With flu shot supplies dwindling at local doctors' offices, the county health department is encouraging healthy people to consider an alternative to the shot: a nasal spray called FluMist.

"Healthy individuals with no contraindications should get the mist and free up the injections for high-risk people," said Wilma Wooten, deputy health officer for the San Diego County Health and Human Services Agency.

Local doctors and pharmacists say they usually recommend getting the injected vaccine over FluMist, which can give people flu symptoms and isn't approved for young children, the elderly or sick patients -- those at the highest risk of dying from the flu.

As with the flu shot, the mist's vaccine doesn't exactly match the flu virus that has sickened thousands throughout the state, so doctors don't know how well the mist protects against this year's flu.

But the supply of flu shots has dried up in most areas, and health officials say the mist may be a good last resort for healthy people who want at least some protection against the virus.

"It's not the best option, but if it comes down to preventing an epidemic, I guess it's probably better than nothing," said Bill Mastin, chief pharmacist for the agency.

Flu has infected thousands throughout the U.S. and has killed at least four people in San Diego County.

FluMist is a new vaccine that is approved only for patients between 5 and 49 years old. To be able to take the mist, patients can't have immune problems, asthma, heart or lung disease, or be pregnant.

Other factors that disqualify patients are blood disorders, airway problems, certain allergies and a history of aspirin therapy in children and adolescents.

The mist is only for healthy people because it contains small particles of a live flu virus, which in some cases can cause flu symptoms. Young children, the elderly and people with underlying medical problems are more at risk of complications from such symptoms, so they aren't able to use FluMist.

Clinics in San Diego and Riverside counties don't offer the mist.

"It doesn't reach the people who are most at risk, so we don't offer it," said Barbara Cole, director of disease control for the Riverside County Department of Public Health.

At $55 to $60 per dose, the mist costs about four times as much as the shot. The mist also requires a prescription, which can require a doctor's consultation that can drive up costs. But the manufacturer of the mist has issued an Internet coupon for a $25 rebate, and at least one large insurance company, Aetna Inc., has said it will cover the mist this flu season.

Even without the discounts or insurance coverage, doctors said, the shot may be worth its price for people who can't afford to miss work, or for caretakers on whom family members depend.

"If you're in a job where missing work isn't an option, or it will make you lose out on pay for three or four days, then a vaccine that costs 50 or 60 bucks is pretty good insurance," said physician Jeffrey Leach, who practices in Vista.

Still, few people have requested the mist. Leach said he hasn't had one patient ask for the nasal vaccine.

According to the mist's manufacturer, just 400,000 doses have been sold to doctors and pharmacies. The company initially planned to sell 4 million doses. About 80 million doses of the flu shot -- all that its manufacturers produced -- have been sold.

Mastin said price has probably played a large role in the low number of FluMist doses sold, along with uncertainty about the effectiveness of the vaccine.

"For a physician to buy 100 doses would cost $6,000 or so, and they just aren't going to buy it without knowing if people will want it," he said. "It's expensive, it might not protect you, and it's not for people who need the most protection anyway … personally, I wouldn't touch the stuff."

People interested in the FluMist vaccine should talk to their doctors or pharmacists, officials said.

The Associated Press contributed to this report. Contact staff writer Erin Walsh at (760) 739-6644 or ewalsh@nctimes.com.