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Risk factors for acquisition of meningococcal carriage in the African meningitis belt
Laura V Cooper1, Anna Robson1, Caroline L Trotter1
1University of Cambridge, Cambridge, UK.
Objective:
To investigate potential risk factors for acquisition in seven countries of the meningitis belt.
Methods:
Households were followed up every 2 weeks for 2 months, then monthly for a further 4 months. Pharyngeal swabs were collected from all available household members at each visit and questionnaires completed. Risks of acquisition over the whole study period and for each visit were analysed by a series of logistic regressions.
Results:
Over the course of the study, acquisition was higher in: (i) 5-to 14-year olds, as compared with those 30 years or older (OR 3.6, 95% CI 1.4-9.9); (ii) smokers (OR 3.6, 95% CI 0.98-13); and (iii) those exposed to wood smoke at home (OR 2.6 95% CI 1.3-5.6). The risk of acquisition from one visit to the next was higher in those reporting a sore throat during the dry season (OR 3.7, 95% CI 2.0-6.7) and lower in those reporting antibiotic use (OR 0.17, 95% CI 0.03-0.56).
Conclusions:
Acquisition of meningococcal carriage peaked in school age children. Recent symptoms of sore throat during the dry season, but not during the rainy season, were associated with a higher risk of acquisition. Upper respiratory tract infections may be an important driver of epidemics in the meningitis belt.
Insights
Meningococcal carriage acquisition is higher in school-aged children, smokers, and those exposed to wood smoke. Sore throat during the dry season increases risk, while antibiotics decrease it, highlighting the role of respiratory infections in meningitis belt epidemics.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Meningococcal carriage is a key factor in disease transmission.
- Understanding acquisition risk factors is crucial for controlling epidemics in the meningitis belt.
Purpose of the Study:
- To identify risk factors associated with meningococcal carriage acquisition in the meningitis belt.
- To analyze acquisition patterns over time and by demographic and environmental factors.
Main Methods:
- A prospective household cohort study was conducted over 6 months in seven meningitis belt countries.
- Pharyngeal swabs and questionnaires were used to collect data on carriage, symptoms, and exposures.
- Logistic regression models were applied to assess risk factors for acquisition.
Main Results:
- Acquisition was significantly higher in 5-to 14-year-olds, smokers, and individuals exposed to wood smoke.
- A sore throat during the dry season increased acquisition risk, whereas antibiotic use decreased it.
- Risk varied between visits, indicating dynamic transmission patterns.
Conclusions:
- School-aged children are a critical group for meningococcal carriage acquisition.
- Upper respiratory tract infections, particularly during the dry season, may drive epidemic meningitis transmission.
- Environmental factors like wood smoke exposure and behavioral factors like antibiotic use influence carriage acquisition.
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