The state Health Department on Friday revised its flu shot recommendations because of a shortage of the vaccine nationwide.

State health officials on Thursday urged all North Dakotans to get shots because of an unusually large outbreak of the illness. Health officials normally emphasize the need for the elderly, the very young and those especially vulnerable to illness to get the shots.

On Friday, the two U.S. companies that make flu shots said they had run out of vaccine and would not be able to meet a surge in demand.

"As a result, the Department of Health is recommending that the remaining injectable influenza vaccine be reserved for those people at risk of developing serious complications from the flu," State Epidemiologist Larry Shireley said. "Healthy people ages 5 through 49 can choose to receive the nasal vaccine, FluMist."

People considered high risk would be those 65 and older, residents of nursing homes and other long-term care facilities, adults and children with chronic health conditions such as diabetes and AIDS, and woman who are at least 14 weeks pregnant.

Health Department spokeswoman Loreeta Frank said Friday that the agency was checking with regional health units to see how much flu vaccine they had on hand.

"Early next week, we should have a pretty good idea," she said.

North Dakota had confirmed 292 cases of the flu as of Thursday, the most recent figures available, Frank said. That compared with just two cases at the same time last year.

Health officials said the actual number of cases is much larger, because most people with the illness do not seek medical help.

(On the Net: Health Department flu Web site: http://www.ndflu.com.)