FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 342:681-689 March 9, 2000 Number 10 Next

	Full Text PDF Editorial by Sheffield, J. V.L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Approximately half of otherwise healthy adults with invasive pneumococcal disease are cigarette smokers. We conducted a population-based case–control study to assess the importance of cigarette smoking and other factors as risk factors for pneumococcal infections.

Methods We identified immunocompetent patients who were 18 to 64 years old and who had invasive pneumococcal disease (as defined by the isolation of Streptococcus pneumoniae from a normally sterile site) by active surveillance of laboratories in metropolitan Atlanta, Baltimore, and Toronto. Telephone interviews were conducted with 228 patients and 301 control subjects who were reached by random-digit dialing.

Results Fifty-eight percent of the patients and 24 percent of the control subjects were current smokers. Invasive pneumococcal disease was associated with cigarette smoking (odds ratio, 4.1; 95 percent confidence interval, 2.4 to 7.3) and with passive smoking among nonsmokers (odds ratio, 2.5; 95 percent confidence interval, 1.2 to 5.1) after adjustment by logistic-regression analysis for age, study site, and independent risk factors such as male sex, black race, chronic illness, low level of education, and living with young children who were in day care. There were dose–response relations for the current number of cigarettes smoked per day, pack-years of smoking, and time since quitting. The adjusted population attributable risk was 51 percent for cigarette smoking, 17 percent for passive smoking, and 14 percent for chronic illness.

Conclusions Cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease among immunocompetent, nonelderly adults. Because of the high prevalence of smoking and the large population attributable risk, programs to reduce both smoking and exposure to environmental tobacco smoke have the potential to reduce the incidence of pneumococcal disease.

Source Information

From the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (J.P.N., J.C.B., M.S.K., R.F.B.); Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta (M.M.F.); Johns Hopkins University School of Hygiene and Public Health, Baltimore (L.H.H.); and Mount Sinai Hospital, Toronto (A.M.).

Address reprint requests to Dr. Butler at the Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 4055 Tudor Centre Dr., Anchorage, AK 99508-5902, or at jcb3{at}cdc.gov.

Full Text of this Article

Related Letters:

Smoking and Pneumococcal Disease
Fleming C. A., Craven D. E., Nuorti J. P., Butler J. C., Breiman R. F.
Extract | Full Text  
N Engl J Med 2000; 343:219-220, Jul 20, 2000. Correspondence

This article has been cited by other articles:

