4.12 Secondhand smoke and increased risk of infectious disease

Exposure to secondhand smoke has been shown to increase susceptibility to, and to worsen, respiratory infection in adults and children. Probable mechanisms include inflammation of the airways, increased permeability of the protective mucosal layer in the airways, impairment of mucociliary clearance, and reduced immune function.1,2

A 2010 systematic review found that, among children aged one to 19 years, exposure to secondhand smoke doubled the risk of invasive meningococcal disease. Exposed children were also more likely to carry the bacteria responsible for meningococcal disease, N. meningitidis.2 Invasive meningococcal disease is an important cause of illness and death in children and young adults in Australia. Meningococcal disease occurs most commonly in individuals aged under 25, with peaks of incidence in those aged four and under and in young adults aged between 15 and 24.3 In 2009, there were 259 notified cases of meningococcal disease. About 10% of those infected die.3 Research conducted in Australia4,5 has also shown that exposure to secondhand smoke is a risk factor for both children and young adults in contracting invasive meningococcal disease. Persons living with smokers have a greater chance of exposure to meningococci, because smokers are more likely to carry the bacteria. Another possible mechanism is that viral infections are more common in smokers, and a preceding viral infection can act as a cofactor for meningococcal disease.6

Evidence suggests that exposure to secondhand smoke is associated with the development of tuberculosis disease in both children and adults.7,8 More research is needed.

Infections in young children, including otitis media (middle ear disease) and respiratory tract infections, including bronchitis, bronchiolitis and pneumonia, are discussed in Section 4.9.

Recent news and research

For recent news items and research on this topic, click here (Last updated October 2016)    


1. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm

2. Lee C, Middaugh N, Howie S and Ezzati M. Association of secondhand smoke exposure with pediatric invasive bacterial disease and bacterial carriage: a systematic review and meta-analysis. PLoS Medicine 2010;7(12):e1000374. Available from: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000374

3. Australian Institute of Health and Welfare. Australia's health 2010. Canberra: AIHW, 2010. Available from: http://www.aihw.gov.au/publications/index.cfm/title/11374

4. McCall B, Neill A and Young M. Risk factors for invasive meningococcal disease in southern Queensland, 2000–2001. Internal Medicine Journal 2004;34(8):464–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15317544

5. Robinson P, Taylor K and Nolan T. Risk-factors for meningococcal disease in Victoria, Australia, in 1997. Epidemiology and Infection 2001;127(2):261–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11693503

6. Arcavi L and Benowitz NL. Cigarette smoking and infection. Archives of Internal Medicine 2004;164(20):2206–16. Available from: http://www.ncbi.nlm.nih.gov/entrez/pubmed/15534156

7. Slama K, Chiang CY, Enarson DA, Hassmiller K, Fanning A, Gupta P, et al. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. International Journal of Tuberculosis and Lung Disease 2007;11(10):1049–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17945060

8. Leung C, Lam T, Ho K, Yew W, Tam C, Chan W, et al. Passive smoking and tuberculosis. Archives of Internal Medicine 2010;170(3):287–92. Available from: http://archinte.ama-assn.org/cgi/content/full/170/3/287

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