10 November 2016
Cases of Invasive meningococcal disease have decreased drastically in both Europe and the U.S over the last decade. In the last year however, several outbreaks of the disease have been reported, of which many cases were in men who have sex with men (MSM). Despite being rare, these outbreaks cause particular alarm as they can be difficult to control and the consequences can be fatal.
The latest outbreak occurred this summer in Los Angeles, USA. According to the Californian Department of Public Health (CDPH), there have been 27 cases of Invasive meningococcal disease in Southern California since March this year. Most of these cases occurred in gay or bisexual men1.
Invasive meningococcal disease is a rare disease (only accounting for 2% of cases of meningococcal disease2) that causes mild fever, and septicaemia and/or meningitis, which could lead to multi-organ failure and potentially death within hours. There are five major serogroups of Neisseria meningitidis, the bacteria that causes meningococcal disease: A, B, C, W and Y; however, the only serogroup associated with the MSM cases has been serogroup C.
Prolonged direct contact with people infected with the disease leads to the transmission of this bacteria. In particular, smoking, close cohabiting, bar patronage and kissing have been identified as high-risk activities. Furthermore, the risk of contracting meningococcal disease increases considerably with age and HIV infection. In fact, HIV-infected individuals’ risk is increased 10-20 fold compared to people of their age who aren’t infected1. While reduced immunity due to HIV infection explains the increased risk for HIV positive individuals, there is no medical answer as to why meningitis might spread more among gay or bisexual men who are HIV negative. An investigation into the connection was launched earlier in the year by the U.S. Centers for Disease Control and Prevention and the New York City Department of Public Health.
The best response to these outbreaks has been the extension of vaccine recommendations to include all members of the MSM community, especially those who are HIV positive. Raising awareness through physician discussion, advertisements on social networking phone apps and websites used by MSM have been suggested as effective ways to reach the population at risk. If you notice any of the symptoms of meningitis, contact your nearest healthcare professional immediately.
References
1 Karlamangla, S: 2016 ‘Meningitis outbreaks among gay men have experts puzzled’ Los Angeles Times, http://www.latimes.com/local/lanow/la-me-ln-meningitis-men-20160729-snap-story.html, accessed 18th Oct 2016.
2 Simon, M. S., Weiss, D., & Gulick, R. M. (2013). Invasive Meningococcal Disease in Men Who Have Sex With Men. Annals of Internal Medicine, 159(4), 300–301. http://doi.org/10.7326/0003-4819-159-4-201308200-00674
Lucy is the Events and Communications Intern at CoMO. She is a graduate from the University of Liverpool, where she studied French and Hispanic Studies. Lucy has experience working for a range of organisations in the charity sector both in the UK and overseas.