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. 2017 Sep 1;65(5):756-763.
doi: 10.1093/cid/cix438.

Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015

Temitope A Folaranmi  1   2 , Cecilia B Kretz  1 , Hajime Kamiya  1   2 , Jessica R MacNeil  1 , Melissa J Whaley  1 , Amy Blain  1 , Mike Antwi  3 , Marie Dorsinville  3 , Massimo Pacilli  4 , Shamika Smith  4 , Rachel Civen  5 , Van Ngo  5 , Kathleen Winter  6 , Kathleen Harriman  6 , Xin Wang  1 , Virginia B Bowen  7 , Manisha Patel  1 , Stacey Martin  1 , Lara Misegades  1 , Sarah A Meyer  1
Affiliations

Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015

Temitope A Folaranmi et al. Clin Infect Dis. .

Abstract

Background: Several clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States in recent years. The epidemiology and risk of meningococcal disease among MSM is not well described.

Methods: All meningococcal disease cases among men aged 18-64 years reported to the National Notifiable Disease Surveillance System between January 2012 and June 2015 were reviewed. Characteristics of meningococcal disease cases among MSM and men not known to be MSM (non-MSM) were described. Annualized incidence rates among MSM and non-MSM were compared through calculation of the relative risk and 95% confidence intervals. Isolates from meningococcal disease cases among MSM were characterized using standard microbiological methods and whole-genome sequencing.

Results: Seventy-four cases of meningococcal disease were reported among MSM and 453 among non-MSM. Annualized incidence of meningococcal disease among MSM was 0.56 cases per 100000 population, compared to 0.14 among non-MSM, for a relative risk of 4.0 (95% confidence interval [CI], 3.1-5.1). Among the 64 MSM with known status, 38 (59%) were infected with human immunodeficiency virus (HIV). HIV-infected MSM had 10.1 times (95% CI, 6.1-16.6) the risk of HIV-uninfected MSM. All isolates from cluster-associated cases were serogroup C sequence type 11.

Conclusions: MSM are at increased risk for meningococcal disease, although the incidence of disease remains low. HIV infection may be an important factor for this increased risk. Routine vaccination of HIV-infected persons with a quadrivalent meningococcal conjugate vaccine in accordance with Advisory Committee on Immunization Practices recommendations should be encouraged.

Keywords: Neisseria meningitidis; homosexuality; male; meningococcal infections.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
Number and proportion of meningococcal disease cases by month among men who have sex with men (MSM) and men not known to be MSM (non-MSM) aged 18–64 years, January 2012–June 2015. Abbreviations: LAC, Los Angeles County; MSM, men who have sex with men; NYC, New York City.
Figure 2
Figure 2
Molecular phylogenetic analysis based on whole-genome sequencing from sporadic and cluster-associated meningococcal isolates among men who have sex with men aged 18–64 years, January 2012–June 2015. The maximum likelihood tree was based on the Tamura-Nei model. The tree is drawn to scale with branch lengths measured in the number of substitution per site. Internal nodes are labeled with bootstrap values (500 iterations). The scale bar is based on the 13 026 positions in the core single-nucleotide polymorphism (SNP) matrix. Labels represent the location of the outbreak and the year collected, FAM18 and MC58 as outgroups. A distance scale bar is shown at the bottom left. *Cluster-associated cases refers to 2 cases epidemiologically linked to the Chicago cluster who were not residents of Chicago. Abbreviations: LAC, Los Angeles County; NYC, New York City.
See this image and copyright information in PMC

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