Notes from the Field: Meningococcal Disease Among Men Who Have Sex with Men — United States, January 2012–June 2015

Hajime Kamiya, MD, PhD1; Jessica MacNeil, MPH2; Amy Blain, MPH2; Manisha Patel, MD2; Stacey Martin, MS2; Don Weiss, MD3; Stephanie Ngai, MPH3; Ifeoma Ezeoke, MPH3; Laurene Mascola, MD4; Rachel Civen, MD4; Van Ngo, MPH4; Stephanie Black, MD5; Sarah Kemble, MD5; Rashmi Chugh, MD6; Elizabeth Murphy, MPH6; Colette Petit6; Kathleen Harriman, PhD7; Kathleen Winter, MPH7; Andrew Beron, MPH8; Whitney Clegg, MD8; Craig Conover MD8; Lara Misegades, PhD2

Since 2012, three clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States. During 2012, 13 cases of meningococcal disease among MSM were reported by the New York City Department of Health and Mental Hygiene (1); over a 5-month period during 2012–2013, the Los Angeles County Department of Public Health reported four cases among MSM; and during May–June 2015, the Chicago Department of Public Health reported seven cases of meningococcal disease among MSM in the greater Chicago area. MSM have not previously been considered at increased risk for meningococcal disease. Determining outbreak thresholds* for special populations of unknown size (such as MSM) can be difficult. The New York City health department declared an outbreak based on an estimated increased risk for meningococcal infection in 2012 among MSM and human immunodeficiency virus (HIV)–infected MSM compared with city residents who were not MSM or for whom MSM status was unknown (1). The Chicago Department of Public Health also declared an outbreak based on an increase in case counts and thresholds calculated using population estimates of MSM and HIV-infected MSM. Local public health response included increasing awareness among MSM, conducting contact tracing and providing chemoprophylaxis to close contacts, and offering vaccination to the population at risk (1–3). To better understand the epidemiology and burden of meningococcal disease in MSM populations in the United States and to inform recommendations, CDC analyzed data from a retrospective review of reported cases from January 2012 through June 2015.

In May 2013 and again in August 2015, CDC requested that health departments review all cases of probable or confirmed meningococcal disease caused by any serogroup and reported among males during January 2012–June 2015 to the National Notifiable Disease Surveillance System and, if possible, determine MSM status. The requests were made through Epi-X, a secure communications network for public health officials, and follow-up with each state health department occurred through individual e-mail correspondence. All 50 state health departments and the health departments of New York City, Los Angeles County, Chicago, and the District of Columbia responded to CDC's request for information. Analysis of the data was restricted to cases occurring among MSM aged 18–64 years.

During the case review period, 527 meningococcal disease cases among males aged 18–64 years were reported. Although MSM status is not routinely collected as part of national meningococcal case reporting and might be underreported, 74 cases were identified among MSM: 23 from New York City, 14 from Los Angeles County, 11 from Chicago, and 26 sporadic cases occurring in states or geographic areas where fewer than three cases of the same meningococcal serogroup were reported among MSM during a 3-month period (4) (Table). MSM status could not be verified for the other 453 meningococcal disease cases among men aged 18–64 years using available data, nor could CDC distinguish between health departments reporting zero cases in MSM and those that had no data on MSM status.

Among the 74 reported cases among MSM aged 18–64 years, the median age was 31 years (range = 20–59 years). Thirty-seven (52%) of 71 patients with known race were white, 29 (41%) were black, two (3%) were Asian, and three (4%) were other race. Neisseria meningitidis serogroup C accounted for 62 (84%) cases; serogroups B, W, and Y accounted for five, two, and three cases, respectively; and the serogroup for two patients was unknown. Overall, 24 (32%) cases were fatal, including six of the New York City cases (26%), five (36%) of the Los Angeles County cases, three (27%) of the Chicago cases, and 10 (38%) of the sporadic cases. Among 63 patients for whom HIV status was reported, 37 (59%) were HIV-positive; among these, 11 (30%) died. Meningococcal vaccination status was known for 41 patients; among these, six (15%) were vaccinated with a quadrivalent meningococcal vaccine. Five of the six vaccinated patients had serogroup C meningococcal disease, and two of the five died. Further analysis of meningococcal disease rates, risk factors, and pulsed-field gel electrophoresis data from all cases identified among MSM is ongoing.

Information on MSM and HIV status of men reported with meningococcal disease is not currently noted on most meningococcal case report forms. However, representative and complete data on MSM and HIV status are needed to better understand the epidemiology of and potential risk factors for meningococcal disease among MSM in the United States and to inform prevention and control recommendations.

Health departments are encouraged to attempt to determine MSM and HIV status during investigations of meningococcal disease cases caused by any serogroup occurring among males aged ≥16 years. If permitted by state law, state health departments are asked to complete a supplemental case report form (available at http://www.cdc.gov/meningococcal/surveillance/index.html) for all cases of meningococcal disease occurring among MSM and submit the forms to CDC via e-mail (meningnet@cdc.gov) or via fax (404-315-4681).

Acknowledgments

Local and state health departments that have contributed to meningococcal surveillance among MSM.

1Epidemic Intelligence Service, CDC; 2Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3New York City Department of Health and Mental Hygiene; 4Los Angeles County Department of Public Health; 5Chicago Department of Health; 6DuPage County Health Department, Wheaton, Illinois; 7California Department of Health; 8Illinois Department of Public Health.

Corresponding author: Jessica MacNeil, jmacneil@cdc.gov.

References

1. Kratz MM, Weiss D, Ridpath A, et al. Community-based outbreak of Neisseria meningitidis serogroup C infection in men who have sex with men, New York City, New York, USA, 2010–2013. Emerg Infect Dis 2015;21:1379–86.
2. Civen R, Nelson El Amin A, Ngo V. Los Angeles County Department of Public Health. Preventing invasive meningococcal disease: routine and special vaccination recommendations. Rx for Prevention 2015;6(1).
3. Chicago Department of Public Health. Health alert: invasive meningococcal disease in men who have sex with men. Chicago, IL: Chicago Department of Public Health; 2015. Available at https://www.chicagohan.org/c/document_library/get_file?p_l_id=18130&folderId=93622&name=DLFE-677.pdf.
4. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No. RR-2).