu shot. They offer shorter needles that go into the skin, not the muscle, and a smaller dose of the vaccine. Sources: Centers for Disease Control and Prevention,, Chattanooga-Hamilton County Health Department, Access Pharmacy

It's no longer as simple as walking into a pharmacy and getting a flu shot. There are options. A lot of options.

Those seeking to avoid the flu will have more than a dozen varieties of vaccines to choose from this year.

Vaccines can be shots to the arm or sprays up the nose, and for the first time some will protect against as many as four strains of the flu virus. Traditional vaccines protected against only three, officials with the Centers for Disease Control and Prevention said.

While the Hamilton County Health Department and local doctors won't be carrying all of the options, many will offer the new quadrivalent vaccine, which protects against four strains of influenza -- the same three strands that trivalent vaccines protect against, plus an additional influenza B strain, which is most harmful to children and not as dangerous as A strains.

Most doctors' offices are receiving flu vaccines now and widespread delivery will begin next month -- traditionally the beginning of flu season.

No shot has been favored by the CDC, but local health officials say the tried and true trivalent vaccine is good for almost everyone. Experts recommend that everyone 6 months or older should receive a vaccine. It cuts the risk of illness by 60 percent, statistics show.

With that in mind, local health officials advise vaccine customers to look beyond the details and remember one thing:

"No matter which vaccine you get, the most important thing is to get one," said Nettie Gerstle, communicable disease control project manager at the county health department.

The U.S. is coming off what the CDC calls a "moderately severe" 2012-2013 flu season.

Last season, 149 American children died from flu complications, according to the CDC. That's the most -- barring the 2009 H1N1 pandemic -- since the CDC started recording flu-associated child deaths in 2004.

And elderly Americans were hospitalized at two-and-a-half times the previous highest rate last year.

Some providers like Access Pharmacy in Hixson are already offering flu vaccines for $30 a pop. Brad Standefer, a pharmacist at Access, said most customers will not have a chance to get a quadrivalent vaccine this year because they are in short supply.

Only a fifth of vaccines delivered this year are expected to be quadrivalent, and all FluMist sprays will be. The FluMist spray is approved only for people ages 2 to 49, because it contains live flu virus strains, compared to the dead strains in injections, which can safely be taken by anyone over 6 months of age, Gerstle said.

But, said Standefer, "In order to find the quadrivalent injection, people are going to be hard-pressed." Many pharmacies have the quadrivalent vaccine on back order.

Standefer said customers should not wait for them to become available.

"What a lot of people are going to do, they're going to hold out for the quadrivalent, and they're going to get the flu," he said.

Standefer also said the quadrivalent injection costs more than its trivalent counterpart.

And he, like Gerstle, said most importantly, people need to get vaccinated.

"None of them work if you don't take them," he said.

Contact staff writer Alex Green at or 423-757-6731.