It's a down right nagging cough and for kids it's one that can turn deadly. There's been a whooping cough outbreak in Arizona two years in a row.

If you've got a middle school student listen up. The state is requiring a new booster shot.

Even if they've been vaccinated for whooping cough before, health officials say it can wear off.

By rolling up her sleeve 13-year-old Ashley is getting a jump start on next school year.

New rules require all kids 11 and older get the "TDAP" vaccine to boost their immunity against "pertussis" -- commonly called whooping cough.

“Sometimes you gave to throw up to catch your breath, you can break ribs, nose bleeds, sometimes seizures,” said Dr. Karen Lewis of the Arizona Department of Health Services.

And sadly, even death, especially among newborns, who haven't yet had their shots.

Just last year, a 19-day old baby died right here in Maricopa County.

Health officials say that's all the more reason to get older siblings, whose immunity might be wearing off, a booster shot, to prevent the nagging disease.

“A whoop, they really do sound like their whooping,” Mesa school’s Nadine Miller said.

After two confirmed cases at Mesa public schools last year district officials are being pro-active for the 2008 school year, warning parents by letter, of the new "TDAP" booster requirements for kids 11 and older.

“The state law state law requires kids have immunizations by time kids start school,” Miller said. “The problem with this vaccine in particularly the state going to give us a year to get everyone into compliance they know it won't happen real quickly.”

Looks like Ashley, who barely flinched, is setting the pace.    

If parents really want to be on top of things, while knocking out the whooping cough vaccine, also ask for the meningitis vaccine.

Health officials say that will be added to the required immunization list one year from now.