A 20-year ecological study of the temporal association between influenza and meningococcal disease

Abstract

Both influenza and meningococcal disease (MD) show seasonal variation with peak incidence rates during the winter. We examined whether fluctuations in occurrence of influenza were associated with changes in the incidence rate of MD, either simultaneously or with a delay of one or 2 weeks, and whether age had an impact on these associations. This ecological study was based on weekly surveillance data on influenza and a complete registration of MD cases (n = 413) in North Jutland County, Denmark, during 1980-1999. A total of 379 MD cases occurred during weeks with influenza registration. The analysis was done using a Poisson regression model taking into account the seasonal variation and trend over time in incidence rate of MD, and stratified by age: < 1 year (n = 38), 1-14 years (n = 189), and > or = 14 years (n = 152). An increase of 100 registered cases of influenza per 100,000 inhabitants was associated with a 7% (95% CI: -1 to 15%) increase in the number of MD cases during the same week. The association was most marked for < 1 year-olds, corresponding to a 29% (95% CI: 6-58%) increase in the number of MD cases per 100 cases of influenza per 100,000 inhabitants. Our findings support the theory that the influenza detection rate is associated with the number of MD cases in the population during the same week.

Many respiratory viruses have temporal association with meningococcal disease

“…It is hypothesised that alterations in the immune response of the host (neutrophil chemotaxic and phagocytes' alterations) and/or damage to respiratory epithelium directly caused by the viruses and/or increased rates of meningococcal transmission are responsible. 2 Respiratory tract viral infections commonly result in coughing among older children and adults who are likely to have high meningococcal carriage rates. 15 In vitro experimentation has demonstrated enhancement of adhesion of N. meningitides capsule to cultured epithelial cells when influenza A neuraminidase is present.…”

“…1 These viruses, together with N. meningitidis, live in upper respiratory tract mucose. 2 Ecological studies in Denmark, 2 the UK/Wales, 3 France, 4 and Spain 5 show a temporal and spatial association between influenza epidemics and MNG, with an increased number of MNG cases following (approximately two weeks after) influenza cases. 3,4 The explanation might be alterations in the immune response of the host and/or damage to the respiratory epithelium caused by the virus.…”

“…3,4 The explanation might be alterations in the immune response of the host and/or damage to the respiratory epithelium caused by the virus. 2 However, these studies used ''influenza-like clinical cases'' without requiring viral confirmation. 2---5 Two small case---control studies with identified respiratory viruses yielded contradictory results.…”

Investigating the aetiology of and evaluating the impact of the Men C vaccination programme on probable meningococcal disease in England and Wales

“…Influenza can also predispose to meningococcal disease and may be responsible for a small excess number of cases [15]. Influenza is also under-recognized in other paediatric infections [8] and, therefore, clinicians should be more aware and consider investigation for influenza more often.…”

Examining secular trends and seasonality in count data using dynamic generalized linear modelling: a new methodological approach illustrated with hospital discharge data on myocardial infarction

“…Neither considers the presence of secular trends and other effects, with the seasonal pattern, a simple sinusoid, remaining fixed over time. A generalized linear model for Poisson observations can handle seasonal components via a harmonic representation, and the secular trend via a polynomial or a spline representation [10]. More flexible generalized additive models [11] have been used to control for seasonality and trend in studies that link an explanatory variable (air pollution) to morbidity and mortality [12,13].…”