WASHINGTON — Fever, chills, vomiting: It starts like a stomach bug or the flu. But bacterial meningitis can go on to kill terrifyingly fast — one of the few infections in the U.S. where someone can feel fine in the morning and be dead by night. And prime targets are tweens, teens and college freshmen.

Amid all the publicity about children's flu shots this year is quiet concern that vaccination against meningococcal meningitis not fall by the wayside, just as doctors are charting some progress against the rare but devastating infection.

In the two years since the government recommended that every adolescent be vaccinated, close to 40 percent of tweens and teens are, says Dr. Carol Baker, a pediatric vaccine specialist at Baylor College of Medicine.

That's a decent start considering parents seldom hear about the tough-to-pronounce illness — say muh-NIN-ja-ka-kul. It affects only about 2,000 Americans a year, with rates recently inching down to historic lows.

But about 15 percent of the people who catch this fast-moving germ die — and one in five of the survivors suffer permanent disabilities including brain damage, deafness or amputated limbs.

"What hasn't changed is the severity," warns Baker, past president of the National Foundation for Infectious Diseases. "The risk is less but if it's your kid, it's everything."

Olga Pasick's son David had just started eighth grade in Wall Township, N.J., in 2004 when one Sunday evening he got a fever. Vomiting began late in the night. The next morning, the pediatrician took one look at the purplish rash forming on David's chest — infection spreading through his bloodstream — and ordered him straight to the hospital.

"He was upset because he wanted to go to school," recalls Pasick. Instead, hours later, the 13-year-old was dead.

Now Pasick has joined a fall campaign by the National Association of School Nurses to urge vaccination.

"It killed David within 24 hours of the first flulike symptoms and he was a healthy kid," she warns.

The nurses' Voices of Meningitis campaign is overshadowed by attention to the new swine flu and predictions of a busy influenza season in schools — and yet opportune for the same reason. Baker, who's not involved with the nurses' group, worries about an uptick in meningococcal infections this fall winter. That's when the disease is most common anyway. Plus, a prior bout of flu can make you more susceptible.

"That is one of the bacteria that flu helps to invade through the mucus membranes of the nose," Baker explains.

There are multiple types of meningitis, an infection of the membranes around the brain and spinal cord. Viral types tend not to be as severe. Babies and older adults are offered vaccine against two other bacterial types.

When it comes to the meningococcal form, 10 percent of the population carries the bacteria harmlessly in their noses and throats. Carriers spread it by coughing, kissing and sharing drinking glasses — particularly in crowded conditions like dormitories where young people can encounter strains of the germ they've never been exposed to before.

Many colleges now require freshmen to be vaccinated, whether they're dorm-dwellers or not.