There's a menace out there that leaves its victims weak and shaky, but it's not a Halloween ghoulie.

October is the beginning of flu season, said Dr. James Mathews, a primary care physician with Butler Health System.

Mathews said flu symptoms include fever, chills, weakness and headaches.

Dr. David Rottinghaus, an emergency room physician at Butler Memorial Hospital, 1 Hospital Way, said the flu is making itself felt already.

“Allegheny County is seeing some cases,” Rottinghaus said. “But reported cases are generally a lot less than those that are out there. We will see quite a bit. It's a seasonal thing. It will start ramping up soon.”

Dr. Thomas McGill, infectious disease specialist at the Butler hospital, said his lab has confirmed 14 cases of the flu since Sept. 25.

He noted that for every case diagnosed, it's probable another 100 cases go unreported.

Flu sufferers can expect more than the sniffles if the flu finds them.

“It will last three days or so, temperatures can reach 104 degrees,” said Mathews. “There will be a sore throat, a cough, nasal congestion. People will ache, have a headache and no appetite.”

“The hacky, dry cough will give then chest pain and a sore throat,” Mathews said.

What's worse, he said, the flu can be a danger to high-risk populations, which include children younger than 2 and adults 65 and older.

There's no silver bullet or crucifix to put this monster down, but medical science does have an answer to keep the flu at bay.

“I recommend all my patients get the flu vaccine,” said Mathews. He recommends a flu shot even for those people who say they never get sick.

“You might not become deathly ill, but you are still spreading it through the community and could give it to someone with chronic complications,” Mathews said.

McGill said a person carrying the flu virus can be infectious 24 to 48 hours before exhibiting flu symptoms himself.

Rottinghaus said what makes the flu so widespread is the ease with which it can jump from host to host.

It's tough because it is so contagious,” Rottinghaus said. “Step one is to get vaccinated. Step two is to practice good hygiene. The flu is transmitted through respiratory droplets. It can be passed through a cough, a sneeze, rubbing your eyes.”

McGill said, “Studies have shown the virus can survive 2 to 8 hours on a hard surface such as a desk.”

It can survive up to 3 days on paper money, he added.

That makes getting a flu shot important, both to protect yourself and others, said Mathews.

“Even if you are young and healthy, you can still spread it. You shed the virus for five days. You may feel better, but you are still shedding the virus and giving it to people,” Mathews said.

“There is no such thing as getting your flu shot too early. The recommendation of the Centers for Disease Control (and Prevention) is anybody greater than 6 months of age get a shot,” said Mathews.

Since the flu is caused by a virus, Mathews said, the two types of vaccines use forms of the virus to create a protection against it.

One vaccine contains live but attenuated or inactive viruses, the other vaccine contains particles or pieces of the flu virus that are dead.

The vaccine containing the attenuated live virus is administered by nasal inhaler.

“Its ability to adhere to cells and cause infection has been decreased,” said Mathews. “Even though it can't cause an infection, the immune system produces antibodies that will recognize the virus in the future.”

These antibodies will ward off any future flu viruses you come in contact with, Mathews said. Or that's the hope.

“There are several strains of flu,” said Rottinghaus. “So we take several strains in a vaccine. It is basically a guess to see what type of flu comes to the U.S.”

“In a flu season there may be several strains active. There's no guarantee that you won't get sick. There are many other viruses out there that can cause a host of symptoms,” said Rottinghaus. “The guessing is good and keeps getting better, but that is no guarantee.”

Mathews said the flu vaccine effects will last about a year.

And, like a creature in a horror movie, the flu keeps coming back in new forms.

Mathews said the flu shot formulation changes because the flu virus strains are always changing.

“One flu virus that was around last year, may change the following year because these things can mutate,” Mathews said. A changed flu virus could be one your body's antibodies doesn't recognize as a foe to be attacked.

“The CDC and WHO (World Health Organization) do a huge surveillance all through the world to see what strains of viruses are currently going around,” Mathews said.

Rottinghaus said flu shots are available at drug stores, primary care physicians' offices and hospitals.

“There are lots and lots of places to get them. There are no shortages of vaccine this year,” he said.

But both Rottinghaus and Mathews agreed, if you do get the flu, don't shuffle to work like a zombie trying to tough it out. Stay away from other people until the sickness has run its course.

“If you are sick, avoid going in to work and infecting other people,” said Rottinghaus.

✓ The U.S. flu season can run from October through May.✓ The Centers for Disease Control reports last year's 2012-2013 flu season resulted in more hospitalizations of people over 65 than any flu season on record. Flu-related illnesses cause some 200,000 hospitalizations each year.✓ People most at risk of the flu and further complications are young children, folks over age 65 and pregnant women. However, the pandemic H1N1 that surfaced in 2009 was most common in teenagers and young adults.✓ 90 percent of flu-related deaths are people age 65 or older.✓ The past few years, on average, 42 percent of Americans were vaccinated against the flu —meaning more than half of all Americans don't typically get a flu shot.Sources: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, Infectious Disease Foundation

Here are some everyday steps you can take to stop the spread of germs and help avoid getting the flu.✓ Bring your own pen — to the bank, grocery store, even to touch the ATM. Anything a sick person touches can harbor germs, including money, mail, ATM keypads, elevator buttons, etc.✓ Use paper — replace hand towels in bathrooms with paper towels. They're not as pretty, but paper towels can help get rid of a ton of germs that live in damp towels.✓ Wash hands frequently — use soap, warm water and rinse long enough to say the alphabet or sing “Happy Birthday.” Recent studies show plain soap and water work just fine.✓ Use a proper hand sanitizer (at least 60 percent alcohol) anytime you touch anything. Make sure you use sanitizer, even under fingernails, where germs hide.✓ Clean with disinfectant — viruses and bacteria can live up to two hours or longer on doorknobs, toys, TV remote controls, keyboards, mouse pads, refrigerator handles, counter tops, railings, faucets, bathroom floors and more.Sources: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, Infectious Disease Foundation