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Neisseria meningitidisis an important cause of serious bacterial infection in children and adults in the US. From 1992 to 1997 invasive disease caused byN. meningitidiswas studied among 1.9 million residents of Dallas County, TX.The demographic characteristics and diagnoses of 151 patients were identified through active, population-based surveillance and review of medical records. Serogroups were determined for strains infecting 129 (85%) patients.The average annualized incidence rate was 1.3 cases per 100 000 person years and was highest for children <1 year (13 cases/100 000 person years). Older patients (50+ years old) were more likely to present with pneumonia and less likely to present with meningitis than younger patients. Neither the fatality rate nor the duration of hospitalization for surviving patients was associated with age. Among patients with a known serogroup, serogroup C disease was found in 35% of cases <1 year old, 64% of those 1 to 49 years old and 44% of those 50+ years old. Serogroup B strains were isolated from 26% of patients <1 year, 17% of patients 1 to 49 years old and none of the patients 50+ years old. Serogroup Y disease increased from 22% to 35% of cases between 1992 and 1997 (P= 0.03). This serogroup was identified in 26% of patients <1 year old, 17% of patients 1 to 49 years old and in 50% of patients 50+ years old. Serogroup C and Y accounted for 61% of cases in children <1 year old and for 79% of cases in all age groups.The results underscore the importance of conjugate vaccines for serogroups C and Y.