Comorbidity increases the risk of invasive meningococcal disease in adults

Abstract

Abstract Background Risk of invasive meningococcal disease (IMD) is increased in patients with complement deficiency and HIV infection. Risk associated with comorbidity is not well described. Methods Nationwide adult case-control study. Cases for the period 1977-2018 were identified by the national meningococcus reference laboratory. Matched controls were identified by registry linkage. Comorbidity diagnosed prior to IMD were based on the International Classification of Disease, eight or tenth revision. Odds ratios (OR) with 95% confidence intervals were estimated by logistic regression after adjustment for sex, age and other comorbidities. Results We identified 1221 cases (45% male), median age 45 years (interquartile range: 22-64 years). The dominant meningococcal serogroups were B (n=738) and C (n=337). Increased risk of IMD was associated with solid organ transplantation (SOT) (OR 40.29 [95% confidence interval (CI), 4.84-335.75]), hemolytic anemia (OR 7.56 [95% CI, 2.63-21.79]), renal disease (OR 2.95 [95% confidence interval (CI), 1.77- 4.91]), liver disease (OR 2.53 [95% CI, 1.57-4.08]), cancer (OR 2.31 [95% CI, 1.85-2.89 ]), diabetes (OR 1.74 [95% CI, 1.26-2.39]), neurological disease (OR 1.72 [95% CI, 1.20-2.46]) and autoimmune disease (OR 1.70 [95% CI, 1.33-2.19]). Having 1, 2 and >2 comorbidities was associated with increased risk of IMD with ORs 1.6 to 3.5. Increased risk was not associated with specific serogroups. Conclusions This study of adults with IMD over four decades showed increased risk of IMD associated with renal disease, immunological disorders, liver disease, cancer, and SOT ranging from a 2- to a 40-fold increased risk. Vaccination may be warranted in these populations.