Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 8—August 2015
CME ACTIVITY - Research
Community-Based Outbreak of Neisseria meningitidis Serogroup C Infection in Men who Have Sex with Men, New York City, New York, USA, 2010−2013
Invasive meningococcal disease (IMD) is a severe infection of the bloodstream and meninges caused by the bacterium Neisseria meningitidis. Although most infected persons recover, 10%–15% of cases are fatal, often within 24 hours of symptom onset. An additional 11%−19% survive with serious neurologic or other complications (1). N. meningitidis colonizes the nasopharynx and is transmitted through close or prolonged contact. Functional asplenia, complement deficiency, and infection with HIV increase sporadic IMD risk, and living in close quarters, smoking, attending bars, and kissing have been associated with IMD outbreaks (2,3).
In the United States, IMD occurs rarely and has been decreasing over the past 25 years; the estimated incidence rate for illness caused by all N. meningitidis serogroups in 2012 was 0.15 cases/100,000 persons, and only 0.03 cases/100,000 persons for serogroup C meningococcal disease (4,5). Infants and young children are the most at risk, followed by persons >65 years of age. Outbreaks, which account for only 2% of reported cases, generally involve small numbers of cases and occur in both community and institutional settings (3). Only 2 IMD outbreaks, both serogroup C meningococcal disease, have been reported as occurring exclusively among MSM; 1 comprised 6 cases in Toronto, Ontario, Canada, in 2001, and another 6 cases in Chicago, Illinois, USA, in 2003. Both outbreaks prompted vaccination campaigns targeting MSM; 3,850 were vaccinated in Toronto and 14,267 in Chicago (6,7).
The first outbreak of IMD in New York City, New York, in >25 years occurred during 2005−2006 and included 23 cases of serogroup C meningococcal disease among current and former illicit drug users and their contacts. The outbreak occurred in a contiguous 4-ZIP code area of central Brooklyn and was resolved after 2,763 persons were vaccinated in a targeted campaign (8). In 2012, the New York City Department of Health and Mental Hygiene (DOHMH) identified the third North America outbreak of serogroup C meningococcal disease occurring among MSM (a fourth outbreak was recognized in Chicago, Illinois, USA in May 2015 [http://www.bcbsil.com/pdf/education/cdph_press_release.pdf]). We report the epidemiology of the 2012 New York City outbreak and efforts of DOHMH to control it.
Ms. Kratz is an epidemiologist in the Office of the Deputy Commissioner of Disease Control at the New York City Department of Health and Mental Hygiene, New York City, NY. Her research interests include emerging infections, surveillance, geospatial analysis, and correctional health.
We thank Mike Antwi, Susan Blank, Paula Del Rosso, Marie Dorsinville, Jeffrey Escoffier, Mary King, John Kornblum, Angel Lapaz, Marcelle Layton, Ying Lin, Ella Mazo, Mark Misener, Stephanie Ngai, and Inessa Rubenstein for their contributions to this research and manuscript, including epidemiology expertise and guidance, data collection and analysis, community messaging, and diagnostic microbiology.
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Suggested citation for this article: Kratz MM, Weiss D, Ridpath A, Zucker JR, Geevarughese A, Rakeman J, et al. Community-based outbreak of Neisseria meningitidis serogroup C in men who have sex with men, New York City, New York, USA, 2010−2013. Emerg Infect Dis. 2015 Aug [date cited].http://dx.doi.org/10.3201/eid2108.141837