Meningococcemia causes substantial morbidity and mortality worldwide, usually in the term of fulminant disease. This paper reviews the background, pathophysiology, clinical manifestations, and treatment of this entity, along with prevention measures and public health issues to be considered. The authors present updated information on breakthroughs in the understanding of genetic predisposition to invasive disease. The status of adjunctive treatment modalities such as monoclonal antibodies and activated protein C, and progress in conjugate vaccine development and implementation are also addressed.