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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2008 Jan 1;99(1):46–51. doi: 10.1007/BF03403740

Modifiable Risk Factors for Invasive Meningococcal Disease During an Edmonton, Alberta Outbreak, 1999–2002

Lance Honish 110,✉, Colin L Soskolne 110, Ambikaipakan Senthilselvan 110, Stan Houston 210
PMCID: PMC6976143  PMID: 18435391

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.

Keywords: Meningococcal infections, risk factors, case-control studies

References

  • 1.Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003;348:1256–66. doi: 10.1056/NEJMra021771. [DOI] [PubMed] [Google Scholar]
  • 2.Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med. 2001;344:1378–88. doi: 10.1056/NEJM200105033441807. [DOI] [PubMed] [Google Scholar]
  • 3.National Advisory Committee on Immunization. Statement on recommended use of meningococ-cal vaccines. Can Commun Dis Rep. 2001;27:ACS–6. [Google Scholar]
  • 4.Stanwell-Smith RE, Stuart JM, Hughes AO, Robinson P, Griffin MB, Cartwright K. Smoking, the environment and meningococcal disease: A case control study. Epidemiol Infect. 1994;112:315–28. doi: 10.1017/S0950268800057733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Fischer M, Hedberg K, Cardosi P, Plikaytis BD, Hoesly FC, Steingart KR, et al. Tobacco smoke as a risk factor for meningococcal disease. Pediatr Infect Dis J. 1997;16:979–83. doi: 10.1097/00006454-199710000-00015. [DOI] [PubMed] [Google Scholar]
  • 6.Baker M, McNicholas A, Garrett N, Jones N, Stewart J, Koberstein V, Lennon D. Household crowding a major risk factor for epidemic meningococcal disease in Auckland children. Pediatr Infect Dis J. 2000;19:983–90. doi: 10.1097/00006454-200010000-00009. [DOI] [PubMed] [Google Scholar]
  • 7.Kriz P, Bobak M, Kriz B. Parental smoking, socioeconomic factors, and risk of invasive meningococcal disease in children: A population based case-control study. Arch Dis Child. 2000;83:117–21. doi: 10.1136/adc.83.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Robinson P, Taylor K, Nolan T. Risk-factors for meningococcal disease in Victoria, Australia, in 1997. Epidemiol Infect. 2001;127:261–68. doi: 10.1017/S0950268801005696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Grein T, O’Flanagan D. Day-care and meningo-coccal disease in young children. Epidemiol Infect. 2001;127:435–41. doi: 10.1017/S0950268801005817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Pereiro I, Diez-Domingo J, Segarra L, Ballester A, Albert A, Morant A. Risk factors for invasive disease among children in Spain. J Infect. 2004;48:320–29. doi: 10.1016/j.jinf.2003.10.015. [DOI] [PubMed] [Google Scholar]
  • 11.Yusuf HR, Rochat RW, Baughman WS, Gargiullo PM, Perkins BA, Brantley MD, Stephens DS. Maternal cigarette smoking and invasive meningococcal disease: A cohort study among young children in metropolitan Atlanta, 1989–1996. Am J Public Health. 1999;89:712–17. doi: 10.2105/AJPH.89.5.712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Intern Med J. 2004;34:464–68. doi: 10.1111/j.1445-5994.2004.00564.x. [DOI] [PubMed] [Google Scholar]
  • 13.Moodley JR, Coetzee N, Hussey G. Risk factors for meningococcal disease in Cape Town. S Afr Med J. 1999;89:56–59. [PubMed] [Google Scholar]
  • 14.Imrey PB, Jackson LA, Ludwinski PH, England AC, 3rd, Fella GA, Fox BC, et al. Outbreak of serogroup C meningococcal disease associated with campus bar patronage. Am J Epidemiol. 1996;143:624–30. doi: 10.1093/oxfordjournals.aje.a008792. [DOI] [PubMed] [Google Scholar]
  • 15.Deutch S, Labouriau R, Schonheyeder HC, Ostergaard L, Norgard B, Sorensen HT. Crowding as a risk factor of meningococcal disease in Danish preschool children: A nationwide population-based case-control study. Scand J Infect Dis. 2004;36:20–23. doi: 10.1080/00365540310017500. [DOI] [PubMed] [Google Scholar]
  • 16.Bruce MG, Rosenstein NE, Capparella JM, Shutt KA, Perkins BA, Collins M. Risk factors for meningococcal disease in college students. JAMA. 2001;286:688–93. doi: 10.1001/jama.286.6.688. [DOI] [PubMed] [Google Scholar]
