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Badahdah AM, Rashid H, Khatami A, Booy R. Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review. Vaccine 2018; 36:4593-4602. [PMID: 29961604 DOI: 10.1016/j.vaccine.2018.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review. METHODS A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures. RESULTS Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes. CONCLUSION IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.
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Affiliation(s)
- Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia
| | - Ameneh Khatami
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Departments of Paediatric Infectious Diseases and Microbiology, School of Medicine, NYU Langone Medical Centre, NY, USA
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge Through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLoS Negl Trop Dis 2018; 12:e0006577. [PMID: 29897915 PMCID: PMC6016946 DOI: 10.1371/journal.pntd.0006577] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/25/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023] Open
Abstract
Background Rheumatic heart disease (RHD) poses a major disease burden among disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These conditions are acknowledged as diseases of poverty, however the role of specific social and environmental factors in GAS infection and progression to ARF/RHD is not well understood. The aim of this systematic review was to determine the association between social determinants of health and GAS infection, ARF and RHD, and the effect of interventions targeting these. Methodology We conducted a systematic literature review using PubMed, the Cochrane Library and Embase. Observational and experimental studies that measured: crowding, dwelling characteristics, education, employment, income, nutrition, or socioeconomic status and the relationship with GAS infection, ARF or RHD were included. Findings for each factor were assessed against the Bradford Hill criteria for evidence of causation. Study quality was assessed using a standardised tool. Principle findings 1,164 publications were identified. 90 met inclusion criteria, comprising 91 individual studies. 49 (50.5%) were poor quality in relation to the specific study question. The proportion of studies reporting significant associations between socioeconomic determinants and risk of GAS infection was 57.1%, and with ARF/RHD was 50%. Crowding was the most assessed factor (14 studies with GAS infection, 36 studies with ARF/RHD) followed by socioeconomic status (6 and 36 respectively). The majority of studies assessing crowding, dwelling characteristics, education and employment status of parents or cases, and nutrition, reported a positive association with risk of GAS infection, ARF or RHD. Crowding and socioeconomic status satisfactorily met the criteria of a causal association. There was substantial heterogeneity across all key study aspects. Conclusion The extensive literature examining the role of social determinants in GAS infection, ARF and RHD risk lacks quality. Most were observational, not interventional. Crowding as a cause of GAS infection and ARF/RHD presents a practical target for prevention actions. Rates of rheumatic heart disease (RHD) are high in disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These are described as diseases of poverty, but exactly what components of poverty promote them has been unclear. The aim of this review was to find what specific social and environmental factors are associated with GAS infection, ARF and RHD, and if actions targeting these can reduce disease rates. We did a search of published literature and found 90 relevant articles. Many supported an association between GAS infection, ARF or RHD and crowding, dwelling characteristics, low education level and employment status, poor nutrition and low social class. There was enough evidence to show that crowding and socioeconomic disadvantage increase the risk of GAS infection and ARF/RHD. However, most studies were of fair to poor quality in their ability to answer the research question, and there was little interventional research. This may relate to challenges inherent in intervening to change social determinants of health, but may also suggest lesser research attention to health issues affecting disadvantaged populations. The association between crowding and disease risk strongly supports initiatives to reduce crowding. This should become a key target for ARF and RHD prevention.
