Neisseria meningitides is one of the leading causes of bacterial meningitis. The epidemio-logy of invasive meningococcal disease varies in different countries and regions. This review summarizes the available data from China describing the burden of meningococcal disease, N. meningitidis serogroups, and vaccination programs. Meningococcal serogroup A (MenA) was predominant for several decades in China. However, since 2000, invasive meningococcal disease caused by MenC, MenW, or MenB has increased. MenC, belonging to a hyperinvasive clonal sequence type ST-4821 (CC4821), emerged in Anhui Province and was subsequently disseminated over two-thirds of all Chinese provinces. Serogroup W (CC11) is endemic and causes death. Serogroup B (CC4821) originated from serogroup C (CC4821) via a capsular switching mechanism. Polysaccharide A and C meningococcal vaccines have been introduced into national routine immunization programs and have effectively reduced invasive meningococcal disease. However, the vaccination strategy must be revised based on the epidemic trends in meningococcal disease in China.