SFDPH Health Advisory: Chicago Reports Invasive Meningococcal Disease among Men Who Have Sex with Men; Recommendations for San Francisco June 18, 2015 Public Health, SF Dept of Public Health IMD, invasive Serogroup C meningococcal disease, meningococcal disease, SFDPH health advisory 0 The Chicago Department of Health reported a cluster of invasive Serogroup C meningococcal disease (IMD) among men who have sex with men (MSM) since mid-May 2015. Characteristics of cases include HIV-positive status and the use of digital apps to meet sexual partners. Chicago DPH has recommended meningococcal vaccination for local HIV-positive MSM, as well as for local MSM regardless of HIV status who have close or intimate contact with multiple partners, or who seek partners through the use of digital applications. The San Francisco Department of Public Health (SFDPH) has been closely monitoring IMD locally. There have been no cases of IMD reported among San Francisco MSM since 2011. IMD is transmitted by close or intimate personal contact. Individuals who wish to reduce their risk of contracting meningococcal disease should consult with their provider regarding vaccination and modification of risk behaviors. Serogroup C is contained in the currently available meningococcal conjugate vaccines; however, vaccination is not 100% effective in preventing IMD. Actions requested of SF clinicians Meningococcal vaccination should be offered to San Francisco MSM and male-to-female transgender persons, regardless of HIV status, who expect close or intimate contact with MSM currently residing in, or traveling from Chicago. To achieve protection, vaccination should be completed at least 7-10 days prior to potential exposure. Increased travel and events such as festivals during the summer and fall may increase exposure risk. Immediately report all San Francisco residents with suspected or confirmed meningococcal disease to the 24/7 Communicable Disease Control Unit (CDCU) of SFDPH at (415) 554-2830. Page the on-call physician if after hours. Do not wait to report until the diagnosis is culture-confirmed; any delay in reporting compromises the ability to identify close contacts and ensure they receive timely antibiotic prophylaxis. SFDPH can assist with coordinating Polymerase Chain Reaction (PCR) testing if needed. Invasive Meningococcal Disease Background and Transmission IMD results from Neisseria meningitidis bacteria which can cause meningitis (infection of the tissues surrounding the brain and spinal cord) or septicemia (infection of the blood). Even if diagnosed early and treated with appropriate antibiotics, IMD still sometimes results in death, permanent brain damage, hearing loss, or kidney failure. Symptoms usually occur 1-10 days after exposure, and often within 4 days. IMD is transmitted by contact with spit, phlegm, mucus, or other fluids from the nose or mouth of someone who already has, or is in the process of developing, meningococcal disease. Typically this occurs from kissing, intimate or sexual contact, sneezing or coughing, living in a crowded space together, or sharing drinks, cigarettes or eating utensils with someone who is infected (who may not show signs of disease). Clinical Description – Prompt Recognition of Cases is Key Prompt recognition and antibiotic treatment of meningococcal disease is critical. Symptoms of meningitis may include sudden onset of fever, headache, and stiff neck, accompanied by nausea, vomiting, photophobia, and altered mental status. Symptoms of septicemia may include fatigue, nausea, vomiting, cold hands and feet, chills, severe muscle aches or abdominal pain, rapid breathing, diarrhea, and a petechial or purpuric rash. The following may be helpful in making the diagnosis: A thorough examination of the skin, conjunctiva and pharynx for petechiae, with particular attention to pressure zones beneath clothes, the palms and the soles Severe muscle or abdominal pain, particularly when there is no apparent alternative etiology Blood pressure values that are in the normal range but are actually low considering the heart rate, temperature, and severity of illness (e.g., BP 100/60 with a heart rate of 140) Platelet counts between 100,000-150,000/mm3 While any one finding does not necessarily indicate IMD, the constellation of findings warrants closer scrutiny and consideration of antibiotic therapy. Antibiotics should not be delayed to obtain diagnostic specimens. Vaccination and Other Prevention Measures One dose of meningococcal conjugate vaccine (Menactra® or Menveo®) is recommended for most adults at increased risk of IMD. Persons with HIV should receive a 2-dose primary series, administered 8-12 weeks apart, as evidence suggests that persons with HIV may not respond optimally to a single dose. While highly effective, vaccination is not 100% effective. Those wishing to further reduce their risk of contracting IMD should consider avoiding contact with spit, phlegm, mucus, or other fluids from the nose or mouth of other persons, especially persons not well known to the individual. In addition, vaccine efficacy wanes over time; adults with ongoing increased risk of IMD are recommended to receive a booster dose every 5 years. Click here to view the updated SFDPH Meningococcal Disease health advisory. Comments are closed.