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Affiliation(s)
- Pasqualina M. Coffey
- Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
- * E-mail:
| | - Anna P. Ralph
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Vicki L. Krause
- Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
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Gianchecchi E, Piccini G, Torelli A, Rappuoli R, Montomoli E. An unwanted guest:Neisseria meningitidis– carriage, risk for invasive disease and the impact of vaccination with insight on Italy incidence. Expert Rev Anti Infect Ther 2017; 15:689-701. [DOI: 10.1080/14787210.2017.1333422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Giulia Piccini
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Alessandro Torelli
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Emanuele Montomoli
- VisMederi Srl, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Catchpole M, Coulombier D. Refugee crisis demands European Union-wide surveillance! ACTA ACUST UNITED AC 2016; 20:30063. [PMID: 26606945 DOI: 10.2807/1560-7917.es.2015.20.45.30063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Mike Catchpole
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Daures M, John M, Balter CV, Simon O, Barguil Y, Missotte I, Grangeon JP, Laumond-Barny S, Noel M, Besson-Leaud L, Spasic PE, de Suremain A, Gourinat AC, Descloux E. Relationships Between Clinico-Epidemiological Patterns of Invasive Meningococcal Infections and Complement Deficiencies in French South Pacific Islands (New Caledonia). J Clin Immunol 2014; 35:47-55. [PMID: 25352052 DOI: 10.1007/s10875-014-0104-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/29/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Invasive Meningococcal Disease (IMD) is three fold more common in New Caledonia (NC) than in metropolitan France and many IMD cases (35.7%) are due to Y and W135 serogroups. The purpose of our study was to identify IMD risk factors in NC. METHODS A retrospective study of all IMD cases that occurred in NC between 2005 and 2011 was conducted. Socio-environmental, clinical and biological data were collected. A search for immune deficiency was proposed to all cases. IMD presentation and outcome were compared according to meningoccal serogroups and the complement deficiency status (C-deficiency). RESULTS Sixty-six sporadic IMD cases (29 B serogroup, 20 Y or W135, 6 C, 1 A, 10 unknown) occurred in 64 patients often <24 years-old and of Melanesian origin. Five patients died (7.8%). No socio-environmental risk factors were identified. No asplenia, HIV infection or immunoglobulin deficiencies were found. Two patients had diabetes and 28 of 53 (52.8%) patients had C-deficiency including 20 (71.4%) cases of late complement component deficiency. Patients with C-deficiency were mainly Melanesian (92.8%) originating from the Loyalty Islands (62.1%). They were mostly infected with Y/W135 (42.9%) or B serogroups (32.1%). They often developed later and more severe disease than patients without C-deficiency (need for intensive cares in 60% versus 28.0% of cases, p = 0.01). CONCLUSIONS A high prevalence of C-deficiency in the Melanesian population may explain epidemiological and clinical features of IMD in NC. Our results imply an adaptation of meningococcal vaccine strategies in NC.
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Affiliation(s)
- Maguy Daures
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia.
| | - Michele John
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | | | - Olivier Simon
- Neurology Department, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Yann Barguil
- Biochemistry and Haemostasis Laboratory, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Isabelle Missotte
- Paediatrics Department, Noumea Territorial Hospital, Noumea, New Caledonia
| | - Jean-Paul Grangeon
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | - Sylvie Laumond-Barny
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | - Martine Noel
- Public Health Service, New Caledonia Health Department, BP N4 - 98851, Nouméa, Cédex, New Caledonia
| | | | | | | | - Ann-Claire Gourinat
- Laboratory of Serology and Molecular Diagnosis, Pasteur Institute, Noumea, New Caledonia
| | - Elodie Descloux
- Department of Internal Medicine, Noumea Territorial Hospital, Noumea, New Caledonia
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Ferraro CF, Trotter CL, Nascimento MC, Jusot JF, Omotara BA, Hodgson A, Ali O, Alavo S, Sow S, Daugla DM, Stuart JM. Household crowding, social mixing patterns and respiratory symptoms in seven countries of the African meningitis belt. PLoS One 2014; 9:e101129. [PMID: 24988195 PMCID: PMC4079295 DOI: 10.1371/journal.pone.0101129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/03/2014] [Indexed: 12/24/2022] Open
Abstract
Objectives To describe the variation in household crowding and social mixing patterns in the African meningitis belt and to assess any association with self-reported recent respiratory symptoms. Methods In 2010, the African Meningococcal Carriage Consortium (MenAfriCar) conducted cross-sectional surveys in urban and rural areas of seven countries. The number of household members, rooms per household, attendance at social gatherings and meeting places were recorded. Associations with self-reported recent respiratory symptoms were analysed by univariate and multivariate regression models. Results The geometric mean people per room ranged from 1.9 to 2.8 between Ghana and Ethiopia respectively. Attendance at different types of social gatherings was variable by country, ranging from 0.5 to 1.5 per week. Those who attended 3 or more different types of social gatherings a week (frequent mixers) were more likely to be older, male (OR 1.27, p<0.001) and live in urban areas (OR 1.45, p<0.001). Frequent mixing and young age, but not increased household crowding, were associated with higher odds of self-reported respiratory symptoms (aOR 2.2, p<0.001 and OR 2.8, p<0.001 respectively). A limitation is that we did not measure school and workplace attendance. Conclusion There are substantial variations in household crowding and social mixing patterns across the African meningitis belt. This study finds a clear association between age, increased social mixing and respiratory symptoms. It lays the foundation for designing and implementing more detailed studies of social contact patterns in this region.
