Risk and protective factors for meningococcal disease in adolescents: matched cohort study
Open accessAbstract
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.
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Of the 14 highest-quality immune function studies, 10 (71%) reported significant positive associations or increased immune functions in response to an R/S intervention.
“Of the 14 studies with the highest quality ratings, 10 (71%) reported significant positive associations [437–443] or increased immune functions in response to a R/S intervention [444–447].”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [443]
Table 4 reports a significant association between religious-ceremony attendance and lower risk of meningococcal disease, supporting this paper as one example of a favorable association. The paper does not report that attendance increased immune function, nor does it assess the cited tally of 10 of 14 highest-quality studies. (LLM, conf=0.84)
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Cites
Wiley Series in Probability and Mathematics Statistics
Huber, P. J. (1981) · Wiley series in probability and statistics · doi:10.1002/0471725250.scard · Cited by 2,257 · see citing works
Religious involvement and mortality: A meta-analytic review.
McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. E. (2000) · Health Psychology · doi:10.1037/0278-6133.19.3.211 · Cited by 1,088 · see citing works
Cigarette Smoking and Invasive Pneumococcal Disease
Nuorti, J. P., Butler, J. C., Farley, M. M., Harrison, L. H., McGeer, A., KOLCZAK, M. S., & Breiman, R. F. (2000) · New England Journal of Medicine · doi:10.1056/nejm200003093421002 · Cited by 796 · see citing works
Viral Infections of Humans. Epidemiology and Control.
Evans, A. S. (1983) · Annals of Internal Medicine · doi:10.7326/0003-4819-98-2-273_2 · Cited by 752 · see citing works
Case-control studies: research in reverse
Schulz, K. F., & Grimes, D. A. (2002) · The Lancet · doi:10.1016/s0140-6736(02)07605-5 · Cited by 487 · see citing works
The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica
Cartwright, K. A. V., Stuart, J. M., Jones, D. M., & Noah, N. D. (1987) · Epidemiology and Infection · doi:10.1017/s0950268800066449 · Cited by 421 · see citing works
Self-citationHibberd, M. L., Sumiya, M., Summerfield, J. A., Booy, R., & Levin, M. (1999) · The Lancet · doi:10.1016/s0140-6736(98)08350-0 · Cited by 368 · see citing works
Self-citationKoenig, H. G., Cohen, H. J., George, L. K., Hays, J. C., Larson, D. B., & Blazer, D. G. (1997) · The International Journal of Psychiatry in Medicine · doi:10.2190/40nf-q9y2-0gg7-4wh6 · Cited by 251 · see citing works
Tobacco smoke as a risk factor for meningococcal disease
Fischer, M., Hedberg, K., CARDOSI, P., Plikaytis, B. D., Hoesly, F. C., Steingart, K. R., BELL, T. A., Fleming, D., Wenger, J. D., & Perkins, B. A. (1997) · The Pediatric Infectious Disease Journal · doi:10.1097/00006454-199710000-00015 · Cited by 210 · see citing works
Influenza A and meningococcal disease