  • 17.Hodgson A, Smith T, Gagneux S, Adjuik M, Pluschke G, Mensah NK, et al. Risk factors for meningococcal meningitis in northern Ghana. Trans R Soc Trop Med Hyg. 2001;95:477–80. doi: 10.1016/S0035-9203(01)90007-0. [DOI] [PubMed] [Google Scholar]
  • 18.Moore PS, Hierholzer J, DeWitt W, Gouan K, Djoré D, Lippeveld T, et al. Respiratory viruses and Mycoplasma as cofactors for epidemic group A meningococcal meningitis. JAMA. 1990;264:1271–75. doi: 10.1001/jama.1990.03450100061026. [DOI] [PubMed] [Google Scholar]
  • 19.Cartwright KA, Jones DM, Smith AJ, Stuart JM, Kaczmarski EB, Palmer SR. Influenza A and meningococcal disease. Lancet. 1991;338:554–57. doi: 10.1016/0140-6736(91)91112-8. [DOI] [PubMed] [Google Scholar]
  • 20.Population Health Division, Disease ControlPrevention, Alberta HealthWellness. Alberta’s Meningococcal Immunization Program—A Full Report: February 2000 to March 2002. Edmonton, AB: Alberta Health and Wellness; 2004. [Google Scholar]
  • 21.Tyrrell GJ, Chui L, Johnson M, Chang N, Rennie RP, Talbot JA, The Edmonton Meningococcal Study Group Outbreak of Neisseria meningitidis, Edmonton, Alberta, Canada. Emerg Infect Dis. 2002;8:519–21. doi: 10.3201/eid0805.010337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Lalu NM. Research Discussion Paper No. 74: Sampling Methods for Telephone Surveys. Edmonton: Department of Sociology, University of Alberta; 1991. [Google Scholar]
  • 23.Schwartz RH, Miller NS. MDMA (ecstasy) and the rave: A review. Pediatrics. 1997;100:705–8. doi: 10.1542/peds.100.4.705. [DOI] [PubMed] [Google Scholar]
  • 24.Johnson M. Outbreak of Meningococcal Disease Due to a Novel Serogroup C Clone. 2001. [Google Scholar]
  • 25.Hosmer DW, Lemeshow S. Applied Survival Analysis: Regression Modeling of Time to Event Data. New York, NY: Wiley; 2000. [Google Scholar]
  • 26.SPSS Inc. (2003). SPSS 12.0 for Windows.
  • 27.Kent H. Raves worry Edmonton MDs, police. CMAJ. 2000;162(13):1864–65. [PMC free article] [PubMed] [Google Scholar]
  • 28.Cook DG, Whincup PH, Jarvis MJ, Strachan DP, Papacosta O, Bryant A. Passive exposure to tobacco smoke in children aged 5–7 years: Individual, family, and community factors. BMJ. 1994;308:384–89. doi: 10.1136/bmj.308.6925.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Caugant DA, Hoiby EA, Magnus P, Scheel O, Hoel T, Bjune G, et al. Asymptomatic carriage of Neisseria meningitidis in a randomly sampled population. J Clin Microbiol. 1994;32:323–30. doi: 10.1128/jcm.32.2.323-330.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Kremastinou J, Blackwell C, Tzanakaki G, Kallergi C, Elton R, Weir D. Parental smoking and carriage of Neisseria meningitidis among Greek schoolchildren. Scand J Infect Dis. 1994;26:719–23. doi: 10.3109/00365549409008641. [DOI] [PubMed] [Google Scholar]
  • 31.Blackwell CC, Tzanakaki G, Kremastinou J, Weir DM, Vakalis N, Elton RA, et al. Factors affecting carriage of Neisseria meningitidis among Greek military recruits. Epidemiol Infect. 1992;108:441–48. doi: 10.1017/S0950268800049943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Thomas JC, Bendana NS, Waterman SH, Rathbun M, Arakere G, Frasch CE, et al. Risk factors for carriage of meningococcus in the Los Angeles County men’s jail system. Am J Epidemiol. 1991;133:286–95. doi: 10.1093/oxfordjournals.aje.a115873. [DOI] [PubMed] [Google Scholar]
  • 33.Stuart JM, Cartwright KA, Robinson PM, Noah ND. Effect of smoking on meningococcal carriage. Lancet. 1989;2:723–25. doi: 10.1016/S0140-6736(89)90781-2. [DOI] [PubMed] [Google Scholar]
  • 34.De Wals P, De Serres G, Niyonsenga T. Effectiveness of a mass immunization campaign against serogroup C meningococcal disease in Quebec. JAMA. 2001;285:177–81. doi: 10.1001/jama.285.2.177. [DOI] [PubMed] [Google Scholar]
  • 35.Honish L, Soskolne CL, Senthilselvan A, Houston S. Modifiable Risk Factors for Invasive Meningococcal Disease, Edmonton, Alberta, 1999–2002: A Case-Control Study. Edmonton: University of Alberta; 2005. [DOI] [PMC free article] [PubMed] [Google Scholar]

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