Association between population prevalence of smoking and incidence of meningococcal disease in Norway, Sweden, Denmark and the Netherlands between 1975 and 2009: a population-based time series analysis

Abstract

ObjectiveTo investigate the relationship between the prevalence of smoking in the population and incidence of invasive meningococcal disease (IMD) among children under 5 years of age.DesignRetrospective, longitudinal, observational study. Poisson regression controlled for confounding factors.SettingNorway, Sweden, Denmark and the Netherlands between 1975 and 2009.PopulationTotal population of approximately 35 million people in these four countries.Data sourcesData were collected from the Ministries of Health, National Statistics Bureaus and other relevant national institutes.ResultsIn Norway, there was a significant positive relationship between the annual prevalence of daily smokers among individuals aged 25–49 years and the incidence of IMD in children under 5 years of age, unadjusted (RR=1.04–1.06, 95% CI 1.02 to 1.07, p<0.001) and after adjustment for time of year (quarter), incidence of influenza-like illness and household crowding (RR=1.05–1.07, 95% CI 1.03 to 1.09, p<0.001). Depending on age group, the risk of IMD increased by 5.2–6.9% per 1% increase in smoking prevalence among individuals aged 25–49 years in adjusted analyses. Using limited datasets from the three other countries, unadjusted analysis showed positive associations between IMD in children related to older smokers in Sweden and the Netherlands and negative associations related to younger smokers in Sweden. However, there were no demonstrable associations between incidence of IMD and prevalence of smoking, after adjustment for the same confounding variables.ConclusionsThe reduced incidence of IMD in Norway between 1975 and 2009 may partly be explained by the reduced prevalence of smoking during this period. High-quality surveillance data are required to confirm this in other countries. Strong efforts to reduce smoking in the whole population including targeted campaigns to reduce smoking among adults may have a role to play in the prevention of IMD in children.

Predictors of smoking cessation: A longitudinal study in a large cohort of smokers

“…The divergent results of the studies reflect the complexity of smoking behaviour that can be influenced by a wide variety of factors [16]. Data for the Nordic countries Denmark, Iceland, Norway and Sweden show that the smoking prevalence has decreased substantially during the last few decades [3][4][5]. In part, this is probably an effect of an increased smoking cessation rate and is therefore in line with the results of the current study.…”

“…The global smoking prevalence has decreased during the last few decades [3], and in many Northern Europe countries the decline has been noticeable [3][4][5]. Nevertheless, smoking still has an immense impact on general health in these countries.…”

Diversity of meningococci associated with invasive meningococcal disease in the Republic of Ireland over a 19 year period, 1996-2015

“…Explanations for EY2005/2006, EY2010/ 2011 and EY2012/2013 are less obvious, although perhaps the "smoking in the workplace" ban introduced in March 2004 which led to reductions in cigarette smoking (both complete cessation and also reduced cigarette consumption among continuing smokers [65][66][67]; could have impacted on the menB disease strains in EY2005/2006. Smoking and exposure to smoke are known predisposing risk factors for IMD [68]. The transient drops in diversity seen in more recent EY, may possibly be due to the adverse winter weather conditions experienced in both of these EYs; the winter of EY2010/2011 was one of the coldest on record in RoI with several atypical heavy and prolonged snowfalls and the winter of EY2013/2014 was distinguished by severe winter storms with uncharacteristically high rainfall and wind speeds (http://www.met.…”

An OMV Vaccine Derived from a Capsular Group B Meningococcus with Constitutive FetA Expression: Preclinical Evaluation of Immunogenicity and Toxicity

“…Meningococcal disease is a severe, potentially life-threatening infection, with highest incidence among children less than five years of age. The incidence in high income countries has decreased in recent decades, in part driven by the implementation of protein-conjugated polysaccharide vaccines providing protection against capsular group C meningococci [ 1 ], but perhaps also as a result of environmental changes including reductions in smoking rates [ 2 ]. Changes in the meningococci circulating in asymptomatic carriage and changes in population immunity may also have led to the decrease in disease incidence.…”