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Objective: To describe the epidemiological, clinical and laboratory features of meningococcal disease and explore the factors responsible for its morbidity and mortality among the pilgrims during Hajj 2000., Setting: This study was conducted at King Faisal Hospital, Makkah, Saudi Arabia., Method: Any patient suspected of meningococcal disease during the period of pilgrimage presenting with fever, head ache, signs of meningeal irritation and turbid CSF, confirmed on gram stain smears. Latex agglutination test and culture was included in this study. Their clinical features, management and outcome was recorded and analysed., Results: Of 105 confirmed cases of meningococcal disease, 64% had predominantly meningitis, 36% meningococcaemia and meningitis. Meningococcal rash was found in 2% and co-morbidity in 18% of cases. Antibiotics used empirically were benzylpenicillin or ceftriaxone along or in combination. Overall case fatility rate was 34%. Delay in diagnosis, delay of antibiotic administration, older patients and patients with serious concurrent medical problems, were the factors leading to higher than expected mortality rate. Maximum number of patients were Pakistanis (18%) followed by Indians (15%) and Indonesians (12%). Overall serogrouping was as follows: group A (44), W135 (19), B (1) and untypable (1). Serogroup W135 appeared more invasive and more fatal., Conclusion: Quadrivalent vaccine ACYW135 is recommended for pilgrims to enter Saudi Arabia and for mass vaccination in local population.