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