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LAC DPH Health Advisory:
Florida Meningococcal Outbreak in Gay, Bisexual, and Other MSM and Vaccine Recommendations for LAC
May 26, 2022
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This message is intended for HIV, infectious disease, primary care, emergency medicine, and urgent care providers.
Please distribute as appropriate.
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Key Messages
- There is a large outbreak of invasive meningococcal disease (IMD) primarily among gay, bisexual, and other men who have sex with men (MSM) in Florida.
- All MSM, regardless of HIV status, should receive at least one dose of meningococcal conjugate (MenACWY) vaccine.
- Consider a booster dose for MSM who received MenACWY vaccine ≥ 5 years ago.
- All HIV-infected adults should receive two doses of MenACWY vaccine at least 8 weeks apart and a booster dose every 5 years for life.
- Free vaccination is available for all persons who are uninsured and underinsured.
- Meningococcal vaccines can be given at the same time as a COVID-19 vaccine.
- Healthcare providers and laboratories must report all IMD suspect cases to LAC DPH immediately.
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Situation
In April 2022, the Centers for Disease Control and Prevention (CDC) reported a large, ongoing outbreak of serogroup C, invasive meningococcal disease (IMD) in Florida, primarily among gay, bisexual, and men who have sex with men (MSM), including those living with HIV. This outbreak is mostly affecting people who live in Florida but has also affected some people who have traveled to Florida. The CDC is encouraging gay, bisexual, and other MSM (with or without HIV) to receive a meningococcal conjugate (MenACWY) vaccine if they live in Florida and discuss getting the vaccine if they plan to travel to Florida.
The most recent serogroup C IMD outbreak in Southern California occurred between 2016-2018 with cases in 6 local health jurisdictions. There were 19 cases, including 3 deaths among Los Angeles County (LAC) residents (unpublished data). The majority of LAC cases were MSM (58%) and 21% were HIV-positive. At that time, in addition to reiterating the 2016 Advisory Committee on Immunization Practices (ACIP) recommendations for meningococcal vaccination of all HIV-infected persons age 2 months and older, the LAC Department of Public Health (DPH) recommended MenACWY vaccination for all MSM, regardless of HIV status or other risk factors.
Due to the ongoing outbreak in Florida as well as crowded gatherings associated with upcoming Pride events, there is heightened risk of IMD among gay, bisexual, and other MSM. LAC DPH reminds and encourages providers to ensure MenACWY vaccination for all gay, bisexual, and other MSM living in LAC. Because meningococcal vaccine induced immunity wanes, a booster dose can be considered for MSM previously vaccinated ≥ 5 years ago. HIV-infected adults who were vaccinated ≥ 5 years ago should receive a booster dose.
Effective antibiotics should be administered to patients promptly upon suspicion of IMD. Of note, CDC has reported multiple cases of penicillin- and ciprofloxacin-resistant meningococcal infection in the United States, including a recent case in California. Providers should conduct antimicrobial susceptibility testing (AST) to determine susceptibility of all meningococcal isolates to penicillin before changing from empirical treatment with cefotaxime or ceftriaxone to penicillin or ampicillin. AST may also help inform post exposure prophylaxis (PEP) decisions; however, this should not delay initiation of PEP with ciprofloxacin, rifampin, or ceftriaxone.
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Actions Requested of Providers
- Ensure all gay, bisexual, and other MSM patients have received at least one dose of the MenACWY vaccine. If they were last vaccinated ≥ 5 years ago, consider a booster dose as meningococcal vaccine immunity wanes.
- Vaccinate all HIV-infected MSM with 2 doses of MenACWY vaccine at least 8 weeks apart and a booster 5 years later and every 5 years thereafter throughout life.
- Consider administering MenACWY vaccine at a COVID-19 vaccine visit. COVID-19 vaccine may be administered without regard to timing of other vaccines. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day, at a single visit. See Coadministration of COVID-19 vaccines with other vaccines.
- Report all suspect cases of IMD immediately to LAC DPH.(See Reporting and Public Health Response below).
- Request antimicrobial susceptibility testing (AST) on N. meningitidis isolates to guide treatment and prophylaxis.
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Available Meningococcal Conjugate Vaccines
Three brands of MenACWY vaccine are licensed and available in the United States:
- MenACWY-CRM (Menveo)
- MenACWY-D (Menactra)
- MenACWY-TT (MenQuadfi)
Although each MenACWY vaccine formulation uses a different protein conjugate, the products are considered interchangeable in persons ≥2 years of age. The same vaccine product is recommended, but not required, for all doses. See CDC Meningococcal Vaccine Recommendations
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Free Meningococcal Vaccine at DPH
LAC DPH continues to provide meningococcal vaccine at no cost for persons who are uninsured and underinsured at DPH public health clinics. The location and hours of DPH clinics are listed at: The location and hours are of DPH clinics are listed at: http://publichealth.lacounty.gov/chs/NurseClinic.pdf.
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Reporting and Public Health Response
Healthcare providers and laboratories must report all IMD suspect cases to LAC DPH immediately. Suspect cases include those with clinical suspicion of IMD or evidence of gram-negative diplococci on gram stain. Laboratory confirmation is not required to report. See reporting information below.
LAC DPH conducts case and contact investigations for suspect meningococcal disease reports in Los Angeles County. Preventive antibiotics are provided to close contacts of IMD cases.
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Contact Information for Questions and Reporting
Los Angeles County DPH Acute Communicable Disease Control:
- Weekdays 8:30am–5pm: call 213-240-7941.
- After-hours: call 213-974-1234 and ask for the physician on call.
Long Beach Health and Human Services:
- Weekdays 8am-5pm: call 562-570-4302.
- After hours: call the duty officer at 562-500-5537.
Pasadena Public Health Department:
- Weekdays 8am-5pm: call 626-744-6089.
- After hours: call 626-744-6043.