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Notes from the Field: Serogroup C Invasive Meningococcal Disease Among Men Who Have Sex With Men — New York City, 2010–2012
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.
Don Weiss, MD, Mike Antwi, MPH, Paula Del Rosso, Marie Dorsinville, MPH, Lillian Lee, MS, Ying Lin, PhD, John Kornblum, PhD, Jay K. Varma, MD, New York City Dept of Health and Mental Hygiene. Alison Ridpath, MD, EIS Officer, CDC. Corresponding contributor: Alison Ridpath, firstname.lastname@example.org, 347-396-2669.
- CDC. Meningococcal disease (Neisseria meningitidis). In: 2012 nationally notifiable diseases and conditions and current case definitions. Atlanta, GA: US Department of Health and Human Services, CDC; 2012:70. Available at http://wwwn.cdc.gov/nndss/document/2012_case%20definitions.pdf. Accessed December 20, 2012.
- New York City Dept of Health and Mental Hygiene. Community Health Survey. New York, NY: New York City Dept of Health and Mental Hygiene; 2012. Available at http://www.nyc.gov/html/doh/html/survey/chs-methods.shtml. Accessed December 21, 2012.
- Popovic T, Schmink S, Rosenstein NA, et al. Evaluation of pulsed-field gel electrophoresis in epidemiological investigations of meningococcal disease outbreaks caused by Neisseria meningitidis serogroup C. J Clin Microbiol 2001;39:75–85.
- Weiss D, Stern E, Zimmerman C, et al. Epidemiologic investigation and targeted vaccination initiative in response to an outbreak of meningococcal disease among illicit drug users in Brooklyn, New York. Clin Infect Dis 2009;48:894–901.
- CDC. Meningococcal disease. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/meningococcal. Accessed December 20, 2012.
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