Meningococcal carriage, alcohol consumption, and campus bar patronage in a serogroup C meningococcal disease outbreak

Abstract

In a recent 15-month university outbreak, disease was linked to patronage of a specific campus-area bar, suggesting that aspects of a campus bar environment might promote meningococcal transmission (P. B. Imrey, L. A. Jackson, P. H. Ludwinski, et al., Am. J. Epidemiol., 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 outbreak were analyzed to determine factors correlated with carriage of any strain of Neisseria meningitidis. Results were validated with data from samples from 344 health center clients and 211 campus bar employees taken 8 months after the last outbreak case. Recent alcohol consumption (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 meningococcal carriage among 1992 campus bar workers was 3.8 times that among health center clients; this prevalence ratio was roughly 2.5 after adjustment for alcohol consumption and bar patronage. Recent antibiotic usage was protective (prevalence odds ratio ‫؍‬ 0.3) among health center clients and bar workers. These findings were generally supported by the validation samples. If alcohol consumption and other aspects of the campus bar environment facilitate transmission of and/or colonization by N. meningitidis, then the introduction of a highly pathogenic substrain into the campus bar environment may provide an unusual opportunity for invasive meningococcal disease within a campus community.

Meningococcal disease and vaccination in North America

“…Preceding viral infection, especially with influenza A, has been suggested as a risk factor 16,17 and active and passive smoking have been clearly linked to an increased risk of disease 18–21 . Overcrowding is an important element in some cases, as is bar and nightclub patronage during outbreaks, probably for similar reasons 22–24 . A number of immunodeficiencies are linked with an increased risk of disease, including complement deficiencies, 25,26 hypogammaglobulinaemia, 27,28 asplenia 29 and, possibly, corticosteroid therapy.…”

Risk of Meningococcal Infection in College Students

“…10,11 Although it is possible that the increased risk of meningococcal infection was in part a result of the relative crowding typically associated with living in a dormitory, on-campus residence could also be a marker for other risk factors recently associated with college students, including alcoholrelated behaviors and exposure to tobacco smoke. [12][13][14] Our study does not allow us to directly assess whether the incidence of *P = .05 for comparison of annual incidence between on-campus vs off-campus housing residents; P = .08 for comparison of annual incidence between oncampus housing residents and the general population. †Students aged 18 to 22 years, excluding the 4-year college population (see "Methods" section).…”

Controle de surto de meningite meningocócica do sorogrupo C no Município de Corupá, Santa Catarina, Brasil, com ações rápidas e efetivas de vigilância epidemiológica e imunização

“…Quando estes fatores estão presentes, uma epidemia pode ser iniciada pela presença, por exemplo, de um co-fator infeccioso, representado por infecções agudas do trato respiratório, que podem comprometer as mucosas e aumentar a probabilidade de invasão pela bactéria. Aglomerações em discotecas e eventos esportivos, hábito de fumar, alcoolismo, fadiga e estresse por acúmulo ou excesso de trabalho, entre outros, são também relacionados como fatores de risco para a doença invasiva 15,16,17,18 . No Estado de Santa Catarina, observam-se casos da doença durante todos os meses do ano.…”