Officials at the New York City Department of Health and Mental Hygiene (NYC DOHMH) are urging men who have sex with men (MSM) to be vaccinated against meningitis, especially if they plan on participating in the city's Gay Pride events, say the authors of an article published online June 17 in the Annals of Internal Medicine.
Outbreaks of invasive meningococcal disease (IMD) among MSM are occurring in NYC and Los Angeles, California, lead author Matthew S. Simon, MD, from the Department of Public Health, Weill Cornell Medical College, New York City, and coauthors write. The situation in NYC is particularly urgent, as up to a million people are expected to gather there to celebrate Gay Pride Week, which begins June 28.
The NYC DOHMH has been aggressively promoting vaccination since October 2012. Health departments in other cities, including Toronto, Ontario, Canada, and San Francisco, California, also are recommending that gay men traveling to New York be vaccinated.
Overall, IMD in the United States is at an all-time low, with an incidence of 0.3 to 0.6 cases per 100,000 persons. However, since August 2010, 22 cases of IMD in MSM have been reported to the NYC DOHMH, putting the incidence of IMD among MSM at 50-fold greater than in the general population. Half these patients were black, and 55% were infected with HIV. They had a mean age of 34 years. Seven of those patients died. In Los Angeles, 4 cases of IMD have been reported in MSM since December 2012.
Thanks to the NYC DOHMH vaccination campaign, more than 11,000 people have been vaccinated, and no new cases of IMD have been reported since February 2013. Some community-based organizations in Los Angeles are now trying a similar approach. "However, vaccine coverage may be suboptimal because of challenges in reaching the populations most at risk, particularly African American MSM who may not self-identify as gay or be engaged in medical care," the authors write.
Primary care providers face multiple delivery barriers, including high procurement costs, limited reimbursement, and inconsistent insurance requirements. This experience "highlights the logistic challenges in effectively implementing new vaccine recommendations for adults."
"Risk factors for acquiring Neisseria meningitidis include smoking, close living quarters, bar patronage, and kissing," the authors write. "Death within 24 hours of onset of symptoms is common, and the case-fatality ratio for IMD in the United States is 10% to 15% and is 3-fold greater in outbreaks."
Recent epidemiologic studies of MSM have revealed rates of N meningitidis carriage as high as 43%, with rectal and urethral colonization rates of 2% and 1%, respectively, although the reason why the illness is concentrated among gay men remains unclear. Also unclear is whether HIV infection is a risk factor, although the authors point out that people with HIV have an increased susceptibility toPneumococcus, which, similar to N meningitidis, is an encapsulated bacterium.
"Providers should be aware of the recent meningococcal cases in NYC and Los Angeles, assess their patients' risk, and discuss the outbreak with their MSM patients," the authors conclude. "Suspected meningococcal cases should be reported promptly to local health departments, where patients should have an epidemiologic investigation that accounts for sexual history and determines HIV status."
The authors have disclosed no relevant financial relationships.
Ann Intern Med. Published online June 17, 2013. Abstract
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