Increased Risk of Invasive Meningococcal Disease Associated with Primary and Secondary Immunodeficiency

BACKGROUND: Risk of invasive meningococcal disease (IMD) is increased for persistent complement deficiency and HIV infection. However, risk associated with other primary and secondary immunodeficiency is unknown. METHODS: Nationwide case–control study of adults aged >18 years. Cases and matched controls were identified by registry linkage. Primary and secondary immunodeficiencies diagnosed prior to IMD were based on International Classification of Disease (ICD), eight or tenth revision. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by conditional logistic regression after adjustment for sex, age, and the year of IMD. RESULTS: We identified 2,179 IMD cases (46% male) with a median age of 44 years (interquartile range: 24–63 years). Increased risk of IMD was associated with HIV infection (OR 10.03 [95% confidence interval (CI), 2.91–34.66]), splenectomy/splenic resection (OR 6.88 [95% CI, 3.9–14.82]), solid organ transplantation (SOT) (OR 20.00 [95% CI, 5.00–79.96]), hemolytic anemia (OR 7.78 [95% CI, 2.90–20.90]), antibody deficiency (OR 6.67 [1.11–39.90]) and autoimmune diseases (OR 1.80 [95% CI, 1.44–2.14]). Primary immunodeficiency overall was not associated with an increased risk (OR 1.43 (95% CI, 0.61–3.36)). CONCLUSION: This large study of Danish adults with IMD over four decades showed an increased risk of IMD associated with HIV infection, SOT, asplenia, hemolytic anemia, antibody deficiency, and autoimmune disease ranging from 2- to a 20-fold increased risk. Vaccination may be warranted in these populations. DISCLOSURES: Z. Barrella Harboe, Pfizer: independent physician, Travel grants.