Invasive meningococcal disease risk sixfold higher for people with HIV
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Key takeaways:
- Between 2009 and 2019, people with HIV had a sixfold higher risk of invasive meningococcal disease.
- Many people with HIV (50%) had not received the recommended MenACWY vaccine.
People with HIV continue to have a higher risk for invasive meningococcal disease compared with people without HIV regardless of the 2016 recommendation that they be vaccinated against it.
“This analysis was a follow-up to a previous evaluation of invasive meningococcal disease (IMD) risk in persons with HIV to better understand how the declining incidence of IMD in the U.S., along with the 2016 Advisory Committee on Immunization Practices MenACWY recommendation for people with HIV, has affected IMD risk in people with HIV,” Gabrielle Cooper, DrPH, MPH, epidemiologist at the CDC’s National Center for Immunization and Respiratory Diseases, told Healio.
To better understand the incidence of IMD and how the 2016 routine quadrivalent meningococcal conjugate vaccine recommended for people with HIV has affected IMD risk, Cooper and colleagues evaluated cases of IMD reported between 2009 and 2019 within the Active Bacterial Core surveillance area among patients aged 13 and older. In total, 636 cases were reported — 16 of which were among people with HIV.
After comparing the incidence of IMD in people with HIV and people without HIV between 2009 and 2019, data showed a sixfold higher IMD risk among people with HIV vs. those without (0.96 vs. 0.16 cases per 100,000).
According to the study, most people with HIV had not received the MenACWY vaccine (50%) or had an unknown vaccination history (43.8%), with only one patient (6.3%) reporting previous MenACWY vaccination.
Additionally, five (31.3%) of the cases occurred after the 2016 ACIP recommendation for routine MenACWY vaccination in people with HIV. Of those five, four (80%) were unvaccinated and one (20%) had an unknown vaccination history.
“As persons with HIV continue to experience increased IMD risk, there is a growing importance of improving implementation of the ACIP MenACWY vaccine recommendation for people with HIV,” Cooper said. “There is also need for continued monitoring of IMD in people with HIV.”
Perspective
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This article reports the analysis of the CDC's Active Bacterial Core surveillance data regarding invasive meningococcal disease from 2009-2019. Of note the authors found a sixfold increase in the risk for invasive meningococcal disease in persons living with HIV compared with those without HIV infection.
Despite the relatively new availability of a quadrivalent meningococcal vaccine, and the 2016 US ACIP recommendation for routine quadrivalent meningococcal conjugate vaccination among persons with HIV infection, ages 2 months and up, there remain many unvaccinated persons living with HIV. The mortality rate of invasive meningococcal disease in this study was 18.8% in persons living with HIV, and a majority were still unvaccinated.
There remains a large opportunity to immunize many more persons living with HIV with the new quadrivalent meningococcal vaccine. Doctors providing medical care to persons living with HIV should focus efforts on encouraging their patients to take the available quadrivalent MenACWY meningococcal vaccine because these patients have a sixfold higher risk for invasive meningococcal disease than those not infected with HIV and because mortality from invasive meningococcal disease is still high (approximately 20%).
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