• Kroening, P. R., Barnes, T. W., Pease, L., Limper, A., Kita, H., Vassallo, R. (2008). Cigarette Smoke-Induced Oxidative Stress Suppresses Generation of Dendritic Cell IL-12 and IL-23 through ERK-Dependent Pathways. J. Immunol. 181: 1536-1547 [Abstract] [Full Text]  
• Benfield, T., Lange, P., Vestbo, J. (2008). COPD Stage and Risk of Hospitalization for Infectious Disease. Chest 134: 46-53 [Abstract] [Full Text]  
• Almirall, J., Bolibar, I., Serra-Prat, M., Roig, J., Hospital, I., Carandell, E., Agusti, M., Ayuso, P., Estela, A., Torres, A., the Community-Acquired Pneumonia in Catalan Countr, (2008). New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J 31: 1274-1284 [Abstract] [Full Text]  
• Bliss, S. J., Larzalere-Hinton, F., Lacapa, R., Eagle, K. R., Frizzell, F., Parkinson, A., Reid, R., Craig, M., Santosham, M., O'Brien, K. L. (2008). Invasive Pneumococcal Disease Among White Mountain Apache Adults, 1991-2005. Arch Intern Med 168: 749-755 [Abstract] [Full Text]  
• Cardozo, D. M., Nascimento-Carvalho, C. M., Andrade, A.-L. S. S., Silvany-Neto, A. M., Daltro, C. H. C., Brandao, M.-A. S., Brandao, A. P., Brandileone, M.-C. C. (2008). Prevalence and risk factors for nasopharyngeal carriage of Streptococcus pneumoniae among adolescents. J Med Microbiol 57: 185-189 [Abstract] [Full Text]  
• Watt, J. P., O'Brien, K. L., Benin, A. L., McCoy, S. I., Donaldson, C. M., Reid, R., Schuchat, A., Zell, E. R., Hochman, M., Santosham, M., Whitney, C. G. (2007). Risk Factors for Invasive Pneumococcal Disease among Navajo Adults. Am J Epidemiol 166: 1080-1087 [Abstract] [Full Text]  
• Lyytikainen, O., Klemets, P., Ruutu, P., Kaijalainen, T., Rantala, M., Ollgren, J., Nuorti, J. P. (2007). Defining the Population-Based Burden of Nosocomial Pneumococcal Bacteremia. Arch Intern Med 167: 1635-1640 [Abstract] [Full Text]  
• Woodhead, M. (2007). Inhaled Corticosteroids Cause Pneumonia ...or Do They?. Am. J. Respir. Crit. Care Med. 176: 111-112 [Full Text]  
• Benowitz, N. L. (2007). Cigarette Smoking and the Personalization of Irinotecan Therapy. JCO 25: 2646-2647 [Full Text]  
• Diaz, A., Barria, P., Niederman, M., Restrepo, M. I., Dreyse, J., Fuentes, G., Couble, B., Saldias, F. (2007). Etiology of Community-Acquired Pneumonia in Hospitalized Patients in Chile: The Increasing Prevalence of Respiratory Viruses Among Classic Pathogens. Chest 131: 779-787 [Abstract] [Full Text]  
• Tonnesen, P., Carrozzi, L., Fagerstrom, K. O., Gratziou, C., Jimenez-Ruiz, C., Nardini, S., Viegi, G., Lazzaro, C., Campell, I. A., Dagli, E., West, R. (2007). Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy. Eur Respir J 29: 390-417 [Abstract] [Full Text]  
• Booy, R., Iskander, M., Viner, R., Senanayake, S. N., Gardner, P. (2007). Prevention of Meningococcal Disease. NEJM 356: 524-526 [Full Text]  
• Jaakkola, M. S., Jaakkola, J. J. K. (2006). Impact of smoke-free workplace legislation on exposures and health: possibilities for prevention.. Eur Respir J 28: 397-408 [Abstract] [Full Text]  
• de Roux, A., Cavalcanti, M., Marcos, M. A., Garcia, E., Ewig, S., Mensa, J., Torres, A. (2006). Impact of Alcohol Abuse in the Etiology and Severity of Community-Acquired Pneumonia. Chest 129: 1219-1225 [Abstract] [Full Text]  
• Kum-Nji, P., Meloy, L., Herrod, H. G. (2006). Environmental Tobacco Smoke Exposure: Prevalence and Mechanisms of Causation of Infections in Children. Pediatrics 117: 1745-1754 [Abstract] [Full Text]  
• Kyaw, M. H., Lynfield, R., Schaffner, W., Craig, A. S., Hadler, J., Reingold, A., Thomas, A. R., Harrison, L. H., Bennett, N. M., Farley, M. M., Facklam, R. R., Jorgensen, J. H., Besser, J., Zell, E. R., Schuchat, A., Whitney, C. G., Active Bacterial Core Surveillance of the Emerging, (2006). Effect of Introduction of the Pneumococcal Conjugate Vaccine on Drug-Resistant Streptococcus pneumoniae. NEJM 354: 1455-1463 [Abstract] [Full Text]  
