by Mike Andrew -
SGN Staff Writer
How worried should we be about meningitis? The short answer is 'not very.' A longer and more complete answer is also a little more complicated.
Certainly media coverage of the recent meningitis outbreak in New York City, and an even more recent death in West Hollywood, have focused the community's attention on what had been a relatively obscure disease, and for many Gay men, it has called to mind the early stages of the AIDS epidemic.
However, meningitis progresses in a much different way than HIV, and fears of a new meningitis epidemic may be overblown.
DEFINING THE PROBLEM
Meningitis is an inflammation of the membranes covering the human brain and spinal cord, called the meninges. While we use the single name 'meningitis' to describe this condition, it has several possible causes.
One common type is viral meningitis, which can be caused by several strains of virus, including HIV. A fungal infection, cryptococcal meningitis, is closely associated with HIV/AIDS, and is, in fact, the immediate cause of 20% to 25% of AIDS-related deaths in Africa.
Bacterial meningitis, caused by Neisseria meningitides bacteria, can be much more dangerous, and this is the type of meningitis found in both the New York City and West Hollywood cases.
Symptoms commonly include severe headache, stiffness or rigidity of the neck, high fever, mental confusion, sensitivity to light, and sometimes a distinctive skin rash. There may be inflammation of the brain itself or its blood vessels, and the infection may lead to sepsis.
While the disease can be fatal, meningitis patients respond very well to antibiotics, especially if they are administered soon after infection, and there are standard vaccines that can prevent the disease.
A RARE DISEASE
According to Dr. Jeffrey Duchin, chief of the Communicable Disease Epidemiology and Immunization Section at Public Health Seattle-King County, cases of bacterial meningitis are very well-documented, but also very rare.
'Viral meningitis is less severe and it's not reportable [to public health officials],' Duchin told SGN, 'but bacterial meningitis, which spreads from person to person, is reportable. That's required in almost every state - so we have very complete reporting.
'In King County we've had only one case this year, and that was a child. In 2012 we had four cases total, two of them adults, and in 2011 we had eight cases.
'Even in New York City, where we're talking about an 'outbreak,' Duchin continued, 'it's only 22 cases since 2010, and only three cases this year.'
While individual cases are well-documented, it can be very difficult to trace a chain of infection, Duchin noted.
'The bacteria are out there all the time,' he said. 'Most of the time, it's what we call 'sporadic' cases, and we never have an explanation.
'When outbreaks occur, sometimes you can trace a connection. There might be some sub-population that's at higher risk. In the New York City outbreak, there's one specific strain of Neisseria that's involved in all the cases, so you can say there's an association. There's a group of individuals who are at higher risk because they're in the same social circle or they share common behaviors.'
HOW DO GAY MEN GET IT?
Neisseria meningitides lives in human mucus and saliva, and is transmitted through those media. Since it does not live in semen, pre-come, fecal matter, or other human secretions that might be exchanged during sex, it is not considered an STD (although saliva can be exchanged during sex through kissing).
According to the New York City Public Health Department, the city's outbreak resulted from 'sexual encounters between men who meet through websites or smartphone apps, or at bars or parties ...'
There are also other situations where Gay men might commonly encounter Neisseria, Duchin said.
'It's transmitted through saliva,' Duchin told SGN, 'so if you're in a bar, and it's noisy, and you're trying to have a conversation, you speak loudly, you might accidently spit on someone, or if you're singing, especially if there's an 'outbreak situation' like there is in New York City.'
Close day-to-day contact, not necessarily sexual, can also be a factor. For example, college students who are going to live in dorms are often urged to get meningitis vaccinations, because sharing eating utensils or drinking glasses, or even living in close quarters, may spread the Neisseria bacteria.
NOT LIKE HIV
One of the reasons this has become a national news story is that so many people remember the early days of the AIDS epidemic, when the disease swept almost unchecked through the community.
'The lesson we learned 30 years ago in the early days of HIV and AIDS is that people were not alerted to what was going on and a lot of infections occurred that didn't need to occur,' said openly HIV-positive West Hollywood City Council member John Duran, at a recent press conference.
'So even with an isolated case here, we need to sound the alarms, especially given the cases in New York.'
However, bacterial meningococcal infection does not progress in the same way as HIV. One of the problems with HIV infections has always been that an individual could become infected but not be symptomatic for a very long time. All during that period, he could be unknowingly infecting others - one person could infect three, those three would infect nine, those nine would infect 81, and so on, with the number of infections increasing geometrically, before anyone was even aware they had contracted the disease.
With bacterial meningitis, on the other hand, the disease progresses very rapidly. According to Duchin, 'someone could show symptoms within two to four days [after infection], a week to 10 days at the outside.'
In the West Hollywood case of Brett Shaad, for example, he experienced symptoms on a Monday, was diagnosed on Wednesday, and was brain-dead by Friday.
The two other reported West Hollywood fatalities occurred in December last year, within a few of days of each other: an unidentified San Diego State University student died on December 10, and Rjay Spoon died on December 18. It is possible that the two December fatalities were related, although no evidence suggests they were, but it is not possible that they were related in any way to Shaad's death.
In short, because Neisseria meningitides is aggressive, develops rapidly, and is often fatal, it is also self-limiting and does not have the potential to give rise to chains of infections in the way that HIV does.
ARE HIV+ MEN AT RISK?
According to Duchin, 'it's possible' that HIV-positive men might be at somewhat greater risk for meningitis infections because of their compromised immune systems.
'People with AIDS would certainly be at risk,' Duchin added, 'but the overall risk would still be very low. We're talking about a couple of cases per 100,000.'
Even with the increased risk, 'antibiotics are very effective in treating the disease,' Duchin said, 'and they would reduce the risk' for HIV-positive individuals.
IS VACCINATION NEEDED?
New York City's Department of Public Health has now recommended meningitis vaccinations for all Gay men regardless of HIV status in the city's five boroughs. In West Hollywood, the AIDS Healthcare Foundation (AHF) is offering free vaccinations at several locations. On the first day, AHF served more than a thousand patients.
On the other hand, Duchin insists, 'There is absolutely no reason for Gay men in King County to get vaccinated.
'People in New York City in an at-risk group need to be concerned, but the vast majority of Gay men, no. If you plan to travel to New York, and you plan to engage in the same behaviors, then you might think about [getting vaccinated] but ordinarily, no.
'It's not good medical practice to recommend unnecessary procedures,' he continued. '[Vaccination] is not routinely recommended. You have to have a reason for it. For example, we recommend it for adolescents, or for lab workers who might be exposed to certain bacteria or viruses ...
'Public Health wouldn't be doing vaccinations at this time. People might be able to get [the vaccine] from a private doctor.'
Duchin urged anyone who exhibited any of the common symptoms of meningitis to seek immediate medical attention.
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