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October marks the start of a new flu season, with a rise in likely cases , federal statistics show.

The advice from federal health officials remains clear and consistent: Get the flu vaccine as soon as possible, especially if you're pregnant or have asthma or another underlying condition that makes you more likely to catch a bad case.

Make no mistake: Complications from the flu are scary, says , an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tenn., who is part of a committee that advises federal health officials on immunization practices.

"As we get older, more of us get heart disease, lung disease, diabetes, asthma," Schaffner says. "Those diseases predispose us to complications of flu — pneumonia, hospitalization or death. We need to make vaccination a routine part of chronic health management."

Federal , he says, are that "anyone and everyone 6 months old and older in the United States should get vaccinated each and every year." People 65 and above and pregnant women, along with patients who have underlying medical issues, should , if they haven't already, Schaffner says.

Within a typical year, about two-thirds of people over 65 get vaccinated against the flu, studies show, compared with 45% of adults overall and 55% to 60% of children. But only about half of pregnant women get vaccinated, and immunization rates for people with chronic diseases hovers around 30% to 40%.

Take the case of , a 55-year-old radio personality and music show host in Orlando, Fla., who was diagnosed with adult onset asthma in 2004 at age 40. For years she didn't get the flu vaccine, figuring her healthful diet, intense exercise and overall fitness would be protective enough.

"I skated along for a lot of years," O'Neal says, "and then, finally, in 2018 — boom! It hit me, and it hit me hard." She was out of work for nearly two weeks and could barely move. She was extremely nauseated and had an excruciating headache and aching body, she says. "I spent a lot of time just sitting on my couch feeling miserable."

O'Neal says it takes a lot to "shut her down," but this bout with the flu certainly did. Even more upsetting, she says, she passed the virus on to her sister who has chronic obstructive pulmonary disease. Fortunately, neither she nor her sister had to be hospitalized, but they certainly worried about it.

"We have lung issues and worry about breathing, so having the flu created lots of anxiety," O'Neal says. This year, she's not taking any chances: She has already gotten her flu shot.

That's absolutely the right decision, says , professor of internal medicine in the division of pulmonary and critical care medicine at the University of Michigan Health System and a national spokesperson for the American Lung Association.

If generally healthy people contract the flu, they may feel sick for a week or more, she says. But for someone with underlying lung conditions, it can take longer to recover from the flu — three to four weeks. "What I worry about most with these patients," Han says, "is hospitalization and respiratory failure."

In fact, Han says, 92% of adults hospitalized for the flu have at least such as diabetes, asthma, or kidney or liver disorders.

When people with underlying lung conditions contract the flu, she says, "the virus goes right to the lung, and it can make a situation where it's hard to breathe even harder."

Other chronic health conditions — diabetes, HIV and cancer, among them — impair the immune system, Han explains, making people with those conditions unable to mount a robust response to the flu virus without the immunization boost of a flu shot.

That means the inflammation and infection when they get the flu can become more severe, she says.

Even many of her own patients don't realize how bad a case of the flu can be, Han says.

"People often tell me, 'That's not me. I've never had the flu. I'm not at risk, and I'm not around people who might give me the flu.' "

O'Neal says she'd always figured she wasn't at risk either — until the flu flattened her.

Healthy pregnant women, too, are more prone to complications and hospitalization if they contract the flu and are strongly urged by the Centers for Disease Control and Prevention and OB-GYNs to get vaccinated against both influenza and pertussis. Yet the majority of mothers-to-be surveyed in the United States — 65% — have not been immunized against those two illnesses, according to a recent report.

Some women mistakenly worry that the flu vaccine isn't safe for them or their babies. "I think some of the fears about safety are certainly understandable, but they're misinformed," says , chief of the epidemiology and prevention branch of the CDC's Influenza Division.

The is clear, Fry says: The vaccine is extremely safe. And she points to a recent study showing that immunization against flu reduces the risk of flu hospitalization among pregnant women by 40%.

As for worries that the woman's vaccination might not be safe for her developing fetus, Fry says the opposite is true. When a pregnant woman is immunized, antibodies that fight the flu virus cross the placenta and can protect her baby in those critical months before and after birth.

"It can 70% of the illness associated with flu viruses in the baby," Fry says. "So it's a double protection: Mom is protected, and the baby's protected." Infants can't get the flu vaccine themselves until they are 6 months old.

Now, the vaccine won't protect against all strains of the flu virus that may be circulating. But Schaffner says the shot is still very much worth getting this year and every year.

"Although it's not perfect, the vaccine we have today actually prevents a lot of disease completely," he says. "And even if you do get the flu, it's likely to be less severe, and you'll be less likely to develop complications."

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