• Coen, P. G, Tully, J., Stuart, J. M, Ashby, D., Viner, R. M, Booy, R. (2006). Is it exposure to cigarette smoke or to smokers which increases the risk of meningococcal disease in teenagers?. Int J Epidemiol 35: 330-336 [Abstract] [Full Text]  
• Tully, J., Viner, R. M, Coen, P. G, Stuart, J. M, Zambon, M., Peckham, C., Booth, C., Klein, N., Kaczmarski, E., Booy, R. (2006). Risk and protective factors for meningococcal disease in adolescents: matched cohort study. BMJ 332: 445-450 [Abstract] [Full Text]  
• Palmer, K. T., McNeill-Love, R., Poole, J. R., Coggon, D., Frew, A. J., Linaker, C. H., Shute, J. K. (2006). Inflammatory responses to the occupational inhalation of metal fume. Eur Respir J 27: 366-373 [Abstract] [Full Text]  
• Fry, A. M., Shay, D. K., Holman, R. C., Curns, A. T., Anderson, L. J. (2005). Trends in Hospitalizations for Pneumonia Among Persons Aged 65 Years or Older in the United States, 1988-2002. JAMA 294: 2712-2719 [Abstract] [Full Text]  
• File, T. M. Jr, Tan, J. S. (2005). Pneumonia in Older Adults: Reversing the Trend. JAMA 294: 2760-2763 [Full Text]  
• Woodhead, M., Blasi, F., Ewig, S., Huchon, G., Leven, M., Ortqvist, A., Schaberg, T., Torres, A., van der Heijden, G., Verheij, T. J. M. (2005). Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 26: 1138-1180 [Abstract] [Full Text]  
• Talbot, T. R., Hartert, T. V., Mitchel, E., Halasa, N. B., Arbogast, P. G., Poehling, K. A., Schaffner, W., Craig, A. S., Griffin, M. R. (2005). Asthma as a Risk Factor for Invasive Pneumococcal Disease. NEJM 352: 2082-2090 [Abstract] [Full Text]  
• Birtles, A., McCarthy, N., Sheppard, C. L., Rutter, H., Guiver, M., Haworth, E., George, R. C. (2005). Multilocus Sequence Typing Directly on DNA from Clinical Samples and a Cultured Isolate To Investigate Linked Fatal Pneumococcal Disease in Residents of a Shelter for Homeless Men. J. Clin. Microbiol. 43: 2004-2008 [Abstract] [Full Text]  
• Arcavi, L., Benowitz, N. L. (2004). Cigarette Smoking and Infection. Arch Intern Med 164: 2206-2216 [Abstract] [Full Text]  
• Flannery, B., Schrag, S., Bennett, N. M., Lynfield, R., Harrison, L. H., Reingold, A., Cieslak, P. R., Hadler, J., Farley, M. M., Facklam, R. R., Zell, E. R., Whitney, C. G. (2004). Impact of Childhood Vaccination on Racial Disparities in Invasive Streptococcus pneumoniae Infections. JAMA 291: 2197-2203 [Abstract] [Full Text]  
• Wernich Thomsen, R., Holmager Hundborg, H., Lervang, H.-H., Paaske Johnsen, S., Schonheyder, H. C., Toft Sorensen, H. (2004). Risk of Community-Acquired Pneumococcal Bacteremia in Patients With Diabetes: A population-based case-control study. Diabetes Care 27: 1143-1147 [Abstract] [Full Text]  
• O'Brien, K. L., Santosham, M. (2004). Potential Impact of Conjugate Pneumococcal Vaccines on Pediatric Pneumococcal Diseases. Am J Epidemiol 159: 634-644 [Abstract] [Full Text]  
• Elssner, A., Carter, J. E., Yunger, T. M., Wewers, M. D. (2004). HIV-1 Infection Does Not Impair Human Alveolar Macrophage Phagocytic Function Unless Combined With Cigarette Smoking. Chest 125: 1071-1076 [Abstract] [Full Text]  
• Klugman, K. P., Madhi, S. A., Huebner, R. E., Kohberger, R., Mbelle, N., Pierce, N., the Vaccine Trialists Group, (2003). A Trial of a 9-Valent Pneumococcal Conjugate Vaccine in Children with and Those without HIV Infection. NEJM 349: 1341-1348 [Abstract] [Full Text]  
• Reefhuis, J., Honein, M. A., Whitney, C. G., Chamany, S., Mann, E. A., Biernath, K. R., Broder, K., Manning, S., Avashia, S., Victor, M., Costa, P., Devine, O., Graham, A., Boyle, C. (2003). Risk of Bacterial Meningitis in Children with Cochlear Implants. NEJM 349: 435-445 [Abstract] [Full Text]  
• Wernette, C. M., Frasch, C. E., Madore, D., Carlone, G., Goldblatt, D., Plikaytis, B., Benjamin, W., Quataert, S. A., Hildreth, S., Sikkema, D. J., Kayhty, H., Jonsdottir, I., Nahm, M. H. (2003). Enzyme-Linked Immunosorbent Assay for Quantitation of Human Antibodies to Pneumococcal Polysaccharides. CVI 10: 514-519 [Full Text]  