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Affiliation(s)
- Claire F. Ferraro
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Maria C. Nascimento
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean-François Jusot
- Unité d'Epidémiologie, Centre de Recherches Médicales et Sanitaires (CERMES), Niamey, Niger
| | | | - Abraham Hodgson
- Navrongo Health Research Centre, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Ghana
| | - Oumer Ali
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Serge Alavo
- L'institut de recherche pour le développement, Dakar, Senegal
| | - Samba Sow
- Center for Vaccine Development-Mali (CVD-MALI), Bamako, Mali
| | | | - James M. Stuart
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Koch K, Søgaard M, Nørgaard M, Thomsen RW, Schønheyder HC. Socioeconomic inequalities in risk of hospitalization for community-acquired bacteremia: a Danish population-based case-control study. Am J Epidemiol 2014; 179:1096-106. [PMID: 24682527 DOI: 10.1093/aje/kwu032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In a Danish population-based case-control study, we examined the association between socioeconomic status (SES) and risk of community-acquired bacteremia, as well as the contribution of chronic diseases and substance abuse to differences in bacteremia risk. Analyses were based on 4,117 patients aged 30-65 years who were hospitalized with first-time community-acquired bacteremia during 2000-2008 and 41,170 population controls matched by sex, age, and region of residence. Individual-level information on SES (education and income), chronic diseases, and substance abuse was retrieved from public and medical registries. Conditional logistic regression was used to compute odds ratios for bacteremia. Persons of low SES had a substantially higher risk of bacteremia than those of high SES (for short duration of education vs. long duration, odds ratio = 2.30 (95% confidence interval: 2.10, 2.52); for low income vs. high income, odds ratio = 2.77 (95% confidence interval: 2.54, 3.02)). A higher prevalence of chronic diseases and substance abuse in low-SES individuals versus high-SES individuals explained 43%-48% of the socioeconomic differences in bacteremia risk. In a country with a universal welfare system, differences in the burden of chronic diseases and substance abuse seem to have major importance in explaining inequalities in bacteremia risk.
