Another outbreak of bacterial meningitis

[leigh.bess.toad]

Here we are again. Just like last year. And there are 3 deaths in the LA area from bacterial meningitis among gay men. And now the LA County Department of Health is recommending that all men who have sex with other men receive the bacterial meningitis vaccine. We went through this last year. There were a similar number of deaths in LA, plus if I remember correctly, one or two in New York and elsewhere. The CDC was investigating but I don't know if they ever found a link. But I do know clinics were set up in LA to administer the vaccine to those who couldn't afford it. Even though I am thousands of miles from LA, I did see my family doc and got it to be safe.

 

Last year's occurrences were the week or two after White Party. One troubling thing for me is that this time it is before White Party. With guys coming from all over. The risk to spread this far and wide would seem to be far greater. Supposedly, I think they are planning on about 30,000 for white party (if that number can be believed). Here are links to an LA Times article about the current events and a link to the forum discussions about last year's outbreak.

 

http://www.latimes.com/local/lanow/la-me-ln-meningitis-los-angeles-county-20140402,0,7154949.story#axzz2xyG3sNzM

 

http://www.companyofmen.org/showthread.php?92849-Bacterial-meningitis-outbreak-More-Norovirus-outbreaks-Concerning&highlight=meningitis

 

Given that this isn't an STD in the traditional sense (no sexual contact is needed to transmit bacterial meningitis, only very close proximity), I'm really kind of worried, especially with White Party coming up in 3 weeks. So have you had the vaccination? Would you consider it now? Any concerns?

[+ Gar1eth]

Here we are again. Just like last year. And there are 3 deaths in the LA area from bacterial meningitis among gay men. And now the LA County Department of Health is recommending that all men who have sex with other men receive the bacterial meningitis vaccine. We went through this last year. There were a similar number of deaths in LA, plus if I remember correctly, one or two in New York and elsewhere. The CDC was investigating but I don't know if they ever found a link. But I do know clinics were set up in LA to administer the vaccine to those who couldn't afford it. Even though I am thousands of miles from LA, I did see my family doc and got it to be safe.

 

Last year's occurrences were the week or two after White Party. One troubling thing for me is that this time it is before White Party. With guys coming from all over. The risk to spread this far and wide would seem to be far greater. Supposedly, I think they are planning on about 30,000 for white party (if that number can be believed). Here are links to an LA Times article about the current events and a link to the forum discussions about last year's outbreak.

 

http://www.latimes.com/local/lanow/la-me-ln-meningitis-los-angeles-county-20140402,0,7154949.story#axzz2xyG3sNzM

 

http://www.companyofmen.org/showthread.php?92849-Bacterial-meningitis-outbreak-More-Norovirus-outbreaks-Concerning&highlight=meningitis

 

Given that this isn't an STD in the traditional sense (no sexual contact is needed to transmit bacterial meningitis, only very close proximity), I'm really kind of worried, especially with White Party coming up in 3 weeks. So have you had the vaccination? Would you consider it now? Any concerns?

 

 

 

 

The risk of anyone getting the disease is probably low. However if you do get infected the outcomes can be so horrific- the risk of death or even severe effects (amputation of limbs for example) is extremely high- that I would say get the vaccine if you have no contraindications to getting the vaccine. The main problem at this point is I'm not sure how much protection you would get after three weeks-probably some protective effect but might not be total. Other things to keep in mind. The vaccine only covers certain strains of the meningococcal bacteria. You are still able to be infected by the non-vaccine strains. For the vaccine covered strains I think the protection is supposed to be about 85%. If you do decide to get it for the White Party, I'd get it now!!

 

But again considering how horrible the outcomes could be if you are infected - amputations of arms, legs, hands, and death- I'd take whatever protection I could get. In fact - I did get it last year. I'm not a Circuit Person but the New York and LA Outbreaks were not correlated with specific Circuit Party Activity only with MSM ( that's public health fancy lingo for 'men who have sex with men'. ) Getting the vaccine seemed like a no brainer.

