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

full-text ►

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

On This Page

• Medscape CME Activity
• Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2
• Figure 3

Tables

• Table 1
• Table 2

Downloads

• PDF[1.43 MB - 8 pgs]
• RIS[TXT - 2 KB]

Molly M. Kratz , Don Weiss, Alison Ridpath, Jane R. Zucker, Anita Geevarughese, Jennifer Rakeman, and Jay K. Varma

Author affiliations: New York City Department of Health and Mental Hygiene, New York, New York, USA (M.M. Kratz, D. Weiss, A. Ridpath, J.R. Zucker, A. Geevarughese, J. Rakeman, J.K. Varma); Centers for Disease Control and Prevention, Atlanta, USA (A. Ridpath, J.R. Zucker, J.K. Varma)

Suggested citation for this article

Abstract

In September 2012, the New York City Department of Health and Mental Hygiene identified an outbreak ofNeisseria meningitidis serogroup C invasive meningococcal disease among men who have sex with men (MSM). Twenty-two case-patients and 7 deaths were identified during August 2010−February 2013. During this period, 7 cases in non-MSM were diagnosed. The slow-moving outbreak was linked to the use of websites and mobile phone applications that connect men with male sexual partners, which complicated the epidemiologic investigation and prevention efforts. We describe the outbreak and steps taken to interrupt transmission, including an innovative and wide-ranging outreach campaign that involved direct, internet-based, and media-based communications; free vaccination events; and engagement of community and government partners. We conclude by discussing the challenges of managing an outbreak affecting a discrete community of MSM and the benefits of using social networking technology to reach this at-risk population.

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.

Acknowledgment

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.

