Social Behavior and Meningococcal Carriage in British Teenagers

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Abstract

Understanding predisposing factors for meningococcal carriage may identify targets for public health interventions. Before mass vaccination with meningococcal group C conjugate vaccine began in autumn 1999, we took pharyngeal swabs from ≈14,000 UK teenagers and collected information on potential risk factors. Neisseria meningitidis was cultured from 2,319 (16.7%) of 13,919 swabs. In multivariable analysis, attendance at pubs/clubs, intimate kissing, and cigarette smoking were each independently and strongly associated with increased risk for meningococcal carriage (p<0.001). Carriage in those with none of these risk factors was 7.8%, compared to 32.8% in those with all 3. Passive smoking was also linked to higher risk for carriage, but age, sex, social deprivation, home crowding, or school characteristics had little or no effect. Social behavior, rather than age or sex, can explain the higher frequency of meningococcal carriage among teenagers. A ban on smoking in public places may reduce risk for transmission.

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Most cited references 31

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The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica.

K Cartwright, J Stuart, D M Jones … (1987)

A total of 6234 nasopharyngeal swabs was collected during a survey of the population of Stonehouse, Gloucestershire in November 1986 as part of an investigation into an outbreak of meningococcal disease. The overall meningococcal carriage rate was 10.9%. The carriage rate rose with age from 2.1% in the 0- to 4-year-olds to a peak of 24.5% in the 15- to 19-year-olds, and thereafter declined steadily with age. Male carriers outnumbered female carriers of meningococci by 3:2. Group B (or non-groupable) type 15 sulphonamide-resistant strains which had caused the outbreak were isolated from 1.4% of subjects. The age distribution of carriers of these strains was similar to that of other meningococci apart from an additional peak in the 5-9-year age group and a more rapid decline in carriage with increasing age. Variations in the carriage rates of the outbreak strain were seen in children attending different schools and in the residents of different areas of the town. The low carriage rate of these strains in a community during a prolonged outbreak supports the hypothesis that these organisms are less transmissible but more virulent than other strains of pathogenic meningococci. Carriage of Neisseria lactamica, which is thought to be important in the development of meningococcal immunity, was most frequent in children under the age of 5 years and was six times commoner in this age group than carriage of Neisseria meningitidis. In older children and adults female carriers of N. lactamica increasingly outnumbered males in contrast to the male preponderance observed with meningococcal carriage.

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Carriage of serogroup C meningococci 1 year after meningococcal C conjugate polysaccharide vaccination.

Martin C J Maiden, James M Stuart (2002)

The UK was the first place to introduce meningococcal serogroup C conjugate (MCC) vaccines. From November, 1999, all people younger than 18 years, about 14 million individuals, were offered MCC immunisation. The uptake rate was more than 70% by November, 2000. We compared the carriage of meningococci in isolates we obtained from 14,064 students aged 15-17 years during vaccination in 1999, with those from 16,583 students of the same age surveyed 1 year later. Carriage of serogroup C meningococci was reduced by 66% (p=0.004). Our results show that MCC vaccines protect against carriage of meningococci that express serogroup C polysaccharide capsules.

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Household crowding a major risk factor for epidemic meningococcal disease in Auckland children.

M Baker, A McNicholas, N Garrett … (2000)

New Zealand is in its ninth year of a serogroup B meningococcal disease epidemic with annual rates of up to 16.9 cases per 100,000. The highest incidence is in Maori and Pacific Island children in the Auckland region. We conducted a case-control study to identify potentially modifiable risk factors for this disease. A case-control study of 202 cases of confirmed and probable meningococcal disease in Auckland children younger than 8 years of age recruited from May, 1997, to March, 1999, was undertaken. Controls (313) were recruited door-to-door by a cluster sampling method based on starting points randomly distributed in the Auckland region. They were frequency matched with the expected distribution of age and ethnicity in the meningococcal disease cases. With the use of a multivariate model and controlling for age, ethnicity, season and socioeconomic factors, risk of disease was strongly associated with overcrowding as measured by the number of adolescent and adult (10 years or older) household members per room [odds ratio (OR), 10.7; 95% confidence interval (CI), 3.9 to 29.5]. This would result in a doubling of risk with the addition of 2 adolescents or adults to a 6-room house. Risk of disease was also associated with analgesic use by the child, which was thought to be a marker of recent illness (OR 2.4, CI 1.5 to 4.0); number of days at substantial social gatherings (10 or more people for > 4 h; OR 1.8, CI 1.2 to 2.6); number of smokers in the household (OR 1.4, CI 1.0 to 1.8); sharing an item of food, drink or a pacifier (OR 1.6, CI 1.0 to 2.7); and preceding symptoms of a respiratory infection (cough, "cold or flu," runny nose, sneezing) in a household member (OR 1.5, CI 1.0 to 2.5). Some of these identified risk factors for meningococcal disease are modifiable. Measures to reduce overcrowding could have a marked effect on reducing the incidence of this disease in Auckland children.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): June 2006

Volume: 12

Issue: 6

Pages: 950-957

Affiliations

[* ]University of Oxford, Oxford, United Kingdom;

[† ]Health Protection Agency, London, United Kingdom;

[‡ ]University of Nottingham, Nottingham, United Kingdom;

[§ ]Health Protection Services Scotland, Glasgow, United Kingdom;

[¶ ]Health Protection Team (North Wales), Mold, United Kingdom;

[# ]Cardiff University, Cardiff, United Kingdom;

[** ]Thames Valley Local Health Protection Unit, Aylesbury, United Kingdom;

[†† ]St Thomas' Hospital, Stockport, United Kingdom;

[‡‡ ]Health Protection Agency Southwest, Stonehouse, United Kingdom

Author notes

Address for correspondence: James M. Stuart, Health Protection Agency South West, The Wheelhouse, Bond’s Mill, Stonehouse, GL10 3RF, UK; email: james.stuart@ 123456hpa.org.uk

Article

Publisher ID: 05-1297

DOI: 10.3201/eid1206.051297

PMC ID: 3373034

PubMed ID: 16707051

SO-VID: d2ec6e6e-cdb3-4f03-9f80-487bb0db097e

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Social Behavior and Meningococcal Carriage in British Teenagers

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Most cited references 31

The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica.

Carriage of serogroup C meningococci 1 year after meningococcal C conjugate polysaccharide vaccination.

Household crowding a major risk factor for epidemic meningococcal disease in Auckland children.

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