Meningitis in Chicago

Concern for gay, bisexual and transgender community
By Scott Warner

Meningitis can affect everyone, but the current outbreak in Chicago is among gay and bisexual men, particularly those who are living with HIV,” says Sarah Kemble, MD, medical director for the Chicago Department of Public Health’s (CDPH) Communicable Disease Program. Dr. Kemble expressed her concern following the CDPH’s announcement in April that two new cases of meningococcal meningitis have been identified in Chicago men. This means that there are now nine confirmed cases from the Chicago area linked to last summer’s outbreak, all in men who have sex with men (MSM), including one related death last June.

Since May 2015, CDPH has distributed nearly 18,000 vaccinations, of which more than14,000 have been administered. With these two new cases identified, CDPH is increasing efforts to raise awareness and making affordable vaccines available across the city, while focusing primarily on MSM, the population which is most affected. “Meningitis still poses a serious threat to all men who have sex with men in Chicago and if they have not been vaccinated within the last five years, they could be at risk,” says CDPH Commissioner Julie Morita, MD. “We are continuing our partnership with more than 80 community and clinical advocates to provide free and low-cost vaccinations to protect our most vulnerable residents.”

Though anyone can contract meningococcal meningitis, African-American MSM and men living with HIV continue to be disproportionately affected by this outbreak, says Magda Houlberg, MD, chief clinical officer of Howard Brown Health. “That’s why we recommend to our clients and the gay, bisexual, and transgender community as a whole to get vaccinated to protect themselves and reduce the chance that they can be infected with something as deadly as meningitis. We’d like to provide a ‘herd immunity.’”

Recommendations from CDPH

CDPH has also released a health alert to Chicago’s medical providers about the ongoing outbreak to remind them of CDPH’s vaccination recommendations for the impacted community. CDPH recommends that all men who have sex with men get vaccinated against meningitis. All MSM who are living with HIV will need two vaccinations at least eight weeks apart. Low-cost vaccinations are available at 80 locations around the city. “The vaccine is safe, effective and available free of charge at CDPH clinics. It is also available at most doctors’ offices, clinics and CDPH partner clinics, including many Walgreens, though some partner sites might request a co-pay,” says CDPH’s Dr. Kemble.

She suggests that physicians ask patients who may be at higher risk for meningitis about their sexual history. “Develop a rapport with them, so they feel comfortable. Ask them if they know about the Chicago outbreak, and start a conversation. Ask them about having sex with other men, or even about being intimate with other men, like sharing drinks or cigarettes—it doesn’t have to be sexual contact for the disease to spread.”

Physicians who are caring for patients they suspect of being infected with meningococcal meningitisor who have confirmed infections should contact CDPH at 312-746-6034 or 312-746-6088, or call 311 and ask to speak to the CDPH physician on call. For more information about meningitis or the services offered by the Chicago Department of Public Health, you can also visit the CDPH website at: www.cityofchicago.org/health.

Educating the Community

Invasive meningococcal disease is a rare but severe bacterial infection that results in serious illnesses including meningitis. Signs and symptoms of meningitis include fever, headache and a stiff neck. This might be accompanied by nausea, vomiting, increased sensitivity to light and general confusion. For those who are unvaccinated and contract the bacteria, symptoms appear three to seven days after exposure. Unfortunately, symptoms are vague and difficult to recognize, and the patient may be in intensive care within 24 hours after symptoms first appear. People can lose limbs, suffer sepsis, as well as neurological defects, and death. Even with antibiotic treatment, at least one in ten people who develop this form of meningitis are expected to die from it.

CDPH will continue addressing multiple aspects of the outbreak including making sure that close contacts of infected individuals receive appropriate preventive measures; educating healthcare providers about diagnosis, treatment and prevention measures; distributing vaccine to healthcare providers; and continuing to educate gay and bisexual men about their need to be vaccinated.