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Bacterial Meningitis Outbreak among HIV Positive Gay Men in New York

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New York City's Department of Health and Mental Hygiene (DHMH) last week announced that it is investigating a cluster of cases of invasive meningococcal disease over the past 2 years involving 12 men who have sex with men, a majority with HIV, of whom 4 have died.

Meningococcal meningitis is characterized by inflammation of the membranes surrounding the brain and spinal cord. The New York outbreak has recently accelerated, health officials conclude, given that 4 of these 12 cases were identified during the last month, resulting in 1 death. All 4 recent infections and half of the earlier ones were in people with HIV. 5 men reported using cocaine or crystal methamphetamine. All but 1 were infected with serogroup C Neisseria meningitides.

Gay/bisexual men and their clinicians are urged to be on the lookout for meningitis symptoms. "Patients with meningococcal disease characteristically present with fever, headache, stiff neck, petechial [small red spots] rash, sepsis, and/or altered mental status," according to a DHMH alert. "Early in the course, an abnormality in pulse, blood pressure or respiratory rate out of proportion to the physical examination may be the only indication of a serious infection."

People exposed to affected individuals should receive prophylactic antibiotics. "Timely antibiotic prophylaxis reduces the risk of secondary transmission among close contacts, but must be administered as soon as possible and within 10 days of the last exposure," according to the health department. People who should receive prophylaxis include household members, child-care center contacts, and "anyone directly exposed to the patient's respiratory or oral secretions."

Below is an edited excerpt from a DHMH press release describing the cases and recommended precautions.

Health Department Investigating Invasive Meningococcal Disease Cases Among Gay Men and Men Who Have Sex with Men

Four cases of invasive meningococcal disease diagnosed in past four weeks; men experiencing high fever, headache, stiff neck and rash are advised to immediately contact their health care providers

September 27, 2012 -- The Health Department is currently investigating a cluster of invasive meningococcal disease, commonly known as meningitis, among gay men and men who have sex with men. Invasive meningococcal disease is a severe bacterial infection that has a high fatality rate. Within the past four weeks, there have been four cases; one died and one person is in critical care.

The cases are spread across several boroughs and among men ages 31 to 42 years old. The most recent four cases have all been among HIV infected men. People living with HIV are at a greater risk than the general population of acquiring invasive meningococcal disease and if infected, dying from infection. This disease is spread by prolonged close contact with nose or throat discharges from an infected person. Examples of prolonged contact include living in the same household or intimate activities, including kissing and sexual contact.

Common symptoms of meningitis are high fever, headache, stiff neck and rash that develop rapidly within 2 days. People that have been in prolonged close contact with infected people need to see their health care provider immediately to receive preventive antibiotics. Symptoms may occur 2 to 10 days after exposure, but usually within 5 days. People who experience symptoms should seek medical care immediately. 

Resources

Frequently Asked Questions on Invasive Meningococcal Disease

Invasive Meningococcal Disease in Men Who Have Sex with Men -- DHMH alert, includes prophylaxis recommendations.

CDC information about N. meningitidis infection.

10/2/12

Sources

New York City Department of Health and Mental Hygiene. Health Department Investigating Invasive Meningococcal Disease Cases Among Gay Men and Men Who Have Sex with Men. Press release. September 27, 2012.

New York City Department of Health and Mental HygieneHealth Department Invasive Meningococcal Disease in Men Who Have Sex with Men. 2012 Alert #27. September 27, 2012.