• Sisk, J. E., Whang, W., Butler, J. C., Sneller, V.-P., Whitney, C. G. (2003). Cost-Effectiveness of Vaccination against Invasive Pneumococcal Disease among People 50 through 64 Years of Age: Role of Comorbid Conditions and Race. ANN INTERN MED 138: 960-968 [Abstract] [Full Text]  
• Gardner, P. (2003). A Need To Update and Revise the Pneumococcal Vaccine Recommendations for Adults. ANN INTERN MED 138: 999-1000 [Full Text]  
• Yamaguchi, H., Friedman, H., Yamamoto, Y. (2003). Involvement of Nicotinic Acetylcholine Receptors in Controlling Chlamydiapneumoniae Growth in Epithelial HEp-2 Cells. Infect. Immun. 71: 3645-3647 [Abstract] [Full Text]  
• Whitney, C. G., Farley, M. M., Hadler, J., Harrison, L. H., Bennett, N. M., Lynfield, R., Reingold, A., Cieslak, P. R., Pilishvili, T., Jackson, D., Facklam, R. R., Jorgensen, J. H., Schuchat, A., the Active Bacterial Core Surveillance of the Emer, (2003). Decline in Invasive Pneumococcal Disease after the Introduction of Protein-Polysaccharide Conjugate Vaccine. NEJM 348: 1737-1746 [Abstract] [Full Text]  
• Simoni, M., Jaakkola, M.S., Carrozzi, L., Baldacci, S., Di Pede, F., Viegi, G. (2003). Indoor air pollution and respiratory health in the elderly. Eur Respir J 21: 15S-20s [Abstract] [Full Text]  
• Artz, A. S., Ershler, W. B., Longo, D. L. (2003). Pneumococcal Vaccination and Revaccination of Older Adults. Clin. Microbiol. Rev. 16: 308-318 [Abstract] [Full Text]  
• Gordon, S B, Read, R C (2002). Macrophage defences against respiratory tract infections: The immunology of childhood respiratory infections. Br Med Bull 61: 45-61 [Abstract] [Full Text]  
• Jaakkola, M.S. (2002). Environmental tobacco smoke and health in the elderly. Eur Respir J 19: 172-181 [Abstract] [Full Text]  
• Matsunaga, K., Klein, T. W., Friedman, H., Yamamoto, Y. (2001). Involvement of Nicotinic Acetylcholine Receptors in Suppression of Antimicrobial Activity and Cytokine Responses of Alveolar Macrophages to Legionella pneumophila Infection by Nicotine. J. Immunol. 167: 6518-6524 [Abstract] [Full Text]  
• Lim, W S, Macfarlane, J T, Colthorpe, C L (2001). Respiratory diseases in pregnancy {bullet} 2: Pneumonia and pregnancy. Thorax 56: 398-405 [Full Text]  
• HUTCHINSON, D, MOOTS, R, HELIÖVAARA, M, AHO, K, KNEKT, P, REUNANEN, A, AROMAA, A, IMPIVAARA, O (2001). Coffee consumption, RF, and the risk of RA. Ann Rheum Dis 60: 540a-541 [Full Text]  
• Robinson, K. A., Baughman, W., Rothrock, G., Barrett, N. L., Pass, M., Lexau, C., Damaske, B., Stefonek, K., Barnes, B., Patterson, J., Zell, E. R., Schuchat, A., Whitney, C. G., for the Active Bacterial Core Surveillance /Emergi, (2001). Epidemiology of Invasive Streptococcus pneumoniae Infections in the United States, 1995-1998: Opportunities for Prevention in the Conjugate Vaccine Era. JAMA 285: 1729-1735 [Abstract] [Full Text]  
• Nelson, E. (2001). The miseries of passive smoiong. Hum Exp Toxicol 20: 61-83 [Abstract]  
• Breiman, R. F., Keller, D. W., Phelan, M. A., Sniadack, D. H., Stephens, D. S., Rimland, D., Farley, M. M., Schuchat, A., Reingold, A. L. (2000). Evaluation of Effectiveness of the 23-Valent Pneumococcal Capsular Polysaccharide Vaccine for HIV-Infected Patients. Arch Intern Med 160: 2633-2638 [Abstract] [Full Text]  
• Fleming, C. A., Craven, D. E., Nuorti, J. P., Butler, J. C., Breiman, R. F. (2000). Smoking and Pneumococcal Disease. NEJM 343: 219-220 [Full Text]  
• (2000). Smoking Increases Risk for Pneumococcal Infections. JWatch Infect. Diseases 2000: 10-10 [Full Text]  
• (2000). Smoking and Invasive Pneumococcal Disease. JWatch General 2000: 3-3 [Full Text]  
• Sheffield, J. V.L., Root, R. K. (2000). Smoking and Pneumococcal Infection. NEJM 342: 732-734 [Full Text]