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Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Approximately 10–15% of meningococcal patients died despite antimicrobial therapies.We used vital records to assess meningococcal disease mortality in the United States during 1990–2002. Meningococcal cases were defined as reported deaths with recorded International Classification of Diseases, 9th revision (ICD-9) codes 036.0–036.9 or ICD-10 codes A39.0–A39.9. Denominator data were obtained from population estimates published by the U.S. Census Bureau. We analyzed the effects of age, sex, race/ethnicity and season of the year on meningococcal disease mortality.We identified 3335 meningococcal deaths. Both the crude and age-adjusted mortality rates were 0.10 death per 100,000 population per year (95% confidence interval, 0.09–0.10). Fifty-eight percent of deaths occurred among persons younger than 25 years old. Mortality was elevated in infants, young adults (15–24 years old), and older adults (older than 74 years old). Mortality rates in African-Americans were 1.45 and 3.32 times higher than mortality rates in whites and Asians/Pacific Islanders, respectively. Mortality caused by meningococcal disease rose in winter months and declined during the summer. Observed mortality rates increased from 1990 to 1997 and decreased from 1997 to 2002.Meningococcal disease continues to be an important, vaccine-preventable cause of death in the United States. Vaccination and other disease prevention efforts should be augmented for higher risk groups. Meningococcal mortality data can be used to assess the effectiveness of these efforts.