Between September and December 2004 there were seven cases of invasive disease due to N. meningitides group C in gay men in BC. Cases presented with meningitis and septicemia, and there was a high case-fatality rate (3 deaths; 43%). The patients were aged 23 to 62 years, and all were residents of or had visited the Lower Mainland prior to the onset of illness. No connections were found between the cases, suggesting the bacteria had become widespread in the gay population. At least five cases (56%) were known to have smoked marijuana or shared joints in the week prior to onset of illness.
The rate of disease in the gay population was estimated at between 13.9 to 48.4 cases per 100 000. This rate was sufficiently high to warrant a vaccination campaign to provide free meningococcal group C conjugate vaccine to all gay and bisexual men in BC. The program was announced through a media campaign and letters to physicians around the province. Vaccine was provided across the province through physician’s offices, public health clinics, and through outreach in gay bars and clubs. By January over 8000 doses of vaccine had been distributed (estimated to represent approximately 13% to 18% of the gay male population in BC).
In March and April 2005, there were two further cases of invasive meningococcal group C disease in gay men in BC, both fatal. These patients were not vaccinated in the earlier campaign. As a result, the meningococcal group C vaccination program for gay and bisexual men in BC is continuing, and a campaign to raise awareness of the need for vaccination among gay men is underway.
Background on N. meningitides group C disease
Patients with invasive disease (e.g., meningitis, septicemia) due to N. meningitides group C may present acutely with sudden fever, intense headache, nausea and vomiting, profound malaise, and/or a petechial rash. Infection may progress to confusion, coma, or death. The case fatality rate is 15%. Specific treatment involves intravenous administration of penicillin, with earlier administration of treatment associated with improved prognosis. The transmission of N. meningitides is by direct contact with saliva (saliva-sharing)—it is not normally sexually transmitted, although urethral infections may occur after oral sex. Approximately 5% to 10% of the general population carries the bacteria in their throat. Asymptomatic carriers can transmit the bacteria to others.
What do I tell my patient?
To prevent infection, all gay and bisexual men (including teenagers) seen in practice should be advised to receive the vaccine. Gay male patients who smoke marijuana and share joints may be at higher risk and should be encouraged to get the vaccine. Other saliva-sharing activities to discuss with patients include transmission through kissing, sharing water bottles, sharing cigarettes or drinks, and sharing eating utensils.
Information about the vaccine
The meningococcal group C conjugate vaccine (currently NeisVac-C) is recommended for all gay and bisexual men in BC and is available through the publicly funded immunization program from the local health department where you normally pick up vaccines. This vaccine is safe and effective in preventing invasive meningococcal group C infections. It is given in adults as a single dose of 0.5 mL IM given in the deltoid. The most common side effects of the vaccine are redness, swelling and/or pain at the injection site; side effects may also include headache, myalgia, or fever. Protective antibody levels are achieved by 10 to 14 days after vaccination, and the vaccine is thought to provide life-long immunity.
NeisVac-C is composed of meningococcal group C polysaccharide conjugated to a detoxified preparation of tetanus toxin and adsorbed onto aluminum hydroxide. The vaccine is not a live vaccine and can be safely given to immunocompromised individuals including those with HIV/AIDS. It is contraindicated in persons with a known hypersensitivity to a previous dose of the vaccine or to any component of the vaccine.
—M. Gilbert, MD, MhSc
S.T. David, MSc
M. Naus, MD, FRCPC
D. Patrick, MD, FRCPC
K. Pielak, RN, MSN
BC Centre for Disease Control
—R. Gustafson, MD, FRCPC
P. Daly, MD, FRCPC
Vancouver Coastal Health Authority
National Advisory Committee on Immunization. Statement on Recommended Use of Meningococcal Vaccines. Can Comm Dis Rep 15 Oct 2001;27:ACS-6. Available at www.phac-aspc.gc.ca/naci-ccni (accessed 26 April 2005).
Heymann DL. Control of Communicable Diseases Manual, 18th ed. Washington, DC: American Public Health Association; 2004.
Patrick DM, Champagne S, Goh SH, et al. Neisseria meningitides carriage during an outbreak of serogroup C disease. Clin Infec Dis 2003;37:1183-1188. PubMed Abstract
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