MSM and HIV+ Individuals Urged to Get Vaccinated for Meningitis in Southern California

Men who have sex with men (MSM) and those who are HIV-positive in Southern California have been urged to get vaccinated for meningitis after an outbreak of the rare bacterial infection there.

Since May, there have been nine confirmed cases, with one fatality, in Los Angeles, Long Beach, and Orange counties. According to the California Department of Public Health (CDPH), most of those infected have been gay and/or bisexual men.

“Gay and bisexual men may be at increased risk of meningococcal disease if they have close or intimate contact with multiple partners, regularly visit crowded venues such as bars and parties, or smoke cigarettes, marijuana or illegal drugs,” the advisory from the CDPH reads. “State health officials urge all HIV-infected persons and gay and bisexual men who may be at increased risk for meningococcal disease to consider receiving [the vaccine].”

The Centers for Disease Control and Prevention (CDC) describes outbreaks of meningitis in the country as “rare.” However, the situation in California is one of two known ongoing outbreaks domestically. The other, at the Rutgers University campus in News Brunswick, NJ, involves two reported cases of serogroup B meningococcal disease, also known as meningitis B. The cases in California have been linked with serogroup C meningococcal disease.

Overall, the CDC reports, incidence of meningococcal disease in the United States has declined significantly since the 1990s, with fewer than 550 cases reported in 2013, the last year for which data are available. In 2014, 426 cases of meningococcal disease were reported to the National Notifiable Disease Surveillance System. The CDC defines an outbreak as “multiple cases of the same serogroup in a community or institution over a short period of time.” As few as two cases of the same serogroup can constitute an outbreak, depending on the size of the institution/community involved.

Although the symptoms of serogroups B and C are similar, and both are considered vaccine-preventable, the vaccines used to protect against them vary. CDPH officials have advised at-risk men to receive two doses of MenACWY (Menactra, Sanofi; Menveo, Novartis), a conjugate vaccine against serogroups A, C, W, and Y.

“All HIV-infected adults should receive two doses of MenACWY,” the CDPH advisory states. “Gay and bisexual men who are at increased risk for meningococcal disease and are not HIV-infected should receive one dose of MenACWY vaccine. Those who have not been tested for HIV within the last year should be offered an HIV test along with vaccination.”

Several groups offering support services to the LGBTQ community as well as those who have HIV/AIDS in Southern California have begun offering free vaccination programs in response to the CDPH advisory.

Conversely, officials in New Jersey, where MenACWY vaccination is required of all students living in college and university residence halls, have advised students at Rutgers to undergo the three-dose regimen of MenB (Trumenba, Pfizer). Students are required to present proof of vaccination prior to the start of the Fall 2016 semester.

The CDC notes that “neither of these vaccines will prevent all cases and each vaccine may perform better against some strains than others.” The agency adds, “[T]here is a limited understanding of how well laboratory test results correspond to the actual effectiveness of each vaccine against any particular strain. Until these vaccines are used more broadly in response to outbreaks, actual effectiveness against specific strains remains unknown.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.