Bacterial Meningitis In Gay Men

There have been a series of small meningitis outbreaks in Los Angeles and New York over the past two years.

Meningitis is spread by close casual contact.  Kissing, sharing utensils and glasses, and other activities that put people in contact with saliva is the generally established route of transmission of the bacteria that causes meningitis.  While the CDC states that the disease is not spread by breathing in the micro-organism, unlike influenza, I am certain that every CDC physician who was on an airplane with someone who had meningitis would be sure to seek treatment.

Meningitis when untreated is rapidly fatal in the vast majority of people.  Early treatment can bring the fatality rate down to 15% or so. From exposure to death or resolution, the time frame is a few days or so.  So when there is an outbreak of meningitis, it is typically very short-lived.

There are outbreaks that occur still, though, because the bacteria that causes the disease lives in the noses/throats of about one in ten people.  The bacteria either mutates to become more virulent or people have lesions in their nose or elsewhere that allows the bacteria to infect the central nervous system.

Most people under 30 were required to get vaccinated for school.  The vaccine is very effective and provides protective immunity in 80-90% of people after a single dose.  The manufacturer of the vaccine states that only a single dose is needed.  The CDC states that protective antibody levels wane after five years or so.  The safety bar for vaccines is very, very high, and there is little risk involved in getting a booster of the meningitis vaccine.

Being a man who has sex with other men seems to confer an increased risk of acquiring meningitis.  The several mini-outbreaks have been focused around gay bars.  Most of the people who have acquired meningitis have been HIV-positive, and it is possible that HIV infection makes the likelihood of exposure to the bacteria resulting in meningitis more likely, it’s also possible that there are just more HIV-positive men who went to the bars where the outbreaks occurred.

It is very important to realize that the absolute risk of acquiring meningitis is very, very small.  Since the introduction of the newer meningitis vaccine, the incidence of bacterial meningitis in the United States is less than one case per 100,000 people per year.

It is also important to recognize that the fungal meningitis outbreak that was the result of contaminated medications being injected directly into the spinal column of patients with back pain is completely different. I personally think that the press that the fungal meningitis outbreak received has made more attention be paid to the bacterial meningitis issue in gay men, which is probably not that dramatically different than it has ever been.

All that being said –

Getting a booster of the meningitis vaccine if one has not had the vaccine in the past five years or is unsure whether he has had it is a prudent and reasonable thing to do.



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