WEST MILFORD-Children here have yet another reason to dread going back to school in September. Three new state immunization requirements kick in this autumn, including the chickenpox vaccine for children in day care, kindergarten and first grade. In addition, students from grades 9 through 12 must be immunized against hepatitis B, and a vaccine against bacterial meningitis is needed for college freshmen and transfer students who will be living in campus dormitories. As of next month, students in those categories must produce written proof they have had the vaccines _ generally a school form signed by a doctor or nurse practitioner, or records from a student's prior school _ unless they have previously provided such evidence to their school. Exceptions can be made on medical and religious grounds. "All of these diseases can certainly cause significant illnesses in individuals with complications," Dr. Eddy Bresnitz, New Jersey's state epidemiologist, said this week. "Death can occur in any individuals who are infected with these organisms." Many students already have the newly required vaccines, because they have been recommended by pediatricians and major medical groups for some time. Still, at Children's Preferred Care in Lawrenceville, a spokeswoman said the number of teens getting hepatitis B vaccines is up about 30 percent over last summer and meningitis shots are up about 20 percent. At Hamilton Pediatric Associates in Hamilton, Mercer County, doctors have long recommended all three vaccines. Registered nurse Joan DiLeo said there's been a slight increase in students getting hepatitis B shots, but no other change. Elizabeth Restuccia, 18, of Chesterfield, got a meningitis vaccine there Wednesday in preparation for the fall, when she will be a freshman at Salisbury University in Maryland, which also is among the dozen states requiring that vaccine. "It didn't hurt," she said. Bacterial meningitis remains rare, with only 29 cases reported in New Jersey last year. But at least four of those patients died, and college freshmen are five times more likely than other people to get bacterial meningitis. It kills up to 15 percent of patients, usually very rapidly after the start of symptoms: fever, headaches, very stiff neck, sore throat and vomiting. "Typical story is, one day they're doing fine, the next day they're sick, the next day they're in the hospital and maybe even dead," Bresnitz said. About 182 to 250 hepatitis B cases are reported in New Jersey most years, but 244 were reported by mid-July. Hepatitis B shots have been required for students entering kindergarten, first and sixth grades since 2001, but the new requirement for high school students targets a group far more likely to get it. That's because hepatitis B, one of the many forms of liver inflammation, is spread through sexual intercourse and contact with contaminated blood or other bodily fluids, such as when IV drug abusers share needles. Like hepatitis C, which is spread the same way but for which there is no vaccine, hepatitis B can cause weakness, lethargy, loss of appetite, and, in severe cases, jaundice, liver swelling, abdominal pain and bleeding problems. "Those who survive it can go on and have chronic hepatitis, which can lead to cirrhosis. Cirrhosis of the liver can lead to liver cancer, which obviously is a lethal disease," Bresnitz said. Many parents still consider chicken pox a rite of passage, but Bresnitz said it causes a considerable number of hospitalizations and kills a small number of people each year. When adults who didn't have it as children are infected, they can develop potentially deadly complications such as pneumonia or encephalitis, a type of brain inflammation. Already, 43 other states require the chickenpox vaccination. The new shots add to the already-long list of immunizations required for school attendance: diphtheria, influenza type b, measles, mumps, pertussis, polio, rubella and tetanus. Some require more than one dose over a particular time span, and some are given in combination, such as measles, mumps and rubella, so the total number of shots can vary. "School nurses are getting the word out to parents so there are no surprises the first week of school," said Mike Yaple, spokesman for the New Jersey School Boards Association. Some schools already have sent notices about the new requirements to parent four or five times, said Richard Vespucci, spokesman for the state Department of Education.