 

Now comes the confusing part- there are two different types of vaccine. One type has 2 different brand names. The other type only one.

 

When talking about these vaccines, I am assuming that no one has received this type of vaccine before. Also I am using United States Guidelines. Foreign Countries may have different vaccines with different guidelines.

 

DISCLAIMER- these are general USA GUIDELINES for healthy people with no medical reasons that would keep them from getting a vaccine. Only your health provider- doctor, nurse practitioner, physician's assistant, public health clinic- can tell you for sure what you need!!!

 

Type #1 menACWY (quadrivalent conjugated vaccines)

A. Menveo

B. Menactra

 

Basically these are the vaccines to use if you are an adult and less than or equal to 55 years of age. Usually you only receive it once. However for those who might be at higher risk of exposure to this bacteria- such as during a community outbreak, a microbiologist who studies the disease, or maybe if you are a constant on the party circuit or a continual MSM, you can receive it every 5 years. There are two vaccines as you can see- they are supposed to be equivalent. They are made by different manufacturers. If you get a repeat dose after 5 years. They are supposedly interchangeable meaning if you get one brand the 1st time, five years later it doesn't matter if you get the same brand or the other one.

 

Then we have

 

 

Type # 2 (MPSV4)

A. Menomune®-A/C/Y/W-135

 

 

This vaccine is designed for people 56 years of age or over- except that even if you are 56 years or older and you think you are going to need more than one dose every 5 years because -DAMMIT- even if you are 56 years of age or older is no reason you can't go to a Circuit Party and dance like it's still 1999. So in that case if you think you are going to continually be in a 'high risk' situation by going to Circuit Parties or whatever- you should get the Type # 1 Vaccine initially and repeat the Type # 1 vaccine every 5 years as long as you are a Circuit Boy ( er Circuit Man) or still a MSM.

 

 

Gman

[+ Funguy]

VERY good Gman.

 

I have one comment/clarification. Type 1 (menactra, menveo) vaccine should be given for those adults who are 55 or less and who have not had previous vaccine. If you are a vaccine virgin, then the recommendation IS 2 doses separated by 2 months +/- booster at 5 years. If you have had previous vaccine and require only the one further vaccine, then type 2 (menomune) can be used for age 56 or older. *

 

For the younger (teenagers) it is recommended that Type 1 vaccine be given once at 11 years and then a booster at 16. That SHOULD protect for life but school is still out, thanks to this new outbreak, about what the MSM population should do.

 

G-man's suggestion re: 5 year booster for adults AFTER they have had the primary (2 shot) series is probably a very valid suggestion.

 

* CDC, meningitis vaccine for adults

 

BTW, the outbreaks (not associated with MSM) at Princeton and UCSB were NOT of the strain of meningococcus bacteria covered by the vaccines that we have in this country. There is a vaccine from Europe and Australia which was cleared to be used and offered to students at those schools.

 

VACCINE AND PROTECT

Think about all of the vaccines which are available, tho not necessarily offered to adults.

 

THANK YOU, Lee and Gman, for bringing this topic to our attention.

 

Play safe and fun,

 

Funguy

[+ Gar1eth]

VERY good Gman.

 

I have one comment/clarification. Type 1 (menactra, menveo) vaccine should be given for those adults who are 55 or less and who have not had previous vaccine. If you are a vaccine virgin, then the recommendation IS 2 doses separated by 2 months +/- booster at 5 years. If you have had previous vaccine and require only the one further vaccine, then type 2 (menomune) can be used for age 56 or older. *

 

For the younger (teenagers) it is recommended that Type 1 vaccine be given once at 11 years and then a booster at 16. That SHOULD protect for life but school is still out, thanks to this new outbreak, about what the MSM population should do.

 

G-man's suggestion re: 5 year booster for adults AFTER they have had the primary (2 shot) series is probably a very valid suggestion.

 

* CDC, meningitis vaccine for adults

 

BTW, the outbreaks (not associated with MSM) at Princeton and UCSB were NOT of the strain of meningococcus bacteria covered by the vaccines that we have in this country. There is a vaccine from Europe and Australia which was cleared to be used and offered to students at those schools.

