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.
Bibliographical noteFunding Information:
The work of the MenAfriCar Consortium was supported by grants from the Bill & Melinda Gates Foundation and from the Wellcome Trust.
The datasets generated and/or analysed during the current study are available in the Unviersity of Cambridge Repository Apollo, [https://doi.org/10.17863/CAM.35686]. The work of the MenAfriCar Consortium was supported by grants from the Bill & Melinda Gates Foundation and from the Wellcome Trust. We thank the many individuals who participated in the household surveys reported in this paper. The work described here also relied upon many staff, including fieldworkers and laboratory technicians whom we thank for their contributions. We acknowledge the directors of the African research centres for their support and the following individuals who provided clinical monitoring: Ngandolo Bongo Nar? (Chad), Frank Baiden (Ghana), Workeabeba Taye (Ethiopia), Haoua Amadou (Niger and Mali) and Birahim Pierre Ndiaye (Senegal). The guidance provided by the MenAfriCar Advisory Committee (Fred Binka, Mamadou Djingarey, Robert Heyderman, Marie-Paule Kieney, Marie-Pierre Preziosi, David Stephens and Marcel Tanner [chairman]) has been much appreciated. We also thank the following individuals who contributed to the establishment of the MenAfriCar Consortium and to its activities in various ways: William Perea (WHO, Geneva, Switzerland), Dominique Caugant (Norwegian Institute of Public Health, Oslo, Norway), Mamadou Djingarey (WHO, Ouagadougou, Burkina Faso), Marc LaForce (PATH, Seattle, USA), Judith Mueller (?cole des hautes ?tudes en sant? publique, Rennes, France), Gerd Pluschke (Swiss Tropical and Public Health Institute, Basle, Switzerland) and Muhamed-Kheir Taha (Institut Pasteur, Paris, France) and other colleagues from WHO and CDC who contributed. The work of the consortium across Africa would not have been possible without the strong logistic support provided by members of the MenAfriCar secretariat in London?Amit Bhasin, Elizabeth Huntley, Karen Williams, Lyanne Wylde and Karen Slater. Studies conducted in each country received full support from the national health and local authorities and this is gratefully acknowledged.
© 2019 John Wiley & Sons Ltd
- Neisseria meningitidis
- risk factors