How to Beat an Outbreak

In September 2012, I was at home fixing dinner one night when I received a series of text messages from an acquaintance I’ll refer to as “Joe.” He wrote asking if I knew about the meningococcal meningitis outbreak affecting gay men. Joe had just learned that his friend—a healthy HIV positive man in his thirties—had died the night before. Twenty-four hours later, his friend’s roommate called to inform him that hospital officials were urging all recent close contacts to begin prophylactic medication because the cause of death was likely due to meningo- coccal meningitis.

Joe read online that persons exposed to meningococ- cal meningitis should begin a course of the antibiotic, Ciprofloxacin, as soon as possible to halt the progression of the disease. Since it was late, Joe was unable to get in touch with his physician and thinking time was of the essence, he decided to reach out to me.

Understandably, Joe had every reason to be con- cerned. Just as I was about to dial his number, I received a phone call. It was from a colleague who had also come in contact with the same man who had just died. He and his partner were worried because they had seen the victim just days earlier, just as Joe described. They too had received the same call from the deceased man’s roommate. The rapidity with which their dear friend suc- cumbed to this disease left them unsettled. After reading about meningococcal meningitis on WebMD they began to panic. Unsure if they should go to the emergency room, they called to ask me for my advice.

First I inquired if they had any symptoms at all. Initially, symptoms of meningitis resemble the flu, with progressive headache, vomiting, and a sudden high fever (over 101.3). Within hours to days, patients may develop difficulty think- ing, a stiff neck, sensitivity to light, and coma. All three reported no symptoms but said their friend’s roommate told them the victim had been vomiting the night before he died and was experiencing severe headaches and high fever for two days. Unfortunately, their friend made a fatal error and never went to see his doctor.

Like many of my colleagues who treat gay and bisexual men, I was keenly aware of the deadly bacterial meningitis outbreak affecting them in New York City. By August the disease had sickened 22 and killed seven men over the past two years. The specific strain linked to all the cases in New York City is part of serogroup C. It’s the same strain that first surfaced when a woman came down with meningitis in New York City back in 2003. Unfortunately, the speed with which meningitis kills has made identifying people at risk difficult.

Meningococcal disease, caused by the bacteria Neisseria meningitidis, infects the protective lining around the brain and spinal cord. Once symptoms have pro- gressed, the disease is fatal without treatment. Even with treatment, up to one-third of all patients die. Fortunately, there is a vaccine to prevent the illness.

At first, the meningitis outbreak in New York City seemed to infect only HIV-positive men, but by March half of the men sickened were HIV negative. Three of the last five men sickened had died. Initially, it was unclear why the current outbreak was affecting only gay and bisexual men. Only two of the men knew each other and there was no evidence they infected each other. Since the bacteria is spread by close contact—such as kissing, sharing a tooth- brush, a cigarette or even a cup—it is easily passed from one person to the next. Usually outbreaks occur in settings where people socialize or live in close quarters, such as in a college dorm or army barracks. In these cases it’s easier to track everyone down and vaccinate and provide prophylac- tic medication. Trying to track down gay men that congre- gate in bars and dance clubs is far more complicated.

“We are very concerned about the outbreak of men- ingitis among men who have sex with men in New York City,” stated Jay Varma, MD, Deputy Commissioner for Disease Control, DOHMH. “We have identified two groups that are at highest risk of contracting meningitis: HIV- infected men who have sex with men, and any men, regardless of HIV status, who regularly have intimate con- tact with other men met through a website, digital appli- cation (App), or at a bar or party. Vaccination is the best defense against this dangerous infection. We urge men who meet these criteria to get vaccinated now and protect themselves from this disease before it is too late.”

My partners and I at Chelsea Village Medical immediately began offer- ing the vaccination to men who had sex with men (MSM). Despite the fact that most insurance compa- nies weren’t covering the cost of the vaccine, many patients decided to pay the out-of-pocket cost, which aver- aged around $150 a shot (the Department of Health recom- mends two injections for HIV-positive individuals).

In an effort to inform the gay community about the out- break, Gay Men’s Health Crisis (GMHC) in conjunction with the Callen-Lorde Community Health Center sponsored a panel discussion about HIV-positive gay and bisexual men and the meningitis outbreak in New York City in 2012. Panelist included Paul Bellman, MD, Gal Mayer, MD, and a representative from the New York City Department of Health and Mental Hygiene, Monica Sweeney, MD. I attend- ed the discussion along with fellow GMHC Board member Demtre Daskalakis, MD, who was concerned that the strain was spreading with the help of social apps such as Grindr— which help gay and bisexual people meet one another—as well as the wide array of online social networks.

Daskalakis had already set up vaccination sites at bars, clubs, nightclubs and parties in order to administer the meningitis vaccine. It was a stroke of genius on his part to cull his resources and connections by asking the Department of Health to supply vaccines for him and his team in order to administer them at the GMHC testing center. This would be the most accessible place for indi- viduals to get the vaccine absolutely free of charge.