Serogroup A is the most common cause of epidemics outside the United States1 Serogroups B and C also cause epidemic disease1 When untreated, case mortality rates have exceeded 50% in endemic countries1   The Centers for Disease Control and Prevention (CDC) states that all travelers who have not already been vaccinated against meningitis should be vaccinated for these indications1: Vaccination is indicated for travelers to countries recognized as having epidemic meningococcal disease caused by vaccine-preventable serogroups (ie, A, C, Y, W-135) Vaccination is required for travelers to Mecca, Saudi Arabia, during the annual Hajj Vaccination is recommended for travelers to the meningitis belt of Africa (ie, from Mali to Ethiopia)   References: 1. Centers for Disease Control and Prevention (CDC). Health Information for International Travel 2001-2002. Atlanta, Ga: US Dept of Health and Human Services; 2000:124-127.