Cartwright, K. A. V., Jones, D. M., Kaczmarski, E., Smith, A. J., Stuart, J. M., & Palmer, S. R. (1991) · The Lancet · doi:10.1016/0140-6736(91)91112-8 · Cited by 209 · see citing works
Self-citationReligiosity and sexual risk-taking behavior during the transition to college
Zaleski, E. H., & Schiaffino, K. M. (2000) · Journal of Adolescence · doi:10.1006/jado.2000.0309 · Cited by 197 · see citing works
A Simultaneous Outbreak of Meningococcal and Influenza Infections
Young, L. S., LaForce, F. M., Head, J. J., FEELEY, J. C., & Bennett, J. V. (1972) · New England Journal of Medicine · doi:10.1056/nejm197207062870102 · Cited by 192 · see citing works
Risk Factors for Meningococcal Disease in College Students
Bruce, M. G. (2001) · JAMA · doi:10.1001/jama.286.6.688 · Cited by 178 · see citing works
Respiratory and Immunologic Consequences of Marijuana Smoking
Tashkin, D. P., Baldwin, G. C., Sarafian, T. A., Dubinett, S. M., & Roth, M. D. (2002) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.2002.tb06006.x · Cited by 178 · see citing works
Respiratory Viruses and Mycoplasma as Cofactors for Epidemic Group A Meningococcal Meningitis
Moore, P. S. (1990) · JAMA · doi:10.1001/jama.1990.03450100061026 · Cited by 176 · see citing works
Ellis, J., Fleming, D., & Zambon, M. C. F. A. (1997) · Journal of Clinical Microbiology · doi:10.1128/jcm.35.8.2076-2082.1997 · Cited by 175 · see citing works
Self-citationPrenatal undernutrition, postnatal environments, and antibody response to vaccination in adolescence
McDade, T. W., Beck, M. A., Kuzawa, C. W., & Adair, L. S. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/74.4.543 · Cited by 172 · see citing works
Smoking, the environment and meningococcal disease: a case control study
Stanwell, R. E., Stuart, J. M., Hughes, A., Robinson, P. M., Griffin, M., & Cartwright, K. A. V. (1994) · Epidemiology and Infection · doi:10.1017/s0950268800057733 · Cited by 156 · see citing works
Self-citationRisk of Meningococcal Infection in College Students
Harrison, L. H. (1999) · JAMA · doi:10.1001/jama.281.20.1906 · Cited by 154 · see citing works
Fanger, N. A., Voigtlaender, D., Liu, C., Swink, S. L., Wardwell, K., Fisher, J., Graziano, R. F., Pfefferkorn, L. C., & Guyre, P. M. (1997) · The Journal of Immunology · doi:10.4049/jimmunol.158.7.3090 · Cited by 147 · see citing works
Neal, K. R. (2000) · BMJ · doi:10.1136/bmj.320.7238.846 · Cited by 146 · see citing works
Connolly, M., & Noah, N. D. (1999) · Epidemiology and Infection · doi:10.1017/s0950268898001848 · Cited by 138 · see citing works
EFFECT OF SMOKING ON MENINGOCOCCAL CARRIAGE
Stuart, J. M., Robinson, P., Cartwright, K. V., et al. (1989) · The Lancet · doi:10.1016/s0140-6736(89)90781-2 · Cited by 137 · see citing works
Self-citationInvasive Meningococcal Disease in Adolescents and Young Adults
Harrison, L. H. (2001) · JAMA · doi:10.1001/jama.286.6.694 · Cited by 136 · see citing works
Changing patterns of case ascertainment and trends in meningococcal disease in England and Wales.
