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PHOENIX -- Arizona ranked near the bottom in its percentage of people receiving flu vaccinations during the 2012-2013 season, an advocacy group reported this week.

According to the Trust for America's Health, 38.3 percent of Arizonans 6 months and older got a flu shot, ranking 49th among all states and the District of Columbia. Among those ages 18-64, 27.3 percent were vaccinated, ranking 50th.

In comparison, Massachusetts ranked first for vaccination rates: 57.5 percent among those 6 months and older and 48.5 percent among those ages 18-64.

Rich Hamburg, deputy director of the Trust for America's Health, said the U.S. overall needs to improve its vaccination rates, since fewer than half of Americans received a flu shot during the 2012-2013 season.

"No matter what the number is in a particular state the goal is to really establish a norm, a cultural norm, of annual flu vaccinations to make sure that we have mechanisms in place to be better able to vaccinate all Americans," he said.

Arizona's flu season started in October and will end sometime in mid-spring. Through early this month, the Arizona Department of Health Services reported 1,016 cases.

Jennifer Tinney, program director with The Arizona Partnership for Immunization, said the state's warm weather can lead to nonchalance when it comes to the flu.

"It's 70 degrees, it's 80 degrees in December and they think, ‘Oh you know winter and flu season are far, far away.' Again, unfortunately, it's just beginning to creep up at that time," she said.

Working-age people, who are most likely to develop the flu, are less likely to get vaccinated because they often balance working full-time with raising a family, Tinney said.

Dr. Lisa Villarroel, medical director for epidemiology and disease control for the Arizona Department of Health Services, said adults can spread the flu virus by showing up to work instead of staying home when sick.

"There is absolutely a culture that's been bred to not appear weak. And so you go to work no matter what," Villarroel said. "I think you'd be doing everyone and your supervisors a favor if you did not do that."

This season, the most prevalent flu strain is H1N1, often referred to as swine flu, which caused the 2009 pandemic resulting in around 10,000 deaths across the U.S. But this time H1N1 doesn't pose as much of a threat - as long as people get a flu shot.

"The best way to prevent the flu is of course to get vaccinated. This is more effective than any other intervention that people can come up with," Villarroel said.

Hamburg, with the Trust for America's Health, said the Affordable Care Act may encourage more vaccinations as people test out their new insurance cards. Under the national health reform, flu vaccinations are covered without a co-pay in all states, something Hamburg said will remove the obstacle of payment.

"We need to remove barriers, whether it's lack of information or lack of access or lack of resources; to seek out and receive these vaccinations, those are all priorities," Hamburg said.

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