Environmental Exposures and Invasive Meningococcal Disease: An Evaluation of Effects on Varying Time Scales

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dc.contributor.authorKinlin, Laura M.
dc.contributor.authorSpain, C. Victor
dc.contributor.authorBrett (previously Ng), Victoria
dc.contributor.authorJohnson, Caroline
dc.contributor.authorWhite, Alexander N. J
dc.contributor.authorFisman, David N.
dc.date.accessioned2015-12-08T22:16:01Z
dc.date.issued2009
dc.date.updated2016-02-24T11:16:53Z
dc.description.abstractInvasive meningococcal disease (IMD) is an important cause of meningitis and bacteremia worldwide. Seasonal variation in IMD incidence has long been recognized, but mechanisms responsible for this phenomenon remain poorly understood. The authors sought to evaluate the effect of environmental factors on IMD risk in Philadelphia, Pennsylvania, a major urban center. Associations between monthly weather patterns and IMD incidence were evaluated using multivariable Poisson regression models controlling for seasonal oscillation. Short-term weather effects were identified using a case-crossover approach. Both study designs control for seasonal factors that might otherwise confound the relation between environment and IMD. Incidence displayed significant wintertime seasonality (for oscillation, P < 0.001), and Poisson regression identified elevated monthly risk with increasing relative humidity (per 1% increase, incidence rate ratio = 1.04, 95% confidence interval: 1.004, 1.08). Case-crossover methods identified an inverse relation between ultraviolet B radiation index 1-4 days prior to onset and disease risk (odds ratio = 0.54, 95% confidence interval: 0.34, 0.85). Extended periods of high humidity and acute changes in ambient ultraviolet B radiation predict IMD occurrence in Philadelphia. The latter effect may be due to decreased pathogen survival or virulence and may explain the wintertime seasonality of IMD in temperate regions of North America.
dc.identifier.issn0002-9262
dc.identifier.urihttp://hdl.handle.net/1885/30490
dc.publisherOxford University Press
dc.sourceAmerican Journal of Epidemiology
dc.subjectKeywords: bacterial disease; climate effect; confidence interval; disease incidence; environmental factor; meningitis; regression analysis; relative humidity; seasonal variation; Adolescent; Adult; Aged; Case-Control Studies; Child; Child, Preschool; Confounding Fa Case-control studies; Environment; Environmental exposure; Meningitis; Meningitis, bacterial; Meteorological factors; Neisseria meningitidis; Regression analysis
dc.titleEnvironmental Exposures and Invasive Meningococcal Disease: An Evaluation of Effects on Varying Time Scales
dc.typeJournal article
local.bibliographicCitation.issue5
local.bibliographicCitation.lastpage595
local.bibliographicCitation.startpage588
local.contributor.affiliationKinlin, Laura M., Research Institute of the Hospital for Sick Children
local.contributor.affiliationSpain, C. Victor, Philadelphia Department of Public Health
local.contributor.affiliationBrett (previously Ng), Victoria, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationJohnson, Caroline, Philadelphia Department of Public Health
local.contributor.affiliationWhite, Alexander N.J, University of Toronto
local.contributor.affiliationFisman, David N., Research Institute of the Hospital for Sick Children
local.contributor.authoremailrepository.admin@anu.edu.au
local.contributor.authoruidBrett (previously Ng), Victoria, u2521639
local.description.embargo2037-12-31
local.description.notesImported from ARIES
local.identifier.absfor111706 - Epidemiology
local.identifier.ariespublicationu4637548xPUB74
local.identifier.citationvolume169
local.identifier.doi10.1093/aje/kwn383
local.identifier.scopusID2-s2.0-60149094001
local.identifier.uidSubmittedByu4637548
local.type.statusPublished Version

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