Ramsay, M. E., Kaczmarski, E., Rush, M., et al. (1997) · PubMed · Cited by 126 · see citing works
Self-citationHealth promotion for adolescents in primary care: randomised controlled trial
Walker, Z., Townsend, J., Oakley, L., Donovan, C., Smith, H., Hurst, Z., Bell, J., & Marshall, S. (2002) · BMJ · doi:10.1136/bmj.325.7363.524 · Cited by 115 · see citing works
The new system of review by multicentre research ethics committees: prospective study
Tully, J. (2000) · BMJ · doi:10.1136/bmj.320.7243.1179 · Cited by 115 · see citing works
Self-citationOutberak of Serogroup C Meningococcal Disease Associated with Campus Bar Patronage
Imrey, P. B., Jackson, L. A., Ludwinski, P. H., England, A. C., Fella, G. A., Fox, B. C., lsdale, L. B., Reeves, M. W., & Wenger, J. D. (1996) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a008792 · Cited by 106 · see citing works
Evans, A. S., & Niederman, J. C. (1982) · Springer eBooks · doi:10.1007/978-1-4613-3237-4_10 · Cited by 99 · see citing works
Wiley Series in Probability and Mathematical Statistics
Chatterjee, S., & Hadi, A. S. (1988) · Wiley series in probability and statistics · doi:10.1002/9780470316764.oth1 · Cited by 95 · see citing works
Kriz, P. (2000) · Archives of Disease in Childhood · doi:10.1136/adc.83.2.117 · Cited by 90 · see citing works
A Cluster of Meningococcal Disease on a School Bus Following Epidemic Influenza
Harrison, L. H. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400050141028 · Cited by 76 · see citing works
Koppula, S. V., Robbins, L. S., Lu, D., Baack, E. J., White, C. R., Swanson, N. A., & Cone, R. D. (1997) · Human Mutation · doi:10.1002/(sici)1098-1004(1997)9:1 · Cited by 72 · see citing works
COEN, P. G., Cartwright, K., & Stuart, J. (2000) · International Journal of Epidemiology · doi:10.1093/ije/29.1.180 · Cited by 71 · see citing works
Self-citationRestricted polymorphism of the mannose-binding lectin gene of indigenous Australians
TURNER, M. W. (2000) · Human Molecular Genetics · doi:10.1093/hmg/9.10.1481 · Cited by 67 · see citing works
Tong, C. Y. W., Donnelly, C., Harvey, G., & Sillis, M. (1999) · Journal of Clinical Pathology · doi:10.1136/jcp.52.4.257 · Cited by 55 · see citing works
Effectiveness of meningococcal C conjugate vaccine in teenagers in England
Bose, A., Coen, P. G., Tully, J., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12563-9 · Cited by 54 · see citing works
Self-citationHaneberg, B., Tønjum, T., Rodahl, K., et al. (1983) · PubMed · Cited by 54 · see citing works
Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis
Moore, P. S. (1990) · JAMA · doi:10.1001/jama.264.10.1271 · Cited by 46 · see citing works
Age incidence of meningococcal infection England and Wales, 1984–1991
Jones, D. M., & Mallard, R. H. (1993) · Journal of Infection · doi:10.1016/0163-4453(93)93978-d · Cited by 38 · see citing works
Kutscher, S.-U., Heise, D., Banger, M., Saller, B., Michel, M. C., Gastpar, M., Schedlowski, M., & Exton, M. S. (2002) · Neuropsychobiology · doi:10.1159/000054955 · Cited by 37 · see citing works
Transient immune deficiency in patients with acute Epstein-Barr virus infection
Junker, A., Ochs, H. D., Clark, E. A., et al. (1986) · Clinical Immunology and Immunopathology · doi:10.1016/0090-1229(86)90188-1 · Cited by 32 · see citing works
Influenza A and meningococcal disease
Reilly, S., & Gaunt, P. N. (1991) · The Lancet · doi:10.1016/0140-6736(91)91999-b · Cited by 29 · see citing works
Risk factors for meningococcal disease in Cape Town.
