TOBACCO-SMOKE AS A RISK FACTOR FOR MENINGOCOCCAL DISEASE

Background. Since 1992 the US Pacific Northwest has experienced a subs tantial increase in the incidence of serogroup B meningococcal disease . The current meningococcal polysaccharide vaccine is poorly immunogen ic in young children and does not protect against N. meningitidis sero group B. Defining alternative approaches to the prevention and control of meningococcal disease is of considerable public health importance. Methods. We performed a case-control study comparing 129 patients in Oregon and southwest Washington with 274 age- and area-matched control s. We used conditional logistic regression analysis to determine which exposures remained associated with disease after adjusting for other risk factors and confounders and calculated the proportion of disease attributable to modifiable exposures. Results. After adjustment for al l other significant exposures identified, having a mother who smokes w as the strongest independent risk factor for invasive meningococcal di sease in children <18 years of age [odds ratio (OR), 3.8; 95% confiden ce interval (CI) 1.6 to 8.9)], with 37% (CI 15 to 65) of all cases in this age group potentially attributable to maternal smoking. Adult pat ients were more likely than controls to have a chronic underlying illn ess (OR 10.8, CI 12.7 to 43.3), passive tobacco smoke exposure (OR 2.5 , CI 0.9 to 6.9) and to smoke tobacco (OR 2.4, CI 0.9 to 6.6). Dose-re sponse effects were seen for passive smoke exposure and risk of diseas e in all age groups. Conclusion. Tobacco smoke exposure independently increases the risk of developing meningococcal disease.