Introduction Since the introduction of routine immunisation with the Meningococcal serogroup C vaccine (1999), the incidence of meningococcal infections, particularly Meningitis C infection, has steadily fallen in Scotland. However, despite the evident success of the vaccine there is still the issue that certain sub-groups of the Scottish population remain at disproportionate risk of acquiring the disease. We have explored the pattern of meningococcal cases in Scotland between 2005 and 2008 by socio-economic group.

Methods The Carstairs index, developed for 2001 census data, was used to match one of seven deprivation categories to the first four postcode digits of 548 Scottish meningococcal cases notified between 2005 and 2008.

Results Between 2005 and 2008 the incidence of meningococcal infection (per 100 000) in Scotland showed a clear socio-economic gradient. While there was a clear socio-economic gradient in children (6.2 cases/100 000 for least deprived category, 12.6 cases/100 000 for most deprived category), there was no equivalent gradient observed for adults. There was no evidence of increased mortality in more deprived groups.

Conclusions There is a clear socio-economic gradient for meningococcal disease in children in Scotland. This finding is consistent with the internationally recognised influence of social inequality as a risk factor for worse health and increased susceptibility to infectious diseases, Despite major investment to reduce child poverty over the past decade it therefore appears that children from socially deprived areas have increased vulnerability to meningococcal infection. Explanations may include differences in housing, exposure to cigarette smoke and other social factors.