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An alert to Arizona parents with children about to start sixth grade: You have an extra responsibility this summer.

Before starting school this academic year, all the state's 11-year-olds must have proof that they've had a new series of vaccinations.

The requirements are one dose of meningococcal vaccine and one dose of TDAP — tetanus, diphtheria and pertussis vaccine.

Pertussis is whooping cough, which occurs every year in Arizona. Last year there were 210 confirmed cases. Preteens and teens get whooping cough more often than any other age group except for infants, according to the U.S. Centers for Disease Control and Prevention.

"Parents should be making appointments with their doctors now to get the vaccines before school starts," said Jennifer Ralston-King, immunization assessment coordinator for the Arizona Department of Health Services.

Ralston-King works closely with schools and school districts. Educators were notified of the new requirement numerous times, she said. The state has been preparing for the new rule for two years, acting on a recommendation by the CDC and the national Advisory Committee on Immunization Practices.

Students must have proof of their immunizations before they'll be allowed into the sixth grade, Ralston-King emphasized. State health officials hope the new rule will not result in confusion on the first day of classes.

"We've gotten the word out so many different times, but there always are people who are not listening, not reading," she said.

Arizona is in the national forefront in requiring adolescents to get meningococcal vaccines, Ralston-King said.

That's mainly due to the work of Tucsonan Leslie Maier, who has advocated for the vaccine and more awareness since her son, Chris Maier, died of bacterial meningitis in 2005, when he was 17. Chris Maier was a soccer standout at Sabino High School who had attended practice the night before he died.

Anyone can get meningitis, which is a serious bacterial infection that can cause swelling of the lining around the brain and spinal cord. But preteens and teenagers are at greater risk, accounting for nearly 30 percent of all cases of reported meningococcal infection in the United States. Meningococcal disease also can cause a blood infection called meningococcemia.

Invasive meningococcal infection is not very common — 12 cases were reported in Arizona last year — but when it strikes, it tends to be extremely serious, with a high mortality rate.

Each year up to 2,800 Americans get the disease, which strikes quickly and can be fatal. It also can lead to devastating complications such as brain damage and deafness, and the amputation of arms, legs, fingers and toes within hours of the first symptoms.