 

VACCINE AND PROTECT

Think about all of the vaccines which are available, tho not necessarily offered to adults.

 

THANK YOU, Lee and Gman, for bringing this topic to our attention.

 

Play safe and fun,

 

Funguy

 

And you see this is why you need to speak with your health care professional. It is possible that Funguy is looking at some new recommendations that I can't find. Funguy, if you are- please send me the link.

 

Also- I am making some assumptions here- that everyone reading this is 16 years or older ( up to and including age 55) and healthy and again with no problems that would keep them from being vaccinated.

 

If these conditions are true- then the recommendations I find are for one dose on either Menveo or Menactra not two doses. Then one dose every 5 years if there is reason- such as in this case community outbreaks or MSM ( men who have sex with men).

 

There is one additional point- there is/has been an outbreak of a strain of this bacteria that is not covered by this vaccine (serogroup B) at UC Santa Barbara and Princeton University. The Food and Drug administration has authorized the use of a vaccine for this special strain of the disease that has not been approved in the United States. The vaccine has been approved in Europe and Australia and found to be safe there. People recommended to get it are students and workers at these two universities. This vaccine does require two doses. The 1st dose and then a repeat dose 1 to 6 months later.

 

Gman

[+ Funguy]

http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-shell.html

 

Meningococcal vaccination

1. Administer 2 doses of quadrivalent meningococcal conjugate vaccine (MenACWY [Menactra, Menveo]) at least 2 months apart to adults of all ages with functional asplenia or persistent complement component deficiencies. HIV infection is not an indication for routine vaccination with MenACWY. If an HIV-infected person of any age is vaccinated, 2 doses of MenACWY should be administered at least 2 months apart.

2. Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, persons at risk during an outbreak attributable to a vaccine serogroup, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.

3. First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.

4. MenACWY is preferred for adults with any of the preceding indications who are aged 55 years or younger as well as for adults aged 56 years or older who a) were vaccinated previously with MenACWY and are recommended for revaccination, or b) for whom multiple doses are anticipated. Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred for adults aged 56 years or older who have not received MenACWY previously and who require a single dose only (e.g., travelers).

5. Revaccination with MenACWY every 5 years is recommended for adults previously vaccinated with MenACWY or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia, persistent complement component deficiencies, or microbiologists). [sic: as well as in cases such as this outbreak]

 

I realize that (1) has specific indications. BUT, I have friends at CDC who have told me that, altho this is the present recommendation in print, it will be changing because of outbreaks which are happening on the present regime. Therefore, to be as totally risk free as one can get, I myself recommend #4.

 

In addition, please DO NOT MAKE THE ASSUMPTION THAT ANYONE WHO IS READING THIS IS 16 OR OLDER / DO NOT ASSUME YOU HAVE TO BE 16 OR OLDER TO BE HAVING SEX (gay or straight) / OR THAT THE 11-16 YEAR OLDS HAVE HAD THEIR VACCINES! As a physician caring for adults as well as kids, I have seen sexually active (gay and straight) kids as young as 11, as well as pregnant girls as young as 12. There is also a very small, yet vocal population who are anti-vaccine, in part or in toto. This population destroys the principle of cocooning which at least protects kids who are not yet vaccinated as well as those who are receiving vaccines but not yet complete. This is why we have outbreaks of measles, whooping cough (epidemic in California now), etc. Even HPV vaccine is being refused by some in the 11-26 year old population (as promoting sexual promiscuity!) and why we will continue to see cervical cancer in women (98% of cases are caused by HPV), throat cancer from oral sex (see Michael Douglas!), anal warts in mostly gay men.

[Steven_Draker]

Thank you, Doc.

 

Is there something like a "high risk group" or "high risk factors" for meningitis?

[+ Funguy]

Thank you, Doc.

 

Is there something like a "high risk group" or "high risk factors" for meningitis?[/color]

 

"high risk" is defined as any condition for which the body is either (1) frequently exposed; or (2) cannot fight infection properly; or (3) certain group for which there is a peculiar exposure.

