The aim of this article is to evaluate confirmatory criteria: culture, latex agglutination, counter immunoelectrophoresis, microscopic examination, and clinical/epidemiological criteria for cases of meningococcal disease reported in Greater Metropolitan Campinas, São Paulo State, Brazil, from 1993 to 2002 (568 cases). The following variables were also studied: clinical features, gender, age, city, hospital, case fatality, seasonality, and Neisseria meningitidis serogroup. Culture as a confirmatory criterion was the dependent variable in univariate analysis. The mean proportion of confirmatory criterion by culture was 68.7%. Clinical features of meningococcal disease -- meningitis without septicemia (OR = 2.87; CI: 1.89-4.38) and septicemia without meningitis (OR = 0.26; CI: 0.17-0.45) -- were associated with confirmation by culture. Case fatality rates were different among all diagnostic criteria. More attention should be given to etiological diagnostic confirmation in more severe cases. Diagnostic methods such as PCR may improve etiological confirmation of meningococcal disease in cases with negative cultures.201531-7