Tully, J; (2006) Risk and protective factors for the development of meningococcal disease in adolescence: A biopsychosocial investigation. Doctoral thesis , UCL (University College London).

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Abstract

Background The incidence of meningococcal disease (MD) in the United Kingdom increased dramatically from 2.4 per 100,000 in the early 1990's to 4.4 per 100,000 by 1996. The age distribution also shifted towards older teenagers in whom the risk profile for disease is poorly understood and the mortality rate higher. Adolescence is a time of biological, social and psychological change and these changes may contribute towards the risk. This study is a prospective population-based case-control study to identify risk and protective factors for MD in adolescents between the ages of 15 and 19 years. Methods Adolescent subjects with MD were recruited at hospital admission in six regions of England from January 1999 to June 2000. One age- and sex-matched control from the same geographical location was recruited per case. Blood samples plus pernasal and throat swabs were taken from cases at hospitalisation and from cases and controls at interview. Data on potential risk and protective factors were gathered at interview. Results 144 case control pairs were recruited (51% male median age 17.6) of which 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for MD were history of preceding illness (matched OR 2.9 95% CI: 1.4-5.9), intimate kissing with multiple partners (OR 3.7, 95% CI: 1.7-8.1), being a university student (OR 3.4, 95% CI: 1.2-10) and preterm birth (OR 3.7, 95% CI: 1.0-13.5). Religious observance (OR 0.09, 95% CI: 0.02-0.6) and meningococcal vaccination (OR 0.12, 95% CI: 0.04-0.4) were protective. Conclusions This is the first large study examining risk factors for MD within an adolescent population. Activities and events increasing risk for MD in adolescence are different from childhood. Students are at higher risk for disease than their counterparts. While altering personal behaviours may moderate risk of MD, it is unlikely that behaviour- based health promotion can significantly reduce disease burden. The development of effective meningococcal vaccines remains a key public health priority.

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