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Biological Health Hazard – Socially-induced Meningococcal Meningitis Outbreak (Fatal): California

2016/07/27

MENINGITIS, MENINGOCOCCAL – USA (04): (CALIFORNIA) FATAL, MEN WHO HAVE SEX WITH MEN, SEROGROUP C, VACCINATION
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Published Date: 2016-07-27 12:05:01
Subject: PRO/EDR> Meningitis, meningococcal – USA (04): (CA) fatal, MSM, sg C, vaccination
Archive Number: 20160727.4371802

Date: Monday, 25 July 2016
Source: Orange County Breeze [edited]

The California Department of Public Health is reporting an increase of meningococcal disease in Southern California, particularly in Orange and Los Angeles Counties. A cluster of cases in the last several months has disproportionately affected men who have sex with men (MSM).

Meningococcal disease is caused by _Neisseria meningitidis_ bacteria, which are transmitted from person-to-person through respiratory droplets, during face-to-face or prolonged contact, or by sharing utensils, drinks, or cigarettes. It is a serious infection that can cause meningitis (brain infection) and/or bacteremia (blood infection), and can lead to death.

To date, Orange County has had 4 cases that are part of the cluster in Southern California; 3 of these cases have occurred since 1 Jun 2016, including 1 death. On average, Orange County has only 5 meningococcal cases each year.

Because of this local increase in risk, the County of Orange Health Care Agency, in conjunction with the Los Angeles County Department of Public Health and City of Long Beach Department of Health and Human Services, is expanding vaccination recommendations for meningococcal disease to include all gay, bisexual, and other men who have sex with men, in addition to all persons with HIV infection.

Higher risk for meningococcal disease in MSM has been associated with: regularly visiting crowded venues such as bars, parties, etc.; regularly having close or intimate contact with multiple partners; smoking or illicit drug use; and/or HIV positive status.

MSM who are unaware of their current HIV status and who have not been tested in the past year should seek HIV testing.

Individuals covered under this new recommendation are encouraged to speak to their medical providers about getting the vaccine. For those who are uninsured or whose insurance does not cover the vaccine, the OC Health Care Agency can provide vaccinations at low or no cost. There are 2 clinics located at 1725 W 17th Street in Santa Ana that will offer vaccine to qualified individuals:

Immunization Clinic: 7:30 am – 4:30 pm, Mon-Fri, closed for lunch 11:45 am – 12:45 pm
Testing, Treatment and Care Clinic: 8 am – 4 pm, Mon, Wed, Thu, and Fri; 10 am – 4 pm Tue.

Both are walk-in clinics, so wait times can be expected. Those needing just vaccination should go to the Immunization Clinic, but if testing for sexually transmitted disease and/or HIV is desired, please go to the Testing, Treatment and Care Clinic. For more information, please call the Health Referral Line at 800-564-8448.

Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Invasive meningococcal disease (IMD) includes meningitis, bacteremia and sepsis and is caused by _Neisseria meningitidis_ bacteria, which are transmitted from person-to-person through respiratory droplets usually during close contact. Persons who are HIV-infected are at increased risk of meningococcal disease.

Outbreaks of IMD have recently occurred among men who have sex with men (MSM) in Germany, Belgium, and France caused by a _N. meningitidis_ serogroup C strain with the same multilocus sequence type (http://www.ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-invasive-meningococcal-disease-among-MSM.pdf). This genotype has also caused IMD in individuals (women, as well as those men who do not identify as MSM) who attended social venues associated with the gay community in France (http://www.eurosurveillance.org/images/dynamic/EE/V20N03/art21016.pdf).

Similar outbreaks among MSM occurred in Canada and the US caused by _N. meningitidis_ serogroup C (see prior ProMED-mail posts listed below).

The California Department of Public Health reported in mid July 2016 an increase of IMD among men living in Southern California, most of whom were MSM (http://ochealthinfo.com/civicax/filebank/blobdload.aspx?BlobID=56087). The current status (as of 14 Jul 2016):
– 22 cases of IMD have been identified in Los Angeles County (LAC), including the city of Long Beach, and Orange County since 1 Jan 2016.
– 15 of these cases have occurred since 1 May 2016.
– 10 cases were in men who have sex with men (MSM), though no direct social connection between cases has been found.
– 8 of the cases in MSM have been confirmed infected with _N. meningitidis_ serogroup C (NmC); 4 of these cases have an indistinguishable strain.
– 3 serogroup C cases have occurred in Orange County residents, with one resulting in death.

According to the Los Angeles County Epidemiology Report – Invasive Meningococcal Disease: 2016. 25 Jul 2016 (http://publichealth.lacounty.gov/acd/docs/IMD2016.pdf):
– 13 cases of IMD have occurred in LAC, excluding Long Beach, since the beginning of 2016.
– 9 of these cases have occurred since 1 May 2016.
– 9 of the 13 cases were males; 8 of whom are serogroup C-positive.
– 7 of the cases were MSM and all were serogroup C-positive.
– No common social linkages among cases in the region.

Subtracting the LAC cases from the totals in Southern California, this leaves
– 9 cases of IMD in Orange County since the beginning of 2016.
– 6 of these cases have occurred since May 1 2016.
– 3 of the cases were MSM; all were serogroup C.

The state of California can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/promed/p/204. A county map can be seen at http://geology.com/county-map/california-county-map.gif. – Mod.ML]

See Also

Meningitis, meningococcal – USA (03): (CA) fatal, MSM, sg C, vaccination 20160630.4314012
Meningitis, meningococcal – USA (02): (CA) fatal, MSM, vaccination, RFI 20160626.4310203
Meningitis, meningococcal – Europe: fatal, MSM, new sexually transmitted strain 20160513.4220814

2015
—-
Meningitis, meningococcal – USA (03): (MN,IL) fatal, MSM, vaccine 20150718.3520169
Meningitis, meningococcal – USA (02): (IL) fatal, MSM, vaccine, RFI 20150711.3502722
Meningitis, meningococcal – France: (Paris) serogroup C, MSM, vaccination 20150124.3116307

2014
—-
Meningitis, meningococcal – USA (04): (CA) fatal, MSM, vaccination, RFI 20140404.2379584

2013
—-
Meningitis, meningococcal – Germany: (BE) fatal, MSM, vaccination 20130725.1844122
Meningitis, meningococcal – USA (02): (New York City) fatal, MSM, vaccination 20130520.1725339
Meningitis, meningococcal – USA: (New York City) fatal, MSM, alert 20130308.1576590

2012
—-
Meningitis, meningococcal – USA (02): (NY) fatal, MSM 20120929.1315676
………………………………………….sb/ml/mj/lm

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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