It’s old news that flu season is coming, and you need to get vaccinated.

But this year, the news comes with a twist: The nasal spray vaccine, FluMist, is not recommended. You need to get a shot.

And here’s the cardiac news: For anyone with any kind of heart condition, the flu vaccine is especially vital.

The Centers for Disease Control and Prevention has embarked on its annual campaign to persuade Americans to get vaccinated against the flu – and not to underestimate the need to avoid what can be a deadly virus.

“Flu is serious. Flu is unpredictable. Flu often gets not enough respect,” said Tom Frieden, M.D., the CDC director. “It is not the common cold … . Flu each year sends hundreds of thousands of people to the hospital and in a bad year, kills up to 49,000 Americans, including elderly, people with underlying conditions and infants.”

The CDC recommends flu vaccine for nearly everyone over 6 months old. Although the figures have trended upward in recent decades, the number of Americans who got vaccinated actually declined slightly in the 2015-2016 flu season. The CDC calculates that about 140 million people, or 46 percent of the eligible population, took its advice last year.

Getting those numbers up faces a new challenge this year. About 15 percent of those vaccinated a year ago opted for the nasal spray vaccine over the syringe. But the CDC and the National Foundation for Infectious Diseases have declared the spray to be ineffective.

“There were concerns about its effect against some flu viruses in the last three seasons,” said Lisa Grohskopf, M.D., of the CDC’s Influenza Division. “For reasons we still don’t completely understand, it didn’t work well against H1N1 viruses that were circulating. Those viruses are expected to circulate again this season so we recommend that FluMist not be used this season.”

The injectable vaccine didn’t have those problems, so children and needle-averse grownups need to gather their courage, have their lollipops or other inducements ready – and get a shot.

“I didn’t even feel it,” Frieden said with a smile as he took his annual shot for the cameras at a Sept. 29 news conference.

Belonephobia, a fancy word for fear of needles and other sharp objects, is only one obstacle in the persuasion campaign.

“A lot of people say, ‘I never got the vaccine and I never got the flu, so I don’t need it,’” Grohskopf said. “You never know when it’s going to be your year.”

Elliot Davidson, M.D., director of the Akron (Ohio) General Center for Family Medicine, said that if a patient has misgivings about the vaccine, he’ll listen “and I’ll counter any objection they might have.”

He stresses that the flu shot can’t give you the flu because the viruses injected have been killed and that any side effects are minor and temporary. Although the vaccine is never 100 percent effective because flu viruses are constantly changing, Davidson said, it’s the best chance to prevent a miserable couple of weeks.

“People don’t realize how sick you get when you get the flu,” he said. “You think you’re going to die or you’re afraid you might not.”

A small number of people can’t get the vaccine, including babies under 6 months, people allergic to its ingredients and anyone who has had Guillain-Barre Syndrome. They need to rely on what is called herd immunity, meaning that enough people around them are vaccinated so the virus is unlikely to spread.

But the vaccine is especially crucial for young children, pregnant women, people over 65, and people suffering from asthma, diabetes, cancer and other diseases.

That certainly includes heart patients, said Michael Rothkopf, M.D., an interventional cardiologist affiliated with Baylor Scott & White Medical Center in Irving, Texas.

“If you get the flu with an underlying heart condition, it’s going to be much more severe and much more complicated to get well,” he said. “It could actually precipitate a heart attack because of underlying coronary disease.”

That is because flu can lead to respiratory distress or pneumonia, Rothkopf said. “Your oxygen levels can drop. In a coronary patient, you need to avoid stress on the heart. Increased heart rate, low blood pressure or reduced oxygen can cause that.”

“It’s synergistic in a bad way,” he said.

In his Northeast Ohio family practice, Davidson said most of his patients take his advice and get vaccinated.

“There’s always going to be some holdouts. I’m not going to twist their arms. But as a last resort I’ll tell them, ‘Our doctors here get graded on this (how many patients get vaccinated). You’re going to make me look bad,’” he said.

“We’ll use any angle we can get,” said Davidson. “It’s that important.”