OBJECTIVES To conduct a systematic literature review of studies in peer-reviewed journals on the epidemiology and economics of invasive meningococcal disease from 1997-2007. METHODS This review employed standard methodology to extract studies from the Scopus on-line database of peer-reviewed, medical and public health literature from the preceding 10 years. U.S. and international populations, policies, practices, study design, and methods were evaluated. RESULTS There has been a steady incidence of meningococcal disease in the U.S. since 1989 ranging from 0.3 – 1.0/100,000 persons per year. Individuals under 1 year of age or between 15 and 24 are generally at a higher risk of infection. High density living arrangements are a major risk factor for meningococcal infection. Worldwide, there is significant variation in the incidence and management of meningococcal disease. The highest incidence of meningitis is found in the “Meningitis Belt” of Africa with serotype A responsible for 66% of disease. In Europe, the incidence of meningitis varies widely from country to country ranging from 2.5/100,000 in Switzerland to 10.2/100,000 in Greece. In general, countries react to outbreaks of meningococcal infection with targeted vaccination programs. There is a high price associated with the use of conjugate vaccines. In a probabilistic model of disease burden an adolescent catch-up vaccination program in the U.S. would cost society $127,000 per life year saved and $223,000 per case averted. Outside the U.S. the cost per life year saved varied substantially by country and by study due to varying costs and modeling techniques. CONCLUSIONS Many nations in the developing world do not implement prevention strategies until an epidemic of meningococcal infection has inflicted a substantial burden of disease, triggering aid organizations to support a catch-up vaccination campaign in response to an outbreak. Variations in health resources between countries significantly affect cost comparisons between countries.