Washington ? Starting next week, it’s time to line up for flu vaccines again, and this year some Americans will get to choose a squirt up the nose instead of a shot in the arm.

But the new nasal-spray vaccine, called FluMist, will cost well more than twice as much as a shot. It also cannot be used by those who need protection against influenza the most: babies and toddlers, people 50 or older, and those with asthma or other chronic illnesses.

Still, FluMist’s expected advertising blitz could generate new interest in flu protection at a pivotal time. Specialists say far too few Americans get vaccinated, including healthy people who may not be at risk of dying but spread around influenza’s misery.

In addition, fearing a winter return of the deadly new SARS virus, the World Health Organization is urging more flu vaccination. While flu vaccine won’t prevent SARS, both diseases have similar symptoms, and WHO contends that holding down the number of serious influenza cases will mean less chance of doctors mistaking flu for SARS.

The U.S. Centers for Disease Control and Prevention doesn’t want to make that connection, cautioning that other respiratory viruses circulate during the winter that could be confused with SARS, too.

There’s reason enough to get flu vaccine, stresses CDC’s Dr. Scott Harper: Influenza kills 36,000 Americans in an average year, hospitalizes 114,000 and infects up to 20 percent of the population.

Roughly 70 million people get a flu vaccination every year, less than half the number especially urged to get it, Harper laments. Among the highest-risk patients, only a third of adults with asthma are vaccinated, and fewer than two-thirds of the elderly, even though flu shots are free under Medicare.

Vaccine experts think that’s partly due to complacency — the last two flu seasons have been mild — and partly due to two years of manufacturing delays that had doctors rationing the season’s earliest inoculations.

The manufacturing problems appear solved: CDC says plenty, 85.5 million doses, are becoming available, and early October inoculations are open to everyone.

For the complacent, “it would be very unusual to have three mild seasons in a row,” warns Dr. William Schaffner of the National Foundation for Infectious Diseases.