Meningitis Cases in New York City
Health department is recommending vaccination for certain men at high risk for meningitis. For the latest information, visit the New York City Department of Health and Mental Hygiene. Photo Credit CDC Meningococcal Disease
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Last October, in NYC: The Other Meningitis Outbreak, I wrote about an ongoing outbreak of bacterial meningitis that had been reported in New York City among certain HIV positive men who had sex with other men (MSM).
Six weeks later, after two more infections had come to light, the New York City Health Department issued a statement recommending that certain MSM – regardless of their HIV status - get the meningitis vaccine.
Health Department Expands Vaccination
Recommendations for Men at Greatest Risk for Contracting Meningitis
Two new cases of meningitis among men who have sex with men were reported over the past five weeks
November 29, 2012 – The Health Department issued new recommendations today for vaccinating against invasive meningococcal disease – commonly known as meningitis – after an increase in cases. Vaccinations are now advised for men, regardless of HIV status, who have had intimate contact with another man that he met through a website, digital application (“App”), or at a bar or party since September 1, 2012 AND live in the following neighborhoods: Bedford-Stuyvesant, Brownsville, Bushwick, Clinton Hill, Crown Heights, Downtown Brooklyn, Dumbo, East New York, Prospect Heights and Williamsburg.
Vaccination can help prevent infection, but does not treat an active infection. A person can be a carrier, and transmit the infection, without falling ill themselves (cite).
Treatment is with antibiotics and steroids, but even with treatment, 10%-15% of patients may die. Severe neurological sequelae may occur as well.
Which brings us to a Notes From The Field report in the most recent MMWR.
Notes from the Field: Serogroup C Invasive Meningococcal Disease Among Men Who Have Sex With Men — New York City, 2010–2012
Weekly
January 4, 2013 / 61(51);1048-1048
On September 27, 2012, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) alerted health-care providers and the public about 12 cases of invasive serogroup C Neisseria meningitidis disease (SCMD) occurring in NYC since August 2010 among men who have sex with men (MSM). Cases were identified through existing mandatory notifiable disease reporting and classified according to the Council of State and Territorial Epidemiologists case definitions (1). By December 31, 2012, a total of 18 cases had been identified among MSM. For 2012, the incidence rate of invasive meningococcal disease among MSM aged 18–64 years was 12.6 per 100,000 persons, compared with 0.16 among non-MSM males aged 18–64 years. MSM and non-MSM population denominators were obtained from the 2010 NYC Community Health Survey (2) a telephone-based survey of approximately 10,000 NYC residents.
All 18 patients were hospitalized, and five deaths occurred. The age range among patients was 21–59 years (median: 32 years). Nine lived in Brooklyn, four in Manhattan, two in the Bronx, and two in Queens; one was homeless. Nine were black, and four were Hispanic. Ten were infected with human immunodeficiency virus (HIV), including eight of 12 cases reported during 2012. Eleven of 12 isolates were closely related (>85%) by pulsed field gel electrophoresis (3) to a strain from a 2006 SCMD outbreak in Brooklyn (4); the last six out of seven patients' isolates were indistinguishable from each other. At least seven patients had met multiple sexual partners online.
On October 4, 2012, DOHMH recommended administration of meningococcal vaccine to HIV-infected male NYC residents who had intimate contact with any man met online, through a smartphone application, or at a bar or party since September 1, 2012. On November 29, DOHMH expanded its recommendation to HIV-uninfected men with the same high-risk behaviors who reside in areas of Brooklyn where recent cases have clustered. In addition, DOHMH publicized this outbreak among the population at risk through advertising, mass e-mail messages on MSM websites, posters distributed at MSM bars and clubs, and outreach to community leaders and physician's groups.
More information regarding invasive meningococcal disease and this outbreak is available on the CDC and DOHMH websites (5). Public health departments should be alert for cases of SCMD in MSM and should ask SCMD patients about sexual history, travel history (including travel to NYC), and HIV status to help determine if this outbreak is spreading to other juridictions.
For more information, the CDC maintains an extensive website on Meningococcal Disease.
