BMJ, doi: 10.1136/bmj.38725.728472.BE, (Published 10 February 2006)

RESEARCH

Risk and protective factors for meningococcal disease in adolescents: matched cohort study

Joanna Tully ¹, Russell M Viner ², Pietro G Coen ¹, James M Stuart ³, Maria Zambon ⁴, Catherine Peckham ⁵, Clare Booth ⁶, Nigel Klein ⁶, Ed Kaczmarski ⁷, Robert Booy ^1*

¹ Academic Centre for Child Health, Queen Mary's School of Medicine and Dentistry at Barts and the London, University of London, London E1 1BB
² Department of Paediatrics, Royal Free and University College Medical School, University College, London WC1E 6BT
³ Health Protection Agency (South West), Stonehouse GL10 3RF
⁴ Health Protection Agency, Respiratory Virus Unit, Health Protection Agency, London NW9 5HT
⁵ Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 3JH
⁶ Infectious Diseases and Microbiology Unit, Institute of Child Health
⁷ Health Protection Agency, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ

^* Correspondence to: robertb2{at}chw.edu.au.

Objective To examine biological and social risk factors for meningococcal disease in adolescents.

Design Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner.

Setting Six contiguous regions of England, which represent some 65% of the country's population.

Participants 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls.

Methods Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression.

Results 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection.

Conclusions Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.

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(Accepted 14 November 2005)
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Rapid Responses:

Read all Rapid Responses

Not a cohort study

Andrew J Hall
bmj.com, 27 Feb 2006 [Full text]

Immunological risk factors for meningococcal disease

Prasanta Padhan
bmj.com, 27 Feb 2006 [Full text]

Retrospective assessment of behavioral factors

Vilhjalmur Rafnsson
bmj.com, 12 Mar 2006 [Full text]

Religion as a marker for behaviour?

Fiona Reynolds
bmj.com, 17 Mar 2006 [Full text]

Response from authors

Robert R Booy, et al.
bmj.com, 6 Apr 2006 [Full text]