Moodley, J., Coetzee, N., & Hussey, G. D. (1999) · PubMed · Cited by 24 · see citing works
Risk factors for meningococcal disease in university halls of residence
Nelson, S., Charlett, A., Orr, H. J., et al. (2001) · Epidemiology and Infection · doi:10.1017/s0950268801005301 · Cited by 24 · see citing works
Mannose-binding lectin and meningococcal disease
Garred, P., MADSEN, H. O., Svejgaard, A., et al. (1999) · The Lancet · doi:10.1016/s0140-6736(05)75241-7 · Cited by 23 · see citing works
Risk-factors for meningococcal disease in Victoria, Australia, in 1997
Robinson, P. M., Taylor, K., & Nolan, T. (2001) · Epidemiology and Infection · doi:10.1017/s0950268801005696 · Cited by 22 · see citing works
Respiratory syncytial virus infection and meningococcal disease
Stuart, J. M., Cartwright, K. A. V., & Andrews, N. J. (1996) · Epidemiology and Infection · doi:10.1017/s0950268800001199 · Cited by 18 · see citing works
Self-citationA cluster of meningococcal disease on a school bus following epidemic influenza
Harrison, L. H. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.151.5.1005 · Cited by 18 · see citing works
Mannose-binding lectin and meningococcal disease
Tang, C. M., & Kwiatkowski, D. P. (1999) · The Lancet · doi:10.1016/s0140-6736(05)75240-5 · Cited by 11 · see citing works
Davison, K. L., Ns, C., Ramsay, M. E., et al. (2002) · PubMed · Cited by 11 · see citing works
Gray, S. J., Borrow, R., & Kaczmarski, E. B. (2003) · Humana Press eBooks · doi:10.1385/1-59259-149-3:61 · Cited by 7 · see citing works
Self-citationRisk of Meningococcal Infection in College Students
Jeansonne, S. W. (2000) · Clinical Pediatrics · doi:10.1177/000992280003900210 · Cited by 5 · see citing works
Including a time‐of‐year effect in the analysis of a matched case‐control study
Stallard, N., & Tombs, L. (2004) · Statistics in Medicine · doi:10.1002/sim.1884 · Cited by 4 · see citing works
Mannose-binding lectin and meningococcal disease
Hibberd, M. L., Sumiya, M., Summerfield, J. A., et al. (1999) · The Lancet · doi:10.1016/s0140-6736(05)75242-9 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- Hotchin NA, Crawford DH. The diagnosis of Epstein Barr virus associated disease. In: Morgan-Capner P, ed. Current topics in clinical virology. Cambridge: Cambridge Univer- sity Press, 1991:115-40.
- Jack D, Bidwell J, Turner M, Wood N. Simultaneous genotyping for all three known structural mutations in the human mannose-binding lectin gene. Hum Mutat 1997;9:41-6.
- Watson JM, Nicholas S, James P. Meningococcal infection and influenza: do surveillance data support an association? Options for the control of influenza III. Amsterdam: Elsevier Science, 1996:82-4.
- Bose A, Coen P, Tully J, Viner R, Booy R. Effectiveness of meningococcal C conjugate vaccine in teenagers in England. Lancet 2003;361:675-6.
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Religion, Spirituality, and Health: The Research and Clinical Implications
Koenig, H. G. (2012) · ISRN Psychiatry · doi:10.5402/2012/278730 · Cited by 2,423 · see citing works
“[451] J.”
BackgroundEpidemic meningitis, meningococcaemia, and Neisseria meningitidis
Stephens, D. S., Greenwood, B., & Brandtzaeg, P. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61016-2 · Cited by 978 · see citing works
Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00070-09 · Cited by 930 · see citing works
- Authors
- Tully, J., Viner, R. M., Coen, P. G., Stuart, J. M., Zambon, M., Peckham, C., Booth, C., Klein, N., Kaczmarski, E., & Booy, R.
- Affiliations
- University of London (GB)
- Corresponding author
- Booy, Robert
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2006-02-10
- Volume
- 332
- Issue
- 7539
- Pages
- 445-450
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1382533
- OpenAlex
- W1999301355
- Cited by
- 175
- References
- 55
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 47 · 2022: 2 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 19 · 2017: 5 · 2016: 7 · 2015: 6 · 2014: 7 · 2013: 6 · 2012: 7
- FWCI
- 9.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- meningococcal disease, adolescents, risk factors, protective factors, multiple sexual partners, university students, preterm birth, meningococcal vaccination, religious practice, Neisseria meningitidis
- MeSH terms
- Adolescent, Adult, Crowding, England, Epidemiologic Methods, Humans, Infant, Newborn, Leisure Activities, Life Style, Meningococcal Infections, Religion, Risk-Taking, Sexual Behavior, Sexual Partners, Socioeconomic Factors, Health Behavior, Meningococcal Vaccines
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