MENINGOCOCCAL CARRIAGE, ALCOHOL-CONSUMPTION, AND CAMPUS BAR PATRONAGEIN A SEROGROUP-C MENINGOCOCCAL DISEASE OUTBREAK

Community outbreaks of serogroup C invasive meningococcal disease are increasing in North America (L. H. Harrison, JAMA 273:419-421, 1995; L . A. Jackson, A. Schuchat, M. W. Reeves, and J. D. Wenger, JAMA 273:38 2-389, 1995; C. M. Whalen, J. C. Hockin, A. Ryan, and F. Ashton, JAMA 273:390-394). In a recent 15-month university outbreak, disease was li nked to patronage of a specific campus-area bar, suggesting that aspec ts of a campus bar environment might promote meningococcal transmissio n (P. B. Imrey, L. A. Jackson, P. H. Ludwinski, et al., Am. J. Epidemi ol., in press). To investigate this hypothesis, oropharyngeal carriage results from samples taken from 867 university health service clients and 85 campus-area bar employees during the last 3 months of the outb reak were analyzed to determine factors correlated with carriage of an y strain of Neisseria meningitidis. Results were validated with data f rom samples from 344 health center clients and 211 campus bar employee s taken 8 months after the last outbreak case. Recent alcohol consumpt ion (adjusted prevalence odds ratio = 3.8 for > 15 versus 0 drinks in last week [P = 0.0012]) and campus bar patronage (adjusted odds ratio = 1.9 for any versus no patronage in last 2 weeks [P = 0.0122]) showed separate effects in both univariate and multiple logistic regression analyses of data from the 1992 health center clients. Prevalence of me ningococcal carriage among 1992 campus bar workers was 3.8 times that among health center clients; this prevalence ratio was roughly 2.5 aft er adjustment for alcohol consumption and bar patronage. Recent antibi otic usage was protective (prevalence odds ratio = 0.3) among health c enter clients and bar workers. These findings were generally supported by the validation samples. If alcohol consumption and other aspects o f the campus bar environment facilitate transmission of and/or coloniz ation by N. meningitidis, then the introduction of a highly pathogenic substrain into the campus bar environment may provide an unusual oppo rtunity for invasive meningococcal disease within a campus community.