Risk Factors for Serogroup B Meningococcal Disease Among College Students

Abstract

Background: College students are at increased risk for invasive meningococcal disease, but which students are most at risk is unclear.

Methods: US meningococcal disease cases in persons aged 18-24 years during 2014-2017 were included. Patients were classified as undergraduate students or other persons. Incidence in different student and non-student populations was compared.

Results: During 2014-2017, 229 meningococcal disease cases were reported in persons aged 18-24 years; 120 were in undergraduate students. Serogroup B accounted for 74% of cases in students. Serogroup B disease incidence was 4-fold higher in undergraduate students, 11.8-fold higher among first-year undergraduate students, and 8.6-fold higher among residence hall residents versus non-undergraduates. During outbreaks, students affiliated with Greek life had a 9.8-fold higher risk of disease compared to other students. A significantly higher party school ranking was observed for schools with sporadic or outbreak cases when compared to schools with no cases.

Conclusions: The findings of increased disease risk among first-year students and those living on campus or affiliated with Greek life can inform shared clinical decision-making for serogroup B vaccines to prevent this rare but serious disease. These data also can inform school serogroup B vaccination policies and outbreak response measures.

Keywords: College students; MenB vaccine; Meningococcal disease.

Figure 1.

Number of serogroup B disease cases classified as sporadic or outbreak-associated and annual incidence by year—United States, 2014–2017. The one 2014 outbreak case was a college student, but the student did not attend the school where the outbreak occurred, so this case was not included in the outbreak analyses in this manuscript.

Figure 2.

Characteristics of colleges with serogroup B disease outbreaks (8 schools), sporadic cases (48 schools), and without serogroup B disease cases (100 schools)—United States, 2014–2017^a,b. A, Mean percentage of 4-year students residing on campus^c. B, Mean percentage of students affiliated with Greek life^c. C, Mean college party school rankings^d. D, Proportion of public colleges per college category^e. E, Median number of undergraduate students^f. Notes: ^aSchools where the characteristic could not be determined were excluded from the analysis. Of the 56 college students with sporadic serogroup B disease, 7 students came from 3 colleges; 3 others had an unknown school name and were therefore excluded from this analysis. ^bComparisons are between outbreaks and no cases and sporadic and no cases. Vertical error bars indicate 95% confidence intervals, and horizontal brackets with asterisks identify comparisons that are statistically significant at P < .05. ^cAnalysis of variance test. ^dWilcoxon signed-rank test. ^ePoisson regression. ^fWilcoxon rank-sum test. *P < .05; **P < .001; ***P < .0001.