Hajime Kamiya, MD, PhD1; Jessica MacNeil, MPH2; Amy Blain, MPH2; Manisha Patel, MD2; Stacey Martin, MS2; Don Weiss, MD3; Stephanie Ngai, MPH3; Ifeoma Ezeoke, MPH3; Laurene Mascola, MD4; Rachel Civen, MD4; Van Ngo, MPH4; Stephanie Black, MD5; Sarah Kemble, MD5; Rashmi Chugh, MD6; Elizabeth Murphy, MPH6; Colette Petit6; Kathleen Harriman, PhD7; Kathleen Winter, MPH7; Andrew Beron, MPH8; Whitney Clegg, MD8; Craig Conover MD8; Lara Misegades, PhD2
\nSince 2012, three clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States. During 2012, 13 cases of meningococcal disease among MSM were reported by the New York City Department of Health and Mental Hygiene (1); over a 5-month period during 2012\u20132013, the Los Angeles County Department of Public Health reported four cases among MSM; and during May\u2013June 2015, the Chicago Department of Public Health reported seven cases of meningococcal disease among MSM in the greater Chicago area. MSM have not previously been considered at increased risk for meningococcal disease. Determining outbreak thresholds* for special populations of unknown size (such as MSM) can be difficult. The New York City health department declared an outbreak based on an estimated increased risk for meningococcal infection in 2012 among MSM and human immunodeficiency virus (HIV)\u2013infected MSM compared with city residents who were not MSM or for whom MSM status was unknown (1). The Chicago Department of Public Health also declared an outbreak based on an increase in case counts and thresholds calculated using population estimates of MSM and HIV-infected MSM. Local public health response included increasing awareness among MSM, conducting contact tracing and providing chemoprophylaxis to close contacts, and offering vaccination to the population at risk (1\u20133). To better understand the epidemiology and burden of meningococcal disease in MSM populations in the United States and to inform recommendations, CDC analyzed data from a retrospective review of reported cases from January 2012 through June 2015.
\nIn May 2013 and again in August 2015, CDC requested that health departments review all cases of probable or confirmed meningococcal disease caused by any serogroup and reported among males during January 2012\u2013June 2015 to the National Notifiable Disease Surveillance System and, if possible, determine MSM status. The requests were made through Epi-X, a secure communications network for public health officials, and follow-up with each state health department occurred through individual e-mail correspondence. All 50 state health departments and the health departments of New York City, Los Angeles County, Chicago, and the District of Columbia responded to CDC's request for information. Analysis of the data was restricted to cases occurring among MSM aged 18\u201364 years.
\nDuring the case review period, 527 meningococcal disease cases among males aged 18\u201364 years were reported. Although MSM status is not routinely collected as part of national meningococcal case reporting and might be underreported, 74 cases were identified among MSM: 23 from New York City, 14 from Los Angeles County, 11 from Chicago, and 26 sporadic cases occurring in states or geographic areas where fewer than three cases of the same meningococcal serogroup were reported among MSM during a 3-month period (4) (Table). MSM status could not be verified for the other 453 meningococcal disease cases among men aged 18\u201364 years using available data, nor could CDC distinguish between health departments reporting zero cases in MSM and those that had no data on MSM status.
\nAmong the 74 reported cases among MSM aged 18\u201364 years, the median age was 31 years (range = 20\u201359 years). Thirty-seven (52%) of 71 patients with known race were white, 29 (41%) were black, two (3%) were Asian, and three (4%) were other race. Neisseria meningitidis serogroup C accounted for 62 (84%) cases; serogroups B, W, and Y accounted for five, two, and three cases, respectively; and the serogroup for two patients was unknown. Overall, 24 (32%) cases were fatal, including six of the New York City cases (26%), five (36%) of the Los Angeles County cases, three (27%) of the Chicago cases, and 10 (38%) of the sporadic cases. Among 63 patients for whom HIV status was reported, 37 (59%) were HIV-positive; among these, 11 (30%) died. Meningococcal vaccination status was known for 41 patients; among these, six (15%) were vaccinated with a quadrivalent meningococcal vaccine. Five of the six vaccinated patients had serogroup C meningococcal disease, and two of the five died. Further analysis of meningococcal disease rates, risk factors, and pulsed-field gel electrophoresis data from all cases identified among MSM is ongoing.
\nInformation on MSM and HIV status of men reported with meningococcal disease is not currently noted on most meningococcal case report forms. However, representative and complete data on MSM and HIV status are needed to better understand the epidemiology of and potential risk factors for meningococcal disease among MSM in the United States and to inform prevention and control recommendations.
\nHealth departments are encouraged to attempt to determine MSM and HIV status during investigations of meningococcal disease cases caused by any serogroup occurring among males aged \u226516 years. If permitted by state law, state health departments are asked to complete a supplemental case report form (available at http://www.cdc.gov/meningococcal/surveillance/index.html) for all cases of meningococcal disease occurring among MSM and submit the forms to CDC via e-mail (meningnet@cdc.gov) or via fax (404-315-4681).
\nLocal and state health departments that have contributed to meningococcal surveillance among MSM.
\n1Epidemic Intelligence Service, CDC; 2Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3New York City Department of Health and Mental Hygiene; 4Los Angeles County Department of Public Health; 5Chicago Department of Health; 6DuPage County Health Department, Wheaton, Illinois; 7California Department of Health; 8Illinois Department of Public Health.
\nCorresponding author: Jessica MacNeil, jmacneil@cdc.gov.
\n* Occurrence of three or more confirmed or probable cases during a period of \u22643 months among persons who are not close contacts of each other and who do not share a common affiliation, with a primary attack rate of at least 10 cases per 100,000 population.
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