title: Risk factors for meningococcal disease in students in grades 9-12.
abstract: BACKGROUND
  Meningococcal disease is a serious problem in adolescents, including high school students. Universal immunization of adolescents with meningococcal conjugate vaccine was recently recommended. We studied risk factors for meningococcal disease in students in grades 9-12.
  
  
  METHODS
  This was a matched case-control study using surveillance for meningococcal disease in students in grades 9-12 in sites throughout the United States. For each case-patient, up to 4 controls were selected from the home room classroom. All subjects answered an extensive questionnaire. Logistic regression was performed to identify risk factors associated with meningococcal disease. Meningococcal isolates were characterized.
  
  
  RESULTS
  Of 69 eligible patients, 49 (71%) were enrolled and had at least 1 control. Isolates were available for 59 (86%) cases. Attending at least 1 barbeque or picnic [matched odds ratio (MOR): 0.26, P value = 0.003] or school dance (MOR: 0.30, P = 0.04) were independently associated with decreased risk of meningococcal disease. Male gender (MOR: 2.94, P = 0.009), upper respiratory infection symptoms (MOR: 2.43, P = 0.04), marijuana use (MOR: 4.21, P = 0.009), and nightclub/disco attendance (MOR: 3.30, P = 0.04) were associated with increased risk. Among 54 students not from Oregon (where serogroup B strains predominate) with available serogroup, 38 (73.1%) cases were potentially vaccine preventable: 18 (34.6%) serogroup C, 19 (36.5%) serogroup Y, and 1 (1.9%) serogroup W-135.
  
  
  CONCLUSIONS
  Certain behaviors increase the risk of meningococcal infection, whereas others are associated with decreased risk. Most meningococcal disease in high school students can be prevented if recommendations on use of meningococcal conjugate vaccine are implemented.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lharriso@edc.pitt.edu
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Kreiner
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Shutt
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Messonnier
authors.forename: Mary
authors.initials: M
authors.lastname: O'Leary
authors.forename: Karen R
authors.initials: KR
authors.lastname: Stefonek
authors.forename: Huai
authors.initials: H
authors.lastname: Lin
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Barrett
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: José T
authors.initials: JT
authors.lastname: Montero
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008585:Meningitis, Meningococcal / Q000453:epidemiology*; D009345:Neisseria meningitidis / Q000145:classification / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012307:Risk Factors; D012703:Serotyping; D012737:Sex Factors; D012919:Social Behavior; D013334:Students; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology