It’s that time of year, when the leaves change color, the weather gets colder, and immune systems need to be prepped for the flu.

But even with constant reminders from health officials, pharmacies and doctors to get the flu shot, there is still considerable hesitancy among age groups less susceptible to complications from the disease.

During the 2017-18 flu season, the latest data available from the U.S. Centers for Disease Control and Prevention, 44 percent of New Hampshire residents received the flu vaccine, 2 percent higher than the national average. Sixty-six percent of children received the vaccine, as did 57 percent of adults 65 or older. But among those between 18 and 64, only 28 percent were vaccinated, 3 percent below the average nationwide.

Dr. Sharon Ferguson, a family practice physician at Cheshire Medical Center in Keene, said this is due mainly to common misconceptions about the flu.

Influenza, which most commonly circulates in late fall through early spring, is a respiratory infection spread when people come in close contact with people who have the virus and inhale airborne droplets or touch contaminated surfaces.

The common cold is also a respiratory infection, making it difficult for some people to tell the two diseases apart, Ferguson said.

The flu begins suddenly, accompanied by achy muscles, a severe cough and significant fatigue. For a cold, the symptoms are much more gradual, with a mild cough, sore muscles and tiredness. The cold also typically includes a stuffy and runny nose, while the flu rarely does.

Among healthier age brackets, it can be easy to shrug the flu off as no big deal.

“People get colds and runny noses, stuffy heads, body aches, and they think they have the flu,” Ferguson said. “[They] think, ‘Oh, I’ve had it, it’s not that bad,’ but it probably wasn’t the flu. They don’t understand the flu can be really bad.”

In 2018, 64 adults died from influenza in the state, according to Beth Daly, chief of the state’s Bureau of Infectious Disease Control.

Among them was Amanda Franks, a New Ipswich resident who died at the age of 38 from sudden influenza complications in January of 2018.

Family members described Franks, an alumna of Keene High School, as otherwise healthy.

Ferguson said there is also misinformation about the flu vaccine.

“A lot of people think they can get the flu from the flu shot, which is impossible. The flu shot is not a live vaccine; we are not giving them a little bit of the flu,” she explained.

If someone does get the flu shortly after receiving the shot, Ferguson added it’s only coincidence, and the vaccine will actually limit the severity and length of the disease.

“People say ‘I’m healthy, I don’t get sick,’ “ she noted. “Well, then you just have a really good track record.”

The vaccine changes slightly each year to keep up with flu strains, as they are constantly evolving. The CDC is recommending one of three different injectable vaccines or the nasal vaccination. Anyone over the age of 6 months should get a flu vaccine, according to the CDC.

Daly said it can take up to two weeks for the vaccine to start working, so people should get immunized now.

In addition, she said people should stay home from work or school when feeling ill, cover their mouths when coughing or sneezing and wash their hands diligently.

And in the midst of the anti-vaccination movement, Ferguson said she “very often” has to help patients understand the importance of vaccines.

“There are certainly people that aren’t interested in any vaccine, and a lot of that is just not understanding what preventative medicine is,” she said.

But aside from helping the individual, Ferguson said vaccinations are also about protecting the community as a whole.

“Our healthier population forgets they could be incubating the flu virus and not have symptoms for [up to] two days, so they are thinking about themselves, but not the other people they are around like grandparents or children,” she explained.

And though the vaccine is not perfect — in that it targets only the most common flu strains — it’s still the best preventative option, Ferguson said.

Vaccines can be given at most pharmacies on a walk-in basis and doctors’ offices by appointment.

Cheshire Medical Center, an affiliate of the Dartmouth-Hitchcock Health System, is also hosting three flu clinics, with the first being held on Oct. 5 from 9 to 11 a.m. for adults only on the hospital’s campus at 580 Court St. in Keene. Insurance companies will be billed after the clinic.

For additional questions, contact the center’s flu hotline at 354-5405.

Olivia Belanger can be reached at 352-1234, extension 9234, or Follow her on Twitter @OBelangerKS.