SummaryBackgroundWe describe the epidemiology, clinical features and outcome of adult meningococcal meningitis in the Netherlands over a 15-year period.MethodsWe studied adults (age ≥ 16 years) who were listed by the Netherlands Reference Laboratory for Bacterial Meningitis and/or included in the prospective nationwide cohort study (MeninGene) between January 2006 and July 2021. Incidences were calculated per epidemiological year (July–June).FindingsWe identified 442 episodes of adult meningococcal meningitis. The median patient age was 32 years (IQR 18–55) and 226 episodes (51%) occurred in female patients. The annual incidence per 100,000 adults fluctuated, from 0.33 in 2006–2007 to 0.05 in 2020–2021, with a temporal increase up to 0.30 from 2016 to 2018, driven by an outbreak of serogroup W (MenW). Of 442 episodes, 274 episodes (62%) in 273 patients were included in the clinical cohort study. The overall case fatality rate was 4% (10 of 274) and 16% (43 of 274) had an unfavourable outcome (Glasgow Outcome Scale score 1–4). Compared to other serogroups, MenW was associated with higher rates of unfavourable outcome (6 of 16 [38%]vs.37 of 251 [15%], P = 0.03) and death (4 of 16 [25%]vs. 6 of 251 [2%], P = 0.001).InterpretationThe overall incidence of adult meningococcal meningitis in the Netherlands is low and outcome is generally favourable. An increase of MenW meningitis occurred from 2016 to 2018, which was associated with more unfavourable outcome and death.Funding10.13039/501100001826Netherlands Organisation for Health Research and Development,10.13039/501100000781European Research Council,National Institute of Public Health and Environmental protection.