OBJECTIVES: To determine whether the nasopharyngitis prodrome of meningococcal disease is caused by the disease itself or respiratory viral coinfection. METHODS: Case control study of children with suspected meningococcal disease. Nasal swabs and a respiratory history were obtained from suspected cases and matched controls. Molecular testing for 12 respiratory viruses was used. RESULTS: 104 suspected cases and controls were recruited. Detection rates for respiratory viruses were 27% (28/104) for suspected cases and 29% (30/104) for controls. Rhinoviruses (43/58, 74%) and adenoviruses (14/58, 24%) occurred most frequently with 3 coinfections. 39 (38%) suspected cases were confirmed as meningococcal disease with a detection rate for respiratory viruses of 26% (10/39). No significant difference was found in the respiratory viral detection rate between this group and their controls, Odds ratio=1.0 (95% CI 0.3 to 3.3). Prodromal respiratory symptoms were significantly more likely for suspected cases (77/104, 74%) than controls (55/104, 53%), Odds ratio 2.8 (95% CI 1.4 to 6.0), but were equally common in confirmed (28/39, 72%) and unconfirmed cases (49/65, 75%), Odds ratio 0.8 (95% CI 0.3 to 2.3). CONCLUSIONS: This study found no evidence that respiratory viral infections contribute to the prodrome of meningococcal disease. Rhinovirus and adenovirus detection by nasal swab is common in well and unwell children.
OBJECTIVES: To determine whether the nasopharyngitis prodrome of meningococcal disease is caused by the disease itself or respiratory viral coinfection. METHODS: Case control study of children with suspected meningococcal disease. Nasal swabs and a respiratory history were obtained from suspected cases and matched controls. Molecular testing for 12 respiratory viruses was used. RESULTS: 104 suspected cases and controls were recruited. Detection rates for respiratory viruses were 27% (28/104) for suspected cases and 29% (30/104) for controls. Rhinoviruses (43/58, 74%) and adenoviruses (14/58, 24%) occurred most frequently with 3 coinfections. 39 (38%) suspected cases were confirmed as meningococcal disease with a detection rate for respiratory viruses of 26% (10/39). No significant difference was found in the respiratory viral detection rate between this group and their controls, Odds ratio=1.0 (95% CI 0.3 to 3.3). Prodromal respiratory symptoms were significantly more likely for suspected cases (77/104, 74%) than controls (55/104, 53%), Odds ratio 2.8 (95% CI 1.4 to 6.0), but were equally common in confirmed (28/39, 72%) and unconfirmed cases (49/65, 75%), Odds ratio 0.8 (95% CI 0.3 to 2.3). CONCLUSIONS: This study found no evidence that respiratory viral infections contribute to the prodrome of meningococcal disease. Rhinovirus and adenovirus detection by nasal swab is common in well and unwell children.