LONDON, Feb. 10 - Deep kissing with multiple partners can nearly quadruple the risk that an adolescent will get meningococcal disease, researchers here reported.
A study of 15- to 19-year-olds with meningococcal disease, who were compared with age- and gender-matched controls, found that intimate kissing with multiple partners, being a college student, and being born pre-term (before 37 weeks' gestation) were all independent risk factors for meningococcal disease.
On the other hand, prophylaxis with a meningococcal vaccine and attending religious services were both associated with reduced risk for meningococcal infections, reported Jonna Tully, Ph.D., of the University of London's Queen Mary College, and colleagues in the online edition of
BMJ, formerly the
British Medical Journal.
"Our findings imply that changing personal behaviors could reduce the risk of meningococcal disease in adolescence," the investigators wrote. But they're also pragmatic about the prospects that teens will give up kissing and get religion.
"Although behavior-based health promotion messages might have a small role in reducing the risk of disease, such campaigns are unlikely to have a major impact," they wrote. "The development of further effective meningococcal vaccines therefore remains a key public health priority."
The rate of meningococcal disease is highest among children under the age of five, but there is a significant second peak in adolescence.
The rate of meningitis and septicemia among teenagers rose significantly in both England and United States during the 1990s, with a noticeable shift toward older teens, and a rise in the prevalence of disease caused by serogroup C strains.
"This rise, together with a higher case fatality rate in the 15- to 19-year age group, caused much concern and was a major stimulus in the United Kingdom for developing the conjugate meningococcal serogroup C vaccine, which has been highly successful," the authors noted.
Although students living in close quarters such as college dormitories are known to be at higher risk for meningococcal disease, it's still unclear why disease peaks in early childhood and again in adolescence.
"Adolescence is a period of biopsychosocial maturation during which the adoption of potentially risky behaviors may produce a distinct risk profile," the authors wrote.
They cited studies suggesting various risk factors for meningococcal disease in teens, including dorm life, campus bar patronage, smoking, Epstein-Barr viral infections, deep kissing, and substance abuse.
To get a better idea of the risk factors involved, the investigators conducted a matched cohort study of 15- to 19-year-olds in six contiguous regions of England that represent about two-thirds of the British population.
The researchers obtained blood samples and nasal and throat swabs from 144 students with confirmed or likely meningococcal disease and from the same number of age- and gender-matched controls. They also conducted confidential interviews to gather data on potential risk factors, and performed analyses using both univariate and multivariate conditional logistic regression.
They found that the significant independent risk factors for meningococcal disease were a history of illness within two weeks of admission (matched odds ratio 2.9, 95% confidence interval, 1.4 to 5.9), intimate kissing with multiple partners (OR 3.7, 95% CI, 1.7 to 8.1), being a university student (OR 3.4, 95% CI 1.2 to 10) and preterm birth (OR 3.7, 95% CI, 1.0 to 13.5).
In the multivariate analysis, only deep kissing with multiple partners remained independently significant.
In contrast, teens who attended one or more religious ceremonies had a significantly lower risk of meningococcal disease (OR 0.09, 95% CI, 0.02 to 0.6) as did those who had been vaccinated (OR 0.12, 95% CI, 0.04 to 0.4).
The investigators also found that risk factors that are significant in young children, such as passive smoking and deficiency in mannose-binding lectin, were not significant risk factors for teens.
The authors noted that their finding of an association between preterm birth and disease risk may have been the result of chance and needs to be confirmed by other studies.
"Interestingly, we found that five of our case patients but no controls were born at gestation of 30 weeks or less," the authors wrote. "This association may be a chance finding, biased by parental report, or, perhaps, could reflect real differences in immune function programming related to timing of birth."
Primary source: BMJ Online First
Source reference:
Tully J et al.
Risk and protective factors for meningococcal disease in adolescents: matched cohort study.
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