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Murray RL, Britton J, Leonardi-Bee J. Second hand smoke exposure and the risk of invasive meningococcal disease in children: systematic review and meta-analysis. BMC Public Health 2012; 12:1062. [PMID: 23228219 PMCID: PMC3534009 DOI: 10.1186/1471-2458-12-1062] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 11/22/2012] [Indexed: 11/30/2022] Open
Abstract
Background Invasive meningococcal disease remains an important cause of serious morbidity and mortality in children and young people. There is a growing body of literature to suggest that exposure to passive smoke may play a role in the development of the disease, therefore we have performed a systematic review to provide a comprehensive estimate of the magnitude of this effect for smoking by any household member, by individual family members, and of maternal smoking before and after birth. Methods Four databases (Medline, Embase, PsychINFO and CAB Abstracts database) were searched to identify studies (to June 2012) and reference lists scanned for further studies. Titles, abstracts and full texts were checked for eligibility independently by two authors. Quality of included studies was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated using random effect models, with heterogeneity quantified using I2. Results We identified 18 studies which assessed the effects of SHS on the risk of invasive meningococcal disease in children. SHS in the home doubled the risk of invasive meningococcal disease (OR 2.18, 95% CI 1.63 to 2.92, I2 = 72%), with some evidence of an exposure-response gradient. The strongest effect was seen in children under 5 years (OR 2.48, 95% CI 1.51 to 4.09, I2 = 47%). Maternal smoking significantly increased the risk of invasive meningococcal disease by 3 times during pregnancy (OR 2.93, 95% CI 1.52-5.66) and by 2 times after birth (OR 2.26, 95% CI 1.54-3.31). Conclusions SHS exposure, and particularly passive foetal exposure to maternal smoking during pregnancy, significantly increases the risk of childhood invasive meningococcal disease. It is likely that an extra 630 cases of invasive meningococcal disease annually in children under 16 are directly attributable to SHS exposure in UK homes.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Abstract
The human bacterial pathogen Neisseria meningitidis remains a serious worldwide health threat, but progress is being made toward the control of meningococcal infections. This review summarizes current knowledge of the global epidemiology and the pathophysiology of meningococcal disease, as well as recent advances in prevention by new vaccines. Meningococcal disease patterns and incidence can vary dramatically, both geographically and over time in populations, influenced by differences in invasive meningococcal capsular serogroups and specific genotypes designated as ST clonal complexes. Serogroup A (ST-5, ST-7), B (ST-41/44, ST-32, ST-18, ST-269, ST-8, ST-35), C (ST-11), Y (ST-23, ST-167), W-135 (ST-11) and X (ST-181) meningococci currently cause almost all invasive disease. Serogroups B, C, and Y are responsible for the majority of cases in Europe, the Americas, and Oceania; serogroup A has been associated with the highest incidence (up to 1000 per 100,000 cases) and large outbreaks of meningococcal disease in sub-Saharan Africa and previously Asia; and serogroups W-135 and X have emerged to cause major disease outbreaks in sub-Saharan Africa. Significant declines in meningococcal disease have occurred in the last decade in many developed countries. In part, the decline is related to the introduction of new meningococcal vaccines. Serogroup C polysaccharide-protein conjugate vaccines were introduced over a decade ago, first in the UK in a mass vaccination campaign, and are now widely used; multivalent meningococcal conjugate vaccines containing serogroups A, C, W-135, and/or Y were first used for adolescents in the US in 2005 and have now expanded indications for infants and young children, and a new serogroup A conjugate vaccine has recently been introduced in sub-Saharan Africa. The effectiveness of these conjugate vaccines has been enhanced by the prevention of person-to-person transmission and herd immunity. In addition, progress has been made in serogroup B-specific vaccines based on conserved proteins and outer membrane vesicles. However, continued global surveillance is essential in understanding and predicting the dynamic changes in the epidemiology and biological basis of meningococcal disease and to influence the recommendations for current and future vaccines or other prevention strategies.
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Affiliation(s)
- Qiuzhi Chang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yih-Ling Tzeng
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David S Stephens
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Laboratories of Microbial Pathogenesis, Department of Veterans Affairs Medical Center, Atlanta, GA
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Morbidity, mortality and spatial distribution of meningococcal disease, 1974-2007. Epidemiol Infect 2009; 137:1631-40. [PMID: 19327198 DOI: 10.1017/s0950268809002428] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To identify determinants for mortality and sequelae and to analyse the spatial distribution of meningococcal disease, we linked four national Danish registries. In the period 1974-2007, 5924 cases of meningococcal disease were registered. Our analysis confirms known risk factors for a fatal meningococcal disease outcome, i.e. septicaemia and high age (>50 years). The overall case-fatality rate was 7.6%; two phenotypes were found to be associated with increased risk of death; C:2a:P1.2,5 and B:15:P1.7,16. B:15:P1.7,16 was also associated with excess risk of perceptive hearing loss. The incidence rates of meningococcal disease were comparable between densely and less densely populated areas, but patients living further from a hospital were at significantly higher risk of dying from the infection. To improve control of meningococcal disease, it is important to understand the epidemiology and pathogenicity of virulent 'successful clones', such as C:2a:P1.2,5 and B:15:P1.7,16, and, eventually, to develop vaccines against serogroup B.
