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No changes proposed to meningococcal vaccine recommendations for MSM

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The Meningococcal Vaccines Work Group of the Advisory Committee on Immunization Practices does not propose any changes to meningococcal vaccine recommendations for men who have sex with men or people with HIV.

Among MSM, outbreaks of meningococcal disease have been reported, the latest of which was in New York City, spanning from August 2010 to February 2012, according to Jessica MacNeil, MPH, an epidemiologist at the CDC. There were 22 cases, and 55% were HIV-positive. Other cases of meningococcal disease in MSM were identified in Los Angeles County from December 2012 to April 2013, and there were sporadic cases as well.

“Outbreaks of meningococcal disease do occur among MSM,” MacNeil said during the ACIP meeting. “A small increase in risk was identified in areas where only sporadic cases were reported and overall burden of disease was low. In addition, a high proportion of cases among MSM were also HIV-positive.”

Although HIV is an established risk factor for several bacterial infections, the limited incidence of meningococcal disease among those with HIV made evaluating the risk challenging, MacNeil said. Data from the CDC’s Active Bacterial Corp Surveillance (ABCS) system indicate that the incidence of meningococcal disease among people with AIDS was 3.48 per 100,000 vs. 0.28 per 100,000 among those without AIDS, for a risk ratio of 12.6. According to MacNeil, among those with HIV, those with meningococcal disease were more likely to have a low CD4 count and a higher viral load.

In a measure of the meningococcal vaccine effective among people with HIV, there was a meager increase in antibody titers to both serotype C and serotype Y among adolescents with HIV who received the vaccine, and the response was lower for those with a low CD4 count or high viral load. The responses also waned, even after the second dose for those who received two doses.

“There is modest increase in absolute risk of meningococcal disease among people with HIV,” MacNeil said. “Given the current incidence of meningococcal disease and HIV infection in the United States, the total number of meningococcal disease cases in people with HIV is likely low and the duration of protection from the vaccine is short.”