There were 176 culture-confirmed cases of melioidosis in north Queensland over the 10 years, 2000-2009. Most (nearly 80%) occurred in the first 4 months of the year. The overall case fatality was 21%, but was 14% in 2005-2009. Of the 173 adult cases, 45% were in Indigenous adults. Both diabetes and alcohol abuse were more prevalent among Indigenous adults with melioidosis than among non-Indigenous adults. The incidences in Indigenous adults were particularly high in the Torres Strait and Northern Peninsula Area, Cape York and Mornington Island, whereas for non-indigenous adults there appears to be a higher risk within Townsville city.