Officials Warn: NYC Meningitis Outbreak Among Gay Men NOT a ’New AIDS’
The New York City Health Department is encouraging HIV-positive men who have had "intimate contact" with men they met on the Internet, through dating apps, or at a bar or party since Sept. 1 to get vaccinated for meningitis after an outbreak of the infection among gay men recently took the life of one man and has left another in critical care.
The cases are the third and fourth in the past five weeks, but the outbreak actually started two years ago. According to the city’s health department, four of the 12 known cases have resulted in death. All have been gay men, or men who have sex with men, and eight were HIV-positive. One-third reported using the Internet to meet men for sex. The median age for the men is 32.
But before anyone panics or fears this is some HIV-like epidemic striking the gay community, experts caution that, rather, it looks like an outbreak that just happens to have spread among a group of gay, mostly HIV-positive men. Two things make it trickier, however: first, the fact that this outbreak is not confined to a small area, but spread across the five city’s boroughs; and second, that HIV-positive people are more susceptible to not only catching the infection, but dying from it.
"I think everybody needs to be aware, but for people who haven’t had direct exposure to one of the cases, there isn’t anything to worry about," said Dr. Howard Grossman, a New York City physician who treats many LGBT and HIV-positive patients.
"I think it could just simply be epidemiologically that these people are more in touch with each other and happen to be HIV-positive," Grossman said. "It’s not an STD."
How You Get Meningitis
Meningitis, an infection of the membranes covering the brain and spinal cord, is spread through "prolonged close contact with nose or throat discharges from an infected person," according to the city’s health department. That is to say, people living together, sharing drinks, kissing, or having sexual contact. Outbreaks usually occur in close quarters, which is why college students are commonly required to get vaccinated before moving into dormitories.
"This is bacteria that lives primarily in the nose," said Dr. James Conway, an associate professor at the University of Wisconsin School of Medicine and Public Health and former adviser to the Meningitis Foundation of America. "It turns out that maybe one in 10 people carry it."
When something causes a breach in the nose lining of one of these carriers (a respiratory infection, for example) and the bacteria enters the system, the person can develop meningitis. Sharing saliva can spread the infection to others, causing a cluster of cases. Occasionally a cluster turns into an outbreak.
Annually there are about 4,100 cases of bacterial meningitis in the United States, resulting in 500 deaths, according to the Centers for Disease Control and Prevention. The most recent outbreak in New York City occurred in 2006.
"What the Health Department then does is instead of just giving some people a dose of antibiotics, they’ll try to aggressively get more vaccines out there into a broader part of the population, so you can shut it down before it becomes a true epidemic, which is very rare," Conway said.
The New York City Department of Health has been at work reaching out to people who may have come in contact with cases and giving them antibiotics. It is making vaccines available throughout the city for at-risk men who can’t obtain them from their own providers.
How You Know If You Contracted it
Grossman said the strain going around seems to be rather more aggressive than normal.
"I would encourage people to be aware of symptoms to watch out for and to get medical help if you think there’s something wrong, I don’t discourage anybody from getting vaccinated," he said. "It’s my understanding that the man who died thought he had the flu, went to bed, and didn’t wake up."
Indeed, when meningitis becomes invasive, meaning it enters the bloodstream, it can feel a lot like the flu. Other telltale symptoms include a stiff neck and rash.
"You don’t have much to distinguish it from a regular flu and it needs to be addressed quickly, but you also don’t want everybody being alarmed," Conway said. "But if you have something flu-like and there’s an outbreak in your community, you do need to get evaluated."
This is especially true of people with HIV, like the latest victim.
"The consequences of the infection can be much worse for people with HIV," noted Dr. Gal Mayer, medical director at the Callen-Lorde Community Health Center, which serves New York’s LGBT community. This is the first meningitis outbreak he’s seen in his 12 years at the center.
"Typically, meningitis outbreaks occur sporadically among students on college campuses where, because of the well-defined population and area, the containment and vaccination strategies tend to be easier than they would be in this case," Mayer said.
The center plans to prescribe antibiotics to any patients who have come into contact with known cases and will immediately launch its vaccination program.
Conway, though uninvolved in the investigation, said it’s important for the public not to jump to conclusions because the outbreak has spread among gay, HIV-positive men.
"This happens in communities of people that are closely involved, in communities of people potentially in a position of sharing secretions, like in dormitories, which we hear about more often," he said. "This is more of a community problem than it is an HIV or gay problem and I hope public perception is such."
Different From That Other Current Outbreak
Coincidentally, there has been another outbreak of meningitis tied to injections of a contaminated drug. The New York Times reports that 119 people have been affected by this outbreak, all of them associated with a pain drug shipped from a pharmacy in Massachusetts.
As many as 13,000 people may have been given methylprednisolone acetate, an epidural steroid that is injected into the neck and spine for pain. As a result of the epidemic, there are calls for a congressional investigation into the way pharmacies prescribe and send out drugs.
A Times map tracing the disease links it primarily to states in the Midwest, the Atlantic Coast from New Jersey to North Carolina, Tennessee and Florida. A new case has just been discovered in New Hampshire, however, and other states are expected to be added to the map.