**Cigarette smoke increases risk of deadly infections**

NEW YORK -- If you're a smoker -- or even exposed to
secondhand smoke -- you are at greater risk for
serious infections with pneumococcal bacteria, which
include meningitis, pneumonia, or blood stream
infections.

"Smokers account for approximately half of otherwise
healthy adult patients with invasive pneumococcal
disease," report Dr. J. Pekka Nuorti, of the Centers
for Disease Control and Prevention (CDC) in Atlanta,
Georgia, and associates. In a study of 228 patients
aged 18 to 64 who had blood infections or meningitis
caused by pneumococci, 58% were current smokers,
according to the report in the March 9th issue of The
New England Journal of Medicine. In comparison, only
24% of 301 healthy "control" subjects were current
smokers.

When other risk factors for such infections were taken
into account -- such as household crowding, lack of
health insurance, low annual household income, high
alcohol consumption, and asthma -- people with
infections were still four times as likely to be
smokers. Nonsmokers with such infections were more
than twice as likely as healthy people to be exposed
to secondhand smoke.

According to a model developed by the authors,
cigarette smoking accounted for just over half the
risk for invasive pneumococcal disease, compared with
17% for passive smoking, 14% for chronic illness, 57%
for smoking and chronic illness combined, and 11% for
living with young children who were in day care.

Increased smoking brought an even higher risk of
pneumococcal infection, the results indicate. As
smoking rose from 1 to 14 cigarettes per day to more
than 25 cigarettes per day, the odds of invasive
infection increased from 2.3 times to 5.5 times.
Similarly, the longer patients smoked, the higher
their risk of getting a serious infection.

For ex-smokers, the risk of pneumococcal disease
gradually declined, to the point that their risk was
similar to nonsmokers approximately 13 years after
they quit, the researchers indicate.

"Our study documents yet another example of an adverse
health effect linked to active and passive smoking,"
Nuorti and colleagues conclude. "Reducing the (rate)
of cigarette smoking to 15% could reduce the incidence
of invasive pneumococcal disease among nonelderly
adults by approximately 18%, preventing approximately
4,000 cases in the United States annually."

"This strong association with smoking may have
implications for extending the indications for the
pneumococcal vaccine," write Drs. John Sheffield and
Richard Root from Harborview Medical Center in
Seattle, Washington, in a related editorial. People
over 65 or those with chronic health conditions can be
vaccinated against streptococcus pneumoniae, according
to the CDC.

But even more important is for smokers to quit.
"Patients looking for additional motivation now have
another reason to stop smoking," Sheffield and Root
conclude.

SOURCE: The New England Journal of Medicine
2000;342:681-689, 732-734.
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