By Kristina Krohn, NBC News
A
deadly bacterial meningitis outbreak striking gay men in New York City
is unlikely to abate any time soon, New York City health officials warn.
The disease has sickened 22 and killed seven NYC men over the last two
years.
After four cases of meningococcal disease among gay men
were reported in Los Angeles county in recent months, there were
concerns that the New York City outbreak had spread, but public health
officials in Los Angeles and New York say the strains are not connected.
The
New York City outbreak has been linked to parties, online websites or
apps that men used to find other men for "close or intimate sexual
contact," according to health officials. But for more than half of the
men sickened by meningitis, there was no evidence that the men had used
any of these means to encounter other men, according to public health
officials.
The specific strain linked to all the cases in New York
City is part of serogroup C. It’s the same strain that first surfaced
when a woman came down with meningitis in New York City back in 2003.
The speed in which meningitis kills has complicated the search for
people at risk.
In New York, “we’ve had several cases who have
been actually found dead in their apartment before they’d even gone to
see a medical provider. So that is, to us, absolutely terrifying," Dr.
Jay Varma, the New York City Deputy Commissioner for Disease Control in
the Department of Health and Mental Hygiene, told The Edge Boston in early March.
Last week, health officials in West Hollywood, Calif. warned members of the public to
be alert after the death of Brett Shaad, 33, from meningitis infection.
Three other cases of meningitis, including two deaths, had been
identified among Los Angeles-area gay men since November.
Public
health officials in Los Angeles are being careful not to cause alarm.
“Right now we do not have an outbreak of meningococcal disease in LA
County,” Dr. Jonathan Fielding, director of Public Health for the Los
Angeles County Health Department, told NBC, citing outbreak definition
requirements from the Centers for Disease Control and Prevention.
Shaad,
an otherwise healthy lawyer, died within a week of developing symptoms.
Elizabeth Ashford, a spokesperson for the family, expressed concern
that the fact that Shaad was gay has been used to unfairly target him
and others affected with meningitis. Allegations that Shaad was involved
in any parties or other risqué activity are false, Ashford said. “This
is not a gay disease, but this is a deadly disease and that is why
people should be conscientious about this disease,” she said.
Initially, meningitis symptoms
may resemble the flu, with worsening headache, vomiting, and a sudden
high fever (over 101.3). Over hours to days, patients develop difficulty
thinking and may fall into a coma.
Meningococcal disease, caused by the bacteria
Neisseria meningitidis,
infects the lining around the brain. Once someone becomes sick, without
treatment it is always fatal -- even with treatment, up to a third of
patients die, Fielding said. There is a vaccine that can prevent
illness, and both the Los Angeles County Department of Public Health and the New York City Department of Health and Mental Hygiene have listed clinics offering free vaccines on their websites.
Varma
is concerned the outbreak is getting worse. There were a total of
thirteen known cases of bacterial meningitis among men last year (triple
the total in 2011). But already in the first three months of 2013, four
men have been hit, not including Shaad and others in Los Angeles.
“Normally
people think of an outbreak as a lot of people getting sick at one
point in time – but here the number of cases is much higher than we
normally expect,” said Varma.
The rate of meningitis in gay men in
New York City has spiked to 60 times higher than their straight
counterparts. Last fall health officials advised vaccination for some
HIV-positive men, but recently expanded the recommendation to include
all gay men statewide who have “traveled to the City” and “met through
an online website, digital application ("app"), or at a bar or party”
since September 1, 2012.
“Many people are scared,” said Anthony
Fortenberry, the director of nursing at Callen-Lorde Community Health
Center, which serves New York’s lesbian, gay, bisexual, and transgender
communities.
Reports of a strange illness affecting gay men in two
major cities may conjure images of the early years of AIDS -- as well
as the stigma that surrounded patients with HIV. But experts are quick
to note the differences, especially since meningitis infection can be
stopped.
Dr. Mike Osterholm, the director of the University of
Minnesota’s Center for Infectious Disease Research and Policy,
understands the “fear factor,” but “this is very different,” he said.
“With HIV/AIDS we never had the hope of eliminating it, we didn’t even
know what was causing it initially. This, we know what is causing it. We
have vaccines and antibiotics that can greatly reduce or eliminate
carriage,” and stop the spread of the disease, Osterholm said.
At
first, the meningitis outbreak in New York City seemed to infect only
HIV positive men, but by March half of the men sickened were HIV
negative. Three of the last five men sickened have died.
It is
unclear why the current outbreak,
so far, is affecting only gay men.
Only two of the men knew each other and there is no evidence they
infected each other, Varma said.
“Many of the outbreaks happen in
settings where a lot of people live or socialize together, like college
dorms or army barracks,” Osterholm said. “When an outbreak occurs in
one of these settings, health officials can track down everyone who
lives in the setting, can vaccinate them and provide prophylactic
medications.”
Getting the vaccine is not "outing" yourself. “It
does not mean you are gay or that someone you know is gay. It is about
protecting yourself,” said Fortenberry.
Osterholm agreed. “This has nothing to do with being gay,” he said.
The bacteria is spread by close contact – such as kissing, or sharing a toothbrush, a cigarette or even a coffee cup.
To
date an estimated 6,700 people have been vaccinated in New York City
since the start of the outbreak;1,182 people in March alone.
The
Centers for Disease Control and Prevention currently recommends that
children and teenagers get vaccinated but immunity wanes, leaving most
adults unprotected.
Varma warns that the outbreak will likely
continue until at-risk men get vaccinated. People interested in getting
vaccinated can find clinics through a website run by New York City’s department of health. In Los Angeles, locations for free vaccines for the uninsured can be found here.
Kristina
Krohn, MD, is an Internal Medicine and Pediatrics Resident at the
University of Minnesota and the 2012-2013 Stanford NBC News Media and
Global Health Fellow.