References

1. Cohn AC, MacNeil JR, Clark TA, Ortega-Sanchez IR, Briere EZ, Meissener HC, Prevention and control of meningococcal disease recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2013;62:1–28 .PubMed
2. Simon MS, Weiss D, Gulick RM. Invasive meningococcal disease in men who have sex with men. Ann Intern Med. 2013;159:300–1. DOIPubMed
3. Brooks R, Woods CW, Benjamin DK, Rosenstein NE. Increased case-fatality rate associated with outbreaks of Neisseria meningitidis infection, compared with sporadic meningococcal disease, in the United States, 1994–2002. Clin Infect Dis. 2006;43:49–54. DOIPubMed
4. Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report: emerging infections program network: Neisseria meningitidis, 2012. 2013 Dec [cited 2015 Mar 30]. http://www.cdc.gov/abcs/reports-findings/survreports/mening12.pdf
5. Chang Q, Tzeng Y-L, Stephens D. Meningococcal disease: changes in epidemiology and prevention. Clin Epidemiol. 2012;4:237–45.
6. Tsang RSW, Kiefer L, Law DKS, Stoltz J, Shahin R, Brown S, Outbreak of serogroup C meningococcal disease caused by a variant of Neisseria meningitidis serotype 2a ET-15 in a community of men who have sex with men. J Clin Microbiol. 2003;41:4411–4. DOIPubMed
7. Schmink S, Watson JT, Coulson GB, Jones RC, Dias PS, Mayer LW, Molecular epidemiology of Neisseria meningitidis isolates from an outbreak of meningococcal disease among men who have sex with men, Chicago, Illinois, 2003. J Clin Microbiol. 2007;45:3768–70. DOIPubMed
8. Weiss D, Stern EJ, Zimmerman C, Bregman B, Yeung A, Das D, 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. DOIPubMed
9. Council of State and Territorial Epidemiologists. Position statement 09-ID-42. Public health reporting and national notification for meningococcal disease. 2010 Jun 10 [cited 2014 Jul 2]. http://www.cste.org/resource/resmgr/PS/09-ID-42.pdf
10. Centers for Disease Control and Prevention. Updated recommendations for use of meningococcal conjugate vaccines – Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60:72–6 .PubMed
11. New York City Department of Health and Mental Hygiene. Alert #28: meningococcal vaccine recommendations for HIV-infected men who have sex with men. 2012 Oct 4 [cited 2014 Aug 22]. https://a816-health29ssl.nyc.gov/sites/NYCHAN/WebPages/home.aspx
12. New York City Department of Health and Mental Hygiene. Alert #36: invasive meningococcal disease in men who have sex with men: two new cases reported in the past 5 weeks. 2012 Nov 29 [cited 2014 Aug 22]. https://a816-health29ssl.nyc.gov/sites/NYCHAN/WebPages/home.aspx
13. New York City Department of Health and Mental Hygiene. Alert #5: invasive meningococcal disease in men who have sex with men: Four new cases reported in 2013, expanded vaccine recommendations. 2013 Mar 6 [cited 2014 Aug 22]. https://a816-health29ssl.nyc.gov/sites/NYCHAN/WebPages/home.aspx
14. NYC Hot Shots PSA for meningitis awareness and vaccination [cited 2013 Jan 19]. https://www.youtube.com/watch?v=yoz-nUawEQ
15. Hartocollis A. City health officials warn some men on lethal strain of meningitis. The New York Times. 2013 Mar 21 [cited 2014 Aug 22].http://www.nytimes.com/2013/03/22/nyregion/city-health-officials-warn-some-men-on-lethal-strain-of-meningitis.html
16. Lovett I. On alert for meningitis in Los Angeles. The New York Times. 2013 Apr 13 [cited 2014 Aug 22].http://www.nytimes.com/2013/04/14/us/after-meningitis-death-in-los-angeles-gay-activists-urge-vigilance.html
17. Hartocollis A. For gay men, a fear that feels familiar. The New York Times. 2013 May 17 [cited 2014 Aug 22].http://www.nytimes.com/2013/05/19/health/for-gay-men-a-fear-that-feels-familiar.html
18. Bilukha OO, Rosenstein N; National Center for Infectious Diseases. Centers for Disease Control and Prevention. Meningococcal disease recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2005;54:1–21 .PubMed
19. Hartocollis A. New York City reports 3 new cases of meningitis. The New York Times. 2014 Sep 3 [cited 2015 Apr6].http://www.nytimes.com/2014/09/06/nyregion/city-reports-3-new-cases-of-meningitis.html
20. Los Angeles County Department of Public Health. Public health issues new vaccination recommendations for men who have sex with men (MSM) at-risk for invasive meningococcal disease. 2014 Apr 2 [cited 2015 Apr 6]. http://publichealth.lacounty.gov/docs/PressReleaseIMDRecommend-4-2-14.pdf
21. Aubert L, Taha M, Boo N, Le Strat Y, Deghmane AE, Sanna A, Serogroup C invasive meningococcal disease among men who have sex with men and in gay-oriented social venues in the Paris region: July 2013 to December 2014. Euro Surveill. 2015;20:21016 .PubMed
22. European Centre for Disease Prevention and Control. Invasive meningococcal disease among men who have sex with men. 2013 Jul 3 [cited 2015 Apr 6]. http://ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-invasive-meningococcal-disease-among-MSM.pdf

Figures

• Figure 1. Monthly invasive serogroup C incidence and cumulative vaccine uptake, New York City, New York, USA, 2009–2015. *Vaccine uptake among MSM only as part of outbreak response. MSM, men who...
• Figure 2. Meningococcal vaccination campaign outreach poster, New York City, New York, USA.
• Figure 3. Weekly invasive meningococcal disease incidence among men who have sex with men (MSM) and vaccine uptake, New York City, New York, USA, August 2012–2013, encompassing the last of 13...

Tables

• Table 1. Epidemiology and risk factors of for 22 outbreak case-patients with invasive meningococcal disease, New York City, New York, USA, 2010–2013
• Table 2. Rates for invasive meningococcal disease for residents (all serogroups) of New York City, New York, USA, 2012

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

DOI: 10.3201/eid2108.141837