Public Release:  Second-hand smoke increases risk of invasive meningococcal disease in children

PLOS

Second-hand smoke increases risk of invasive meningococcal disease in children

Children exposed to second-hand smoke are more likely to get invasive meningococcal disease than children who are not exposed, reports a study from Chien-Chang Lee at the Harvard School of Public Health (Boston, USA) and colleagues published in this week's PLoS Medicine. The authors also found a possible association of second-hand smoke exposure with invasive pneumococcal disease and Haemophilus influenzae type b.

By reviewing and analysing published studies (30 case-control and 12 cross-sectional studies, mostly conducted in high income countries with good vaccination policies), the authors used the findings of all studies that had compared the occurrence of invasive bacterial disease in children exposed to second-hand smoke with its occurrence in children not exposed to second-hand smoke. The authors found that exposure to second-hand smoke doubled the likelihood of invasive meningococcal disease (with a total odds ratio for second hand smoke exposure of 2.02) and although there was an increase in the risk of developing invasive pneumococcal disease and Haemophilus influenzae type b, this increase could not be distinguished from chance finding, perhaps because a relatively small number of studies were available. However, nasal carriage of N. meningitidis (which causes meningitis) and S. pneumoniae in children exposed to second-hand smoke was significantly increased compared to those who were not exposed. The effects were generally stronger in the youngest children, those below 6 years of age, who are more vulnerable.

These results suggest that by decreasing children's exposure to second-hand smoke, for example by parents stopping smoking or not smoking at home, deaths and illness caused by invasive bacterial diseases could be reduced. Such a reduction would be particularly beneficial in poor countries, where vaccination against invasive bacterial diseases is low.

The authors conclude: "Because the burden of invasive bacterial disease is highest in developing countries where second-hand smoke is increasing, there is a need for high-quality studies to confirm these results, and for interventions to reduce exposure of children to second-hand smoke."

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Funding: This work was supported by a grant from the National Institute of Environmental Health Sciences (1R21ES017855-01) and by a grant for CHERG to the US Fund for UNICEF and for the Global Burden of Diseases, Injuries, and Risk Factors Study. Both grants were from the Bill & Melinda Gates Foundation. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Lee C-C, Middaugh NA, Howie SRC, Ezzati M (2010) Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial

Carriage: A Systematic Review and Meta-analysis. PLoS Med 7(12): e1000374. doi:10.1371/journal.pmed.1000374

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PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-07-12-ezzati.pdf

CONTACT:
Majid Ezzati
MRC-HPA Centre for Environment and Health
Department of Epidemiology and Biostatistics
School of Public Health
Imperial College London
St Mary's Campus
Norfolk Place
London W2 1PG, UK
Tel: +44 (0)20 7594 0767
Fax: +44 (0)20 7594 3456
E-mail: majid.ezzati@imperial.ac.uk

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