A meningitis outbreak among New York City gay and bisexual men that was ostensibly ended in February of 2013 appears to have returned with the September 5 announcement by the city’s health department of related meningitis cases out of Brooklyn and Queens among three HIV-positive men who have sex with men.
“In response to three new meningitis cases among men who have sex with men, the Health Department began an investigation to track the spread of the outbreak and determine who else may be at risk,” the department wrote in a September 15 statement. “We have determined that all of the recent cases share a common social network, and we are working with cases to identify unvaccinated people in that social network and offer them vaccine.”
The department distributed “educational materials at events popular with gay men in Brooklyn on September 7 and September 13,” and it launched an “online media campaign, using social media sites and popular ‘hook-up’ apps used by men who have sex with men, to promote vaccination among men who have sex with men in Brooklyn,” the statement said.
The agency is recommending that all sexually active gay and bisexual men get vaccinated for the bacteria.
This meningitis strain has been lingering in New York City since at least 2006, when it caused an outbreak among injecting drug users in Central Brooklyn infecting 23 people and killing seven of them. Between June 28 and September 30 of 2006, the health department vaccinated 2,763 people. An additional three cases were seen after the vaccination campaign ended.
The same bug reappeared in mid-2012 and ultimately infected 22 gay and bisexual, with a 23rd infection in an upstate man who spent significant time in the city. There were seven deaths in that outbreak. The last case was seen in February of 2013. The health department purchased nearly 12,000 vaccine doses to combat that outbreak and got a significant assist in delivering vaccinations from the Callen-Lorde Community Health Center, a clinic that serves the LGBT community, and Gay Men’s Health Crisis, an AIDS group, which collectively vaccinated thousands of at risk men in 2012 and 2013.
Meningitis appears to have established a foothold among gay and bisexual men. Los Angeles had a cluster of three related cases in December 2012 and January of 2013. The bacteria that caused those cases also caused the New York cases. In April of this year, the Los Angeles health department reported, “Four new cases of invasive meningococcal disease have occurred in men who have sex with men” since January 1.
In August of 2013, the Salt Lake County Health Department in Utah reported a meningitis death in a 20-year-old gay man who undertook “recent cross country travel” and was infected with the bacteria that was the same as the one found in Los Angeles and New York.
In a July 2013 issue, the journal Science reported on a five-case meningitis cluster among gay and bisexual men in Germany that year. France reported three cases among gay men, and Belgium reported one case. The same bug caused the US and European cases.
That the bug is genetically the same is unremarkable as most meningitis infections, which typically occur one case at a time rather than in clusters, are caused by the same meningitis strain. What is notable are the epidemiological links among the cases and the implied linkage in outbreaks occurring among men who have sex with men on two continents.
“The cases in Europe similarly do not have a direct link to NYC so we can’t say that they are part of that outbreak, but no, this is not really a coincidence and again indicates there is some unusual pattern of sustained transmission going on that we need to keep trying to sort out,” wrote Dr. Thomas Clark, a medical epidemiologist at the federal Centers for Disease Control and Prevention, in a 2013 email to Gay City News.