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Canadian Journal of Public Health

, Volume 99, Issue 1, pp 46–51 | Cite as

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

  • Lance Honish
  • Colin L. Soskolne
  • Ambikaipakan Senthilselvan
  • Stan Houston
Article

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 

Résumé

Contexte

Une éclosion de maladie invasive à méningocoque (MIM) survenue dans le Grand Edmonton (Alberta), au Canada, entre décembre 1999 et juin 2002 avait entraîné 84 cas confirmés en laboratoire. La plupart des cas étaient infectés par Neisseria meningitidis du sérogroupe C, et le plus haut taux d’incidence selon l’âge avait été observé dans le groupe des 15 à 19 ans.

Méthode

Nous avons mené une étude cas-témoin pour déterminer les facteurs de risque de MIM modifiables chez les cas liés à l’éclosion. Deux témoins recrutés par composition aléatoire ont été assortis par âge et par sexe à chaque cas. Un questionnaire téléphonique a été administré aux 132 participants (44 cas et 88 témoins). Les mesures du risque ont été obtenues par régression logistique conditionnelle.

Résultats

L’analyse multivariée a mis au jour trois facteurs de risque significatifs: la fréquentation des bars (RC=35,2; IC de 95 % = 2,64–468), la participation à des fêtes techno (RC=12,8; IC de 95 % = 1,47–111) et le tabagisme maternel (RC=8,88; IC de 95 % = 1,67–47,4). L’utilisation d’un humidificateur à la maison était un facteur de protection (RC=0,07; IC de 95 % = 0,009–0,64).

Conclusion

Malgré le manque de précision des estimations du risque dans le modèle multivarié, l’étude a décelé un nouveau facteur de risque de MIM: la participation à des fêtes techno.

Motsclés

infections à méningocoques facteurs de risque études cas-témoins 

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References

  1. 1.
    Musher DM. How contagious are common respiratory tract infections? N Engl J Med 2003;348:1256–66.CrossRefGoogle Scholar
  2. 2.
    Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2001;344:1378–88.CrossRefGoogle Scholar
  3. 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. 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.CrossRefPubMedCentralGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Robinson P, Taylor K, Nolan T. Risk-factors for meningococcal disease in Victoria, Australia, in 1997. Epidemiol Infect 2001;127:261–68.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Grein T, O’Flanagan D. Day-care and meningo-coccal disease in young children. Epidemiol Infect 2001;127:435–41.CrossRefPubMedCentralGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefPubMedCentralGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Moodley JR, Coetzee N, Hussey G. Risk factors for meningococcal disease in Cape Town. S Afr Med J 1999;89:56–59.Google Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Cartwright KA, Jones DM, Smith AJ, Stuart JM, Kaczmarski EB, Palmer SR. Influenza A and meningococcal disease. Lancet 1991;338:554–57.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Population Health Division, Disease Control and Prevention, Alberta Health and Wellness. Alberta’s Meningococcal Immunization Program—A Full Report: February 2000 to March 2002. Edmonton, AB: Alberta Health and Wellness, 2004.Google Scholar
  21. 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.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Lalu NM. Research Discussion Paper No. 74: Sampling Methods for Telephone Surveys. Edmonton: Department of Sociology, University of Alberta, 1991.Google Scholar
  23. 23.
    Schwartz RH, Miller NS. MDMA (ecstasy) and the rave: A review. Pediatrics 1997;100:705–8.CrossRefGoogle Scholar
  24. 24.
    Johnson M. Outbreak of Meningococcal Disease Due to a Novel Serogroup C Clone. ProMED-mail, January 18, 2001. Available online at: https://doi.org/www.promedmail.org/pls/askus/f?p=2400:1202:87765::NO::F2400_P1202_CHECK_DIS PLAY,F2400_P1202_PUB_MAIL_ID:X,13104 (Accessed October 2, 2007).Google Scholar
  25. 25.
    Hosmer DW, Lemeshow S. Applied Survival Analysis: Regression Modeling of Time to Event Data. New York, NY: Wiley, 2000.Google Scholar
  26. 26.
    SPSS Inc. (2003). SPSS 12.0 for Windows.Google Scholar
  27. 27.
    Kent H. Raves worry Edmonton MDs, police. CMAJ 2000;162(13):1864–65.PubMedCentralGoogle Scholar
  28. 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.CrossRefPubMedCentralGoogle Scholar
  29. 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.PubMedCentralGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefPubMedCentralGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 33.
    Stuart JM, Cartwright KA, Robinson PM, Noah ND. Effect of smoking on meningococcal carriage. Lancet 1989;2:723–25.CrossRefGoogle Scholar
  34. 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.CrossRefGoogle Scholar
  35. 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.Google Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Lance Honish
    • 1
  • Colin L. Soskolne
    • 1
  • Ambikaipakan Senthilselvan
    • 1
  • Stan Houston
    • 2
  1. 1.Department of Public Health Sciences, School of Public HealthUniversity of Alberta, Health DivisionEdmontonCanada
  2. 2.Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and DentistryUniversity of AlbertaCanada

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