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11
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Maintaining protection against invasive bacteria with protein–polysaccharide conjugate vaccines. Nat Rev Immunol 2009; 9:213-20. [DOI: 10.1038/nri2494] [Citation(s) in RCA: 309] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Modifiable risk factors for invasive meningococcal disease during an Edmonton, Alberta outbreak, 1999-2002. Canadian Journal of Public Health 2008. [PMID: 18435391 DOI: 10.1007/bf03403740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND An outbreak of invasive meningococcal disease (IMD) in metro Edmonton, Alberta, Canada between December 1999 and June 2002 resulted in 84 laboratory-confirmed cases. Most cases were infected with Neisseria meningitidis serogroup C, and the highest age-specific incidence was observed in the 15-19 year age group. METHODS A case-control study was conducted to identify modifiable IMD risk factors among outbreak cases. Two controls were matched to each case on age and sex, and were recruited through random-digit dialing. A questionnaire was telephone-administered to 132 study participants (44 cases, 88 controls). Conditional logistic regression was utilized to calculate risk measures. RESULTS Multivariate analysis revealed three statistically significant risk factors: bar patronage (OR 35.2; 95% CI: 2.64-468), "rave" attendance (OR 12.8; 95% CI: 1.47-111) and maternal smoking (OR 8.88; 95% CI: 1.67-47.4). Humidifier use in the home was protective (OR 0.07; 95% CI: 0.009-0.64). CONCLUSION While the precision of risk estimates was low in the multivariate model, this study has identified rave attendance as an emergent IMD risk factor.
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Stein-Zamir C, Abramson N, Zentner G, Shoob H, Valinsky L, Block C. Invasive meningococcal disease in children in Jerusalem. Epidemiol Infect 2007; 136:782-9. [PMID: 17662169 PMCID: PMC2870872 DOI: 10.1017/s0950268807009259] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Neisseria meningitidis is an important cause of childhood meningitis and septicaemia. Between 1999 and 2005, 133 invasive meningococcal disease (IMD) cases occurred in Jerusalem, 112 (84.2%) of them in children aged 0-14 years. The annual incidence rate in Jerusalem was higher than the national average (2.45+/-0.6 vs. 1.13+/-0.16/100 000 population, P=0.002). Most of the children (82.1%) were from low socio-economic Arab and Jewish ultra-orthodox communities; mortality was higher among Arab than Jewish children (1.3 vs. 0.22/100 000 person-years, P=0.004). A cluster of 10 children with severe meningococcal sepsis (three fatalities) emerged in the winter of 2003-2004. Compared to the other 102 cases in 1999-2005 both meningococcaemia (100% vs. 51%, P=0.003) and mortality (30% vs. 6.9%, P=0.014) rates were higher. Serogroup B comprised 77.6% of the bacterial isolates. Pulsed-field gel electrophoresis showed considerable variability among cluster isolates, but significant resemblance in Arab cases throughout 1999-2005. The increased susceptibility of specific sub-populations to IMD necessitates further evaluation.
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Affiliation(s)
- C Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Israel.
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MacLennan J, Kafatos G, Neal K, Andrews N, Cameron JC, Roberts R, Evans MR, Cann K, Baxter DN, Maiden MC, Stuart JM. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis 2006; 12:950-7. [PMID: 16707051 PMCID: PMC3373034 DOI: 10.3201/eid1206.051297] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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Affiliation(s)
| | | | - Keith Neal
- University of Nottingham, Nottingham, United Kingdom
| | - Nick Andrews
- Health Protection Agency, London, United Kingdom
| | | | | | | | - Kathy Cann
- Thames Valley Local Health Protection Unit, Aylesbury, United Kingdom
| | | | | | - James M. Stuart
- Health Protection Agency Southwest, Stonehouse, United Kingdom
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