A new strain of bacteria causing a potentially lethal form of meningitis probably first appeared back in 2005 or 2006 among drug users in the Bronx. After disappearing for a while, it recently resurfaced in New York City. There have been over 20 cases–a number that appears to be climbing–and at least 7 deaths. For unknown reasons, the new strain of bacteria has primarily affected gay and bisexual men who have sex with men, regardless of HIV status. The disease spreads from person to person predominantly via intimate contact with bodily fluid; kissing and sexual intercourse are common modes of transmission, but even sneezing and coughing can spread the disease.
New Vaccination Recommendations
In response to this outbreak, and in the hope of limiting its scope, the New York Department of Health (NYDOH) recommends vaccination with the standard meningococcal vaccine for all men who have regular intimate contact with other men met through a website, app, or at a bar or party. The NYDOH also recommends meningitis vaccination for all HIV-positive men who have sex with men. Other communities, including San Francisco, recommend vaccination to men who plan to travel to New York and anticipate intimate contact with other men. These guidelines pertain regardless of any prior history of meningococcal vaccination. The vaccine is highly (albeit not 100 percent) effective, and can substantially reduce one’s risk of contracting the disease after exposure.
What Is Meningitis?
Meningitis is an infection of the tissues lining the brain and spinal cord. It has many causes, some of which are potentially lethal. Bacterial meningitis, particularly when caused by the bacteria meningococcus, and especially when caused by this new strain, can be very dangerous. If you suspect that you may be developing symptoms of meningitis, seek medical attention immediately, as the disease can prove fatal within hours. Go to an emergency room or call 911 if:
- You develop symptoms of meningitis
- Your symptoms do not improve with treatment
- You have been exposed to meningitis
Onset and Symptoms of Meningitis
Symptoms typically appear quickly after exposure, coming on within 1 to 5 days (and rarely, as long as 10 days), and beginning with fever, headache, confusion, and stiff neck. Other symptoms that may develop include nausea, vomiting, abdominal pain, diarrhea, light sensitivity, fatigue, chills, muscle aches, and a rash of dark purple spots, most commonly appearing on the trunk and legs.
None of these symptoms alone indicates a bacterial meningitis infection, but the sudden appearance of several of them together–particularly fever, stiff neck, headache, altered mental status, and rash–mandate immediate medical attention. The earlier an infected person is treated, the better the chances of a good outcome.
Meningitis Prevention and Treatment
Of course, preventing meningococcal meningitis in the first place is far preferable to treating it. It’s important to note that the vaccine only prevents disease; it doesn’t treat it. The NYDOH recommends a single dose of meningococcal vaccine (Menactra or Menveo) for people at risk; in addition, people with HIV should receive 2 doses 8 to 12 weeks apart. Because the potency of the immune response elicited by a vaccine wanes over time, revaccination is recommended every 5 years for individuals who continue high-risk behavior.
Treatment for meningococcal meningitis includes supportive care (e.g., IV fluids, blood pressure support, and respiratory support), usually in an intensive care setting, and intravenous antibiotics. Because it can take a while to identify the organism causing meningitis, antibiotics are the treatment of choice, as they address the most likely and dangerous pathogens, and can then be tailored to the specific organism once it has been identified. High doses of steroids may be part of the treatment course as well, as they have been shown to improve the patient’s neurologic outcome.
Finally, if you have been in close contact with a person who has meningococcal meningitis, you should get prophylactic doses of an antibiotic to reduce your risk of contracting the disease. Close contact applies to anyone living in the same household as the person with meningitis, or anyone else who may have come in contact with that person’s secretions, such as a partner or health care provider.