 

For THIS type of meningitis:

 

(1) would include groups 2 and 3 above. This covers medical/scientific populations who work with the bacteria and therefore are frequently exposed. Dormitory conditions which promote large numbers of people in close proximity on a daily basis - college, military, etc. Also travelers to and residents of places where the disease is endemic.

 

(2) cannot fight disease because the spleen has been lost (for any reason). This will include people born without a spleen, loss of spleen through car accidents, etc., surgical removal for any reason, certain diseases which cause splenic dysfunction - e.g. cancers, sickle cell anemia. Certain deficiencies in the disease-fighting blood substances, e.g. certain white blood cells and other components of the immune system. Simply being HIV+ doesn't qualify as the immune system may still be intact tho being HIV+ is not a reason NOT to vaccinate (e.g. age group 11-16 yrs need vaccine yet still could be HIV+).

 

(3) is the group we are talking about - MSM. It would certainly depend on your level of promiscuity or simply proximity of large groups of gay men - e.g. White Party, etc. are HUGE, wall-to-wall numbers of gay men. The source of the spread in these cases is unknown- usually respiratory, as in dormitories, etc. but it could be direct or very close contact (e.g. the bacteria resides in the nose and throat).

 

There are other types of meningitis, viral and bacterial, but this type going around is caused by the meningococcal bacteria (Neisseria meningitidis).

 

Hope this helps...

[leigh.bess.toad]

(3) is the group we are talking about - MSM. It would certainly depend on your level of promiscuity or simply proximity of large groups of gay men - e.g. White Party, etc. are HUGE, wall-to-wall numbers of gay men. The source of the spread in these cases is unknown- usually respiratory, as in dormitories, etc. but it could be direct or very close contact (e.g. the bacteria resides in the nose and throat).

 

Thanks funguy. That is my concern with the White Party. As I pointed out, last year's outbreak (and I use that term advisedly and only because epidemiologists specifically used it last year and have not this year) occurred after White Party. And if there is already a bacterial infection in the population in SoCal that is most likely to attend, I just think it is something that attendees need to be aware of. I am concerned that people are treating it as if it were an STD and it isn't. As you point out, it comes from being in close proximity to a carrier. Which is why it is almost universal that all college students living in dorms receive the vaccine before being allowed to enter the dorms. This policy for meningitis vaccination for college dorms is within the last 10 years or so. And has worked its way down into high schools and below now.

 

I guess one question you could address if you would is the one that Gman sort of raised -- if someone were to get the vaccination today, how much efficacy would it have in 3 weeks when the White Party occurs? If I remember from when I got mine last year, my PCP said something like a month, but I could be mistaken.

 

The real problem with bacterial meningitis is that the symptoms can come on so quickly and can mimic something less severe and suddenly explode and then are are at a point of no return. In otherwise healthy young people. That was the case of Brett Shaad last year. As it has been with the outbreaks on college campuses I have read about. Which is why public health officials take meningitis outbreaks so serious.

 

Thanks for the info funguy. I appreciate the knowledge.

[Mark Gordon]

Thanks for the excellent info guys. The vaccine is available for free on demand in Canada. Just ask your doctor to have it in stock before your appt. I got mine during last year's outbreak.

[+ Funguy]

Lee - you are right, it takes 3-4 weeks for full protection. Sort of like the Flu vaccine - it takes 2-3 weeks and when you are exposed before the vaccine works, you blame your case of flu on the shot!

 

Truthfully, if one were to go the White Party, I'd be real careful who you kiss (mouth and nose are in proximity)! Carriers harbor it in the nose and throat and have NO symptoms, hence the term "carrier". It's not an STD in the classical sense; but, guess what!

 

Meningococcal meningitis can proceed from nothing to death (or worse, in my opinion) in the space of a few hours. As a resident in infectious disease, I had the misfortune to diagnose and care for several adults and kids with this form of meningitis and NONE had an outcome which would be acceptable to me.

 

Glad I could be of service.

 

Be careful out there…..but still enjoy!

 

Funguy