Abstract
Invasive meningococcal disease can cause rapid death or disability in unsuspecting healthy students residing in residential colleges. Carriage of Neisseria meningitidis is a precursor to the disease. While Neisseria meningitidis is present in an estimated 15% of the adult population, overseas studies have shown carriage is usually far higher among residential tertiary college students. This comprehensive study of meningococcal carriage and risk factors for carriage provides contemporary data relevant to students residing in residential colleges in New Zealand. Several meningococcal vaccines offer protection against invasive meningococcal disease; however, a variety of factors affect uptake of vaccinations by students residing in residential colleges. Uptake of vaccines has become an issue public interest in the context of the COVID-19 pandemic, yet there is little international literature on factors effecting vaccine uptake among students residing in residential colleges.
Following several cases of invasive meningococcal disease in University of Otago residential colleges in Dunedin in 2018, a meningococcal pharyngeal carriage and risk factor study among first year students residing in residential colleges was undertaken. This thesis reports on the 2018 carriage study and uses multivariable analysis to determine independent risk factors for carriage. Whole genome sequencing was performed on all meningococcal isolates from the carriage survey and this data are used to inform discussion on transmission pathways.
The thesis then reports on two subsequent surveys in 2019 and 2020 that examined factors that impact on the uptake of vaccinations among students residing in residential colleges. While these surveys focused on meningococcal vaccinations, the 2020 survey took place during the emerging COVID-19 pandemic and included factors that influence students’ decisions to receive a COVID-19 vaccination. Both studies utilise data from the National Immunisation Register (NIR) and Student Health records to validate self-reported vaccination status.
The work presented in this thesis and subsequent publications will help to inform public heath responses to invasive meningococcal disease cases in residential college settings, inform preventative strategies such as funding for meningococcal vaccinations, and assist development of targeted health promotion strategies to raise vaccination uptake among students residing in residential colleges.