DAVID GREENE, host: Now, the HPV vaccine is not the only new vaccine parents need to be thinking about. States are starting to pass laws requiring teens and preteens to get a host of other shots, as NPR's Nancy Shute reports.

NANCY SHUTE: Parents used to think that once their kids were out of elementary school, they were done with vaccines. But the rules are changing.

(SOUNDBITE OF AD)

UNIDENTIFIED WOMAN: Parents, there's a new rule for school. Students entering seventh through twelfth grade this fall need proof of a whooping cough booster shot before starting school. Don't wait.

SHUTE: That's an ad running in California. It's about a new law aimed at stopping a deadly outbreak of whooping cough that killed 10 children last year. Whooping cough is also known as pertussis. Ron Chapman is head of the California Department of Public Health.

RON CHAPMAN: We had over 9,000 cases of pertussis in California, which was the highest number of cases since 1947.

SHUTE: Whooping cough spreads easily in schools, and the protection that children get from pertussis shots when they're babies wears off. That's why health officials are trying to get all middle- and high-schoolers vaccinated.

CHAPMAN: There's a huge, massive vaccination response. We're talking about vaccinating upwards of 3 million children in California.

SHUTE: To do that, they're using every public health tool in the book. There are Facebook pages, Twitter feeds, rap songs.

(SOUNDBITE OF RAP SONG)

UNIDENTIFIED MAN: (Rapping) See your doc, get your shots. It's worth it now. My skills in soccer and my health are perfect. What? Preteens, get your shots.

SHUTE: Parents are targeted, too. Jeanette Restauro got four different reminders to get her 11-year-old daughter vaccinated.

JEANETTE RESTAURO: The first time I got the information was through my daughter's backpack. And then a few weeks later they did it again - and once on the email, and once on a phone recording.

SHUTE: Restauro, who lives in Fairfield, California, took her daughter in to get the shot. In the past few years, dozens of states have passed laws requiring shots for teens and preteens.

Sharon Humiston is a pediatrician at Children's Mercy Hospital in Kansas City, Missouri. She studies teenage vaccinations.

Dr. SHARON HUMISTON: It used to be that once you were in kindergarten, you were done with immunizations. But that's not how it is anymore. We have immunizations throughout the lifespan now.

SHUTE: Sometimes that's because the shots wear off, like whooping cough, and you need a booster. In other cases, it's because doctors have come up with new vaccines. But it's not always easy to get teenagers in for those shots. One problem is that a lot of teens aren't covered by health insurance. Another is that parents and kids just aren't familiar with the diseases.

Meningococcal disease is one of those. It's a rare but deadly form of meningitis.

HUMISTON: I think that most parents, once they see a photograph of one adolescent who has lost their limbs to meningococcal disease, they end up choosing the vaccine.

SHUTE: That's why state and federal health agencies are making a big push to educate parents and teens about vaccines - like with this video, which urges students to get flu shots.

(SOUNDBITE OF VIDEO)

UNDENTIFIED MAN: My housemates are pretty cool. I guess.

It would be a lot easier to hang out with them if they took better care of themselves. I told Steve to get his flu shot. Oh, but no, he was too busy playing video games...

SHUTE: In some cases, teens may need also vaccines like chicken pox or hepatitis B. As teen vaccines become more common, parents and pediatricians are learning that big kids may not cry, but they don't always handle shots so well. Sharon Humiston sees that as a pediatrician.

HUMISTON: We even sometimes have adolescents who faint after getting their shots.

SHUTE: Which is a reminder that teenagers aren't quite grown up.

HUMISTON: We do think of them as being so big and robust, and that they can protect themselves somehow. But you know, no one can protect themselves against these microscopic viruses.

SHUTE: And when it comes to health, teens still need parents watching their backs. Nancy Shute, NPR News.

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