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Meningococcal Disease in Men who have sex with Men

15 July 2013

Situation

Between August 2010, and February 2013, an outbreak of invasive meningococcal disease (IMD) (serogroup C) has been reported in New York City amongst Men who have Sex with Men (MSM). To date there have been 22 cases, with 7 deaths recorded. In response, the New York City Health Department has been recommending vaccination for groups at particularly high risk, since September 2012.

In June 2013, France reported 3 cases of serogroup C IMD in adult MSM. Subsequently Germany has reported 3 cases of serogroup C IMD from February and May 2013, of which two have died. None of the French or German cases had epidemiological links to each other or the New York City outbreak. Preliminary strain analysis has demonstrated that the French and German cases have a similar phenotype (but not identical genotype) to those in the New York City outbreak and this strain has been associated with sporadic cases and outbreaks in Europe and the USA.

The European Centre for Disease Prevention and Control (ECDC) has carried out a rapid risk assessment of the situation and recommended enhanced surveillance at the European level, particularly over the summer period with on-going Gay Pride and other festivals, to detect possible spread quickly and to co-ordinate any required response. Public Health England last week issued a briefing letter to Sexual Health and HIV physicians caring for MSM via the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA).

UK Context

IMD caused by serogroup C is now rare in the UK. Vaccination against N. meningitidis serogroup C using monovalent serogroup C conjugate (MenC) vaccine has been offered since 1999 and is currently available for all individuals under 25 years. As coverage in the campaign was very high (>85%), almost all the UK young adult population (up to 35 years old) will be highly protected against serogroup C IMD.

There is currently no evidence of either increased levels of serogroup C IMD amongst MSM in the UK or increased risk to UK-born MSM from travel to Europe or to the USA. Therefore there is no indication for a change of vaccination policy or clinical practice.

Vaccine Recommendations (including for Travellers)

  • Individuals who are under 25yrs and have not received a meningococcal C vaccine should be offered vaccination in line with national recommendations.
  • MSM aged 25 years and over who are travelling to New York City, or to one of the Gay Pride or other festivals in Europe this summer and who have not received a meningococcal C containing vaccine, may wish to discuss their individual risks with their healthcare provider and consider the need for travel vaccination. Travel in itself is not a risk, but factors associated with the New York City outbreak included being HIV positive and having regular intimate contact with multiple male partners met through a website, smartphone application, bar or party.
  • Vaccination for the ≥25 year old traveller should be charged to the individual (private prescription) since it is not covered by national policy recommendations.
  • If considering travel vaccination, either MenC vaccine or one of the quadrivalent meningococcal vaccines can be used. However, MenC vaccine may be difficult to obtain privately.
  • Further information on available meningococcal meningitis vaccines can be found here.
  • All cases of invasive meningococcal disease should be notified to the local Health Protection Team.

For further country specific travel health advice please refer to the appropriate page on TRAVAX.

Resources

1. Rapid risk assessment: Invasive meningococcal disease among men who have sex with men. European Centre for Disease Prevention and Control. July 3 2013. http://www.ecdc.europa.eu/en/publications/Publications/rapid-risk-assessment-invasive-meningococcal-disease-among-MSM.pdf

2. Immunisation against infectious diseases: the Green Book. Public Health England. https://www.gov.uk/government/organisations/public-health-england/series/immunisation-against-infectious-disease-the-green-book