Meningococcal meningitis deserves its sinister reputation. At the dawn of the 21st century , here we still are at the mercy of a bacterium able to invade the bloodstream and damage vital organs with devastating speed. Even with prompt diagnosis and expert treatment, the mortality rate is around 10 per cent. No-one knows exactly what transforms the meningococcus from a germ that colonises the throat of 10-25 per cent of people into a virulent pathogen capable of turning a fit young adult into a corpse within hours.

The epidemiology of meningococcal disease has changed. There are now more group C cases, and more deaths in late teens, than ever before. Until recently, vaccines against meningitis C were made from the polysaccharide capsule of the bacterium and were poor at creating lasting immunity . The polysaccharide vaccine was, however , better than nothing, which is why new college students were of fered it last autumn.

In partnership with the Department of Health, Wyeth Laboratories have accelerated development of the new meningitis C conjugate vaccine (MCC). The technology , similar to that involved in producing the highly successful haemophilus influenzae vaccine (Hib), overcomes many of the limitations of the earlier polysaccharide vaccine. Starting in November 1999, the UK programme focused initially on youngsters aged 15-17 years. My own 15-year-old was one of the first in the country to receive MCC at school - and this arm was much less painful than the one that got a diphtheria and tetanus booster .

The phase of the MCC programme running in GP surgeries is the immunisation of babies at two, three and four months, and those at 13 months with their measles, mumps and rubella (MMR). Most parents have welcomed the new vaccine. Yet, there are some who wonder whether it is a good idea to give so many vaccines at once to such young children.

But the real problem with MCC has been its availability . The situation looks like a re-run of what happened with some previous vaccines, notably the polysaccharide meningitis C vaccine for college entrants last year. It is chaos for those practices which only received a tiny fraction of the vaccines needed to implement the programme. In the absence of DoH advice on how to eke out supplies, some local immunisation co-ordinators have guided GPs - with advice that varies widely from area to area, and can increase conflict between doctors and parents.

Even if there were 100 per cent immunity to meningitis C, there will be other forms of meningitis, so public vigilance still needs to be high.

Lay people are also already aware of the rash associated with meningococcal disease. What they do not seem to know is that it is a late sign, usually seen in meningococcal septicaemia when the patient is gravely ill. It is common for a GP to be summoned urgently to see a child with headache and a nondescript rash who is happily munching crisps or playing with Lego.

There will undoubtedly be a vaccine against meningitis B soon. Unfortunately , the outer capsule of the group B bacterium is frustratingly similar to antigens found in the human body , but research will surely deliver in the next few years. Parents look forward to its arrival with a mixture of relief and anxiety. For doctors, the vaccine causes as many headaches as the disease.