With Bridie Taylor, education director, the Meningitis Trust

It is nice to be able to report some really good news. Since the Meningococcal C vaccine was introduced into the routine immunisation schedule in 1999, cases of this strain have dropped by around ninety five percent in all age groups. This, oddly, has not been widely reported.

And while Haemophilus Influenzae type b (Hib) used to be the leading cause of meningitis in children under the age of five, with around eight hundred cases and twenty five deaths reported each year in England and Wales, there are now only around fifty cases annually thanks to the introduction of the Hib vaccine in 1992.

But we cannot be complacent. There are a number of other bacteria and viruses that cause meningitis and there is still no vaccine available for the remaining major strain of the disease prevalent in the UK - Meningococcal Group B, the most common cause of bacterial meningitis.

The disease peaks in the winter months. It can develop rapidly, and in its most serious form the results can be devastating, sometimes fatal. Children under the age of one are most at risk, followed by children aged one to five. Until we have effective vaccines that can protect against all of these other strains, it is vital that parents are aware of the signs and symptoms to look out for.

What is meningitis? The term does not really describe the true extent of the disease. Meningitis basically means inflammation of the meninges, which are the linings around the brain. There are many different causes including viruses, bacteria and fungi.

Viral meningitis is almost always a fairly mild condition and lasts from four to ten days. Most children make a complete recovery although they may suffer from headaches and tiredness for up to a year afterwards.

Although less common, the disease caused by bacteria is a different story. A bacterium known as meningococcus lives in the nasopharynx (the back of the throat) of healthy people. At any one time, about ten percent of the population could be carrying it.

Smokers, people living in overcrowded households and military recruits all have increased rates of carriage of the bacterium. It is spread by sneezing, coughing and intimate kissing. Fortunately most people naturally develop protection against these bacteria.

Meningococcal bacteria can cause both meningitis and septicaemia (blood poisoning). Once in the bloodstream, the bacteria multiply rapidly and stimulate the immune system into overdrive at a frightening speed. Meningococcal meningitis and septicaemia together are known as meningococcal disease.

How can you recognise the signs? The first signs are often cold hands and feet, leg pain and abnormal skin colour. Other symptoms in children can include fever, headache, nausea, vomiting, stiff neck, dislike of bright lights and drowsiness or confusion.

A symptom of meningococcal septicaemia is a rash that does not fade under pressure. The rash may appear as a few small spots anywhere on the body and can spread quickly to look like fresh bruises. The spots or rash are caused by blood leaking into tissues under the skin. Spots or a rash that do not fade under pressure will still be seen when the side of a clear drinking glass is pressed firmly against the skin. A fever with spots or a rash that does not fade under pressure is a medical emergency.