Share this: FacebooktwitterFacebooktwitter

Date: June 3, 2015

To:            HIV primary care providers, pharmacies co-located with HIV clinics, Centers of
 Excellence pharmacies

From:      Stephanie Black, MD, MSc, Medical Director, Communicable Diseases Program and Sarah Kemble, MD, Medical Director, Communicable Diseases Program

CDPH Alert: Invasive Meningococcal Disease in Men Who Have Sex with Men

Since mid-May 2015, the Chicago Department of Public Health (CDPH) has been actively investigating reports
 of 3 confirmed cases of invasive meningococcal disease (IMD) in men who have sex with men (MSM), one of
 which was fatal. All 3 N. meningitidis isolates are serogroup C. Characteristics of cases include HIV diagnosis
or use of on-line “hook-up” apps to seek sexual partners (e.g., Grindr, Jack’d, Adam4Adam).

Among HIV-positive MSM in Chicago, the annual incidence rate of IMD in 2015 has reached about
 23/100,000, surpassing the Advisory Committee on Immunization Practices (ACIP) recommended threshold of 
10/100,000 for initiating a meningococcal vaccination campaign.1

Due to this cluster, CDPH is recommending meningococcal vaccination for
 1) HIV-positive MSM and
 2) MSM regardless of HIV status who have close or intimate contact with anonymous partners or
 seek sexual partners through the use of on-line “hook-up” apps.

In 2003, an outbreak of IMD occurred among MSM in Chicago.2 From 2010-2013, an outbreak of IMD in MSM
was identified in New York City; cases included HIV-positive MSM and MSM who used digital applications to
meet sexual partners.3

Obtaining meningococcal vaccine: Men in the risk categories defined above may obtain vaccine through
one of 3 methods:

  • Primary healthcare providers
  • Pharmacies
  • CDPH fast-track clinics located at:
    • Englewood Neighborhood Health Center: 641 W. 63rd St, Lower 
Level, phone (312) 745-1000 (hours: Thurs 9a-4:30p and Fri 8a-3:30p)
    • Uptown Neighborhood Health
 Center: 845 W. Wilson Ave., 2nd level, phone 312-742-3227 (hours: Mon, Wed, Fri. 8:30a-3:30p and 
Tues/Thurs 9a-4:30p).

The CDPH Immunization Program will provide meningococcal vaccine for patients that meet the CDPH vaccination
 recommendation, regardless of insurance status. If you wish to order vaccine, contact Kevin Hansen at 312-746-9330 or via email at kevin.hansen@cityofchicago.org.

In addition, a provider hotline at 312-746-4835 is available from 8:30a-4:30p.

Two meningococcal conjugate vaccines (i.e., Menactra, Menveo) that contain serogroups A, C, W135, and Y
are licensed for use in adults through age 55 years. Non-immunocompromised adults only need one dose for
 adequate protection; HIV-infected and other immunocompromised individuals should receive 2 doses, 8 weeks
 apart (i.e., at 0 and 2 months). Meningococcal polysaccharide vaccine (i.e., Menomune) should be used for 
adults aged 56 and older.

Clinical manifestations: Patients with meningococcal disease characteristically present with fever, headache,
 stiff neck, petechial rash, sepsis, and/or altered mental status. Early in the course, an abnormality in pulse,
blood pressure or respiratory rate out of proportion to the physical examination may be the only indication of a
 serious infection. Rapid recognition of IMD with administration of appropriate antibiotics increases the
 probability of survival. Treatment with antibiotics should not be delayed pending the results of diagnostic 
testing. Early clues to meningococcal disease may include:

  • Presence of petechial or purpuric rash. It is especially important to examine the skin thoroughly for the 
presence of petechiae. In the early stages of meningococcal disease the rash may be maculopapular 
and blanch.
  • Severe abdominal pain.
  • Severe muscle pain, usually in the extremities or back.

Timely antibiotic prophylaxis reduces the risk of transmission to close contacts, but must be administered as 
soon as possible and within 10 days of the last exposure. CDPH routinely investigates all IMD cases to identify
 close contacts and assists providers with administering antibiotic prophylaxis. Persons that should receive
 prophylaxis include:

  • Household members.
  • Child-care center contacts
  • Anyone directly exposed to the patient’s respiratory or oral secretions (e.g., through kissing, intimate 
contact, mouth-to-mouth resuscitation, endotracheal intubation, or endotracheal tube management).

Additional information from the Centers for Disease Control and Prevention about N. meningitidis infection and
 meningococcal vaccines can be found at:
http://www.cdc.gov/meningococcal/index.html and
 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a3.htm

Please remember to report cases of IMD to CDPH immediately. Please also ensure that bacterial isolates
 are submitted to the Illinois Public Health Laboratory for serogrouping and molecular typing in a timely fashion.
 To report a suspect or confirmed case of meningococcal disease please call:
Business hours: 312-746-5377 or 312-746-5925; 
Non-business hours: Call 311 and ask for the communicable disease physician on-call.

References

  1. Bilukha OO, Rosenstein N; National Center for Infectious Diseases, Centers for Disease Control and
 Prevention. Prevention and control of meningococcal disease: recommendations of the Advisory
 Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005;54:1 -21.
  1. Schmink, S, Watson J, Coulson GB et al. Molecular Epidemiology of Neisseria meningitidis from an 
outbreak of meningococcal disease among men who have sex with men, Chicago, Illinois, 2003, 
Journal of Clinical Microbiology 2007; 45(11):3768-3770.
  1. Kratz MM, Weiss D, Ridpath A et al. Community-based outbreak of Neisseria meningitidis Serogroup C
in men who have sex with men, New York, New York, USA, 2010-2013, Emerging Infectious Diseases;
2015; 21(8), publication pending.