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Influenza Increases Invasive Meningococcal Disease Risk in Temperate Countries

35 Pages Posted: 19 Mar 2019

See all articles by Angela Salomon

Angela Salomon

University of Toronto - Dalla Lana School of Public Health

Isha Berry

University of Toronto - Dalla Lana School of Public Health

Ashleigh R. Tuite

University of Toronto

Steven Drews

Canadian Blood Service

Todd Hatchette

Nova Scotia Health Authority

Frances Jamieson

Public Health Ontario

Caroline Johnson

Philadelphia Department of Public Health

Jeff Kwong

University of Toronto - Dalla Lana School of Public Health

Bruno Lina

University of Claude Bernard Lyon 1

Jose Lojo

Philadelphia Department of Public Health

Anne Mosnier

Open Rome

Victoria Ng

Public Health Agency Canada

Philippe Vanhems

Hospices Civils de Lyon; University of Claude Bernard Lyon 1

David Fisman

University of Toronto - Dalla Lana School of Public Health; University of Toronto, Faculty of Medicine, Department of Medicine, Division of Infectious Diseases

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Abstract

Background: Streptococcus pneumoniae is the most commonly identified cause of bacterial pneumonia, and invasive pneumococcal disease (IPD) has a high case fatality rate.  The wintertime co-seasonality of influenza and IPD in temperate countries has suggested that pathogen-pathogen interaction or environmental conditions contribute to IPD risk.  We evaluated the contribution of influenza and environmental conditions, using standardized methodology, across multiple geographical regions.    

Methods: Case data for 25,292 cases from jurisdictions in Canada, the United States and Australia were available.  Associations between influenza, temperature, absolute humidity and ultraviolet radiation and IPD were evaluated using a case-crossover design. Identical models were used in all jurisdictions; heterogeneity of effects was explored using meta-analytic methods.    

Findings: In adjusted models, elevated influenza activity at a 2-week lag was associated with increases in IPD risk (adjusted OR (aOR) per standard deviation increase 1.07, 95% CI: 1.01-1.13). Increased humidity decreased IPD risk at a 1-week lag (aOR per gram.m-3 of water 0.98, 95% CI 0.96-1.00).  Other effects were heterogeneous; meta-regression suggested that combinations of environmental factors might represent unique local "risk signatures".    

Interpretation: Influenza drives IPD risk in temperate countries.  This association is not explained by co-seasonality or case characteristics and appears generalizable.  Absolute humidity attenuates IPD risk in the same jurisdictions.  The generalizable nature of these associations has important implications for influenza control and advances the understanding of seasonality of this important disease.    

Funding Statement:  Supported by Canadian Institutes for Health Research Operating Grants (#222287 and #337516) and by the Canadian Immunization Research Network.

Declaration of Interests: The authors state: "None."

Ethics Approval Statement: This study was approved by the Research Ethics Board of the University of Toronto (protocol #: 00036083. Protocol Title: Wintertime Seasonality of Influenza and Invasive Bacterial Disease: Influence of Environment, Pathogen Interactions, Time Scales, and Geography).

Keywords: Neisseria meningitidis; invasive meningococcal disease; influenza; meningitis; epidemiology; seasonality; case-crossover; Canada; Australia; United States; France

Suggested Citation

Salomon, Angela and Berry, Isha and Tuite, Ashleigh R. and Drews, Steven and Hatchette, Todd and Jamieson, Frances and Johnson, Caroline and Kwong, Jeff and Lina, Bruno and Lojo, Jose and Mosnier, Anne and Ng, Victoria and Vanhems, Philippe and Fisman, David, Influenza Increases Invasive Meningococcal Disease Risk in Temperate Countries (December 3, 2019). Available at SSRN: https://ssrn.com/abstract=3352010 or http://dx.doi.org/10.2139/ssrn.3352010

Angela Salomon

University of Toronto - Dalla Lana School of Public Health

Toronto, Ontario
Canada

Isha Berry

University of Toronto - Dalla Lana School of Public Health

Toronto, Ontario
Canada

Ashleigh R. Tuite

University of Toronto

105 St George Street
Toronto, Ontario M5S 3G8
Canada

Steven Drews

Canadian Blood Service

1800 Alta Vista Drive
Ottawa, Ontario K1G 4J5
Canada

Todd Hatchette

Nova Scotia Health Authority

Halifax
Canada

Frances Jamieson

Public Health Ontario

Kingston, Ontario
Canada

Caroline Johnson

Philadelphia Department of Public Health

Philadelphia, PA
United States

Jeff Kwong

University of Toronto - Dalla Lana School of Public Health

Toronto, Ontario
Canada

Bruno Lina

University of Claude Bernard Lyon 1

43 Bl du 11 novembre 1918
Lyon, Villeurbanne cedex 69622
France

Jose Lojo

Philadelphia Department of Public Health

Philadelphia, PA
United States

Anne Mosnier

Open Rome ( email )

67, Rue du Poteau
Paris, 75018
France

Victoria Ng

Public Health Agency Canada

Ontario
Canada

Philippe Vanhems

Hospices Civils de Lyon

3 Quai des Célestins
Lyon, 69002
France

University of Claude Bernard Lyon 1

43 Bl du 11 novembre 1918
Lyon, Villeurbanne cedex 69622
France

David Fisman (Contact Author)

University of Toronto - Dalla Lana School of Public Health ( email )

Toronto, Ontario
Canada

University of Toronto, Faculty of Medicine, Department of Medicine, Division of Infectious Diseases ( email )

Canada

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