title: Tobacco smoke as a risk factor for meningococcal disease.
abstract: BACKGROUND
  Since 1992 the US Pacific Northwest has experienced a substantial increase in the incidence of serogroup B meningococcal disease. The current meningococcal polysaccharide vaccine is poorly immunogenic in young children and does not protect against N. meningitidis serogroup 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 controls. 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 all other significant exposures identified, having a mother who smokes was the strongest independent risk factor for invasive meningococcal disease in children < 18 years of age [odds ratio (OR), 3.8; 95% confidence 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 patients were more likely than controls to have a chronic underlying illness (OR 10.8, CI 2.7 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-response effects were seen for passive smoke exposure and risk of disease in all age groups.
  
  
  CONCLUSIONS
  Tobacco smoke exposure independently increases the risk of developing meningococcal disease.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: K
authors.initials: K
authors.lastname: Hedberg
authors.forename: P
authors.initials: P
authors.lastname: Cardosi
authors.forename: B D
authors.initials: BD
authors.lastname: Plikaytis
authors.forename: F C
authors.initials: FC
authors.lastname: Hoesly
authors.forename: K R
authors.initials: KR
authors.lastname: Steingart
authors.forename: T A
authors.initials: TA
authors.lastname: Bell
authors.forename: D W
authors.initials: DW
authors.lastname: Fleming
authors.forename: J D
authors.initials: JD
authors.lastname: Wenger
authors.forename: B A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003625:Data Collection; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008589:Meningococcal Infections / Q000453:epidemiology*; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D014028:Tobacco Smoke Pollution