Tobacco smoking and meningococcal disease in adolescents and young adults: a systematic review and meta-analysis.

ABSTRACT

OBJECTIVES: Systematically review the evidence on the association between active and passive tobacco smoking and invasive meningococcal disease (IMD) in adolescents and young adults aged 15-to-24-years. METHODS: Electronic searches were conducted in Ovid MEDLINE, EMBASE, and Web of Science to June 2020. Reference lists were hand-searched. Two independent reviewers screened articles for eligibility. Risk of bias was assessed using an adapted Risk of Bias in Non-Randomised Studies - of Interventions tool. Meta-analyses were conducted using random-effects models. RESULTS: Of 312 records identified, 13 studies were included. Five studies provided data on the association between active smoking and IMD in the target age group; pooled odds ratio (OR) 1.45 (95% CI 0.93-2.26). The overall OR, including eight studies with a wider participant age range, was 1.45 (95% CI 1.12-1.88). For passive smoking, the equivalent ORs were 1.56 (95% CI 1.09-2.25) and 1.30 (95% CI 1.06-1.59) respectively. All studies were at high risk of bias. CONCLUSIONS: Active and passive smoking may be associated with IMD in adolescents and young adults. Since active smoking has also been linked to meningococcal carriage, and passive smoking to IMD in young children, smoking cessation should be encouraged to reduce transmission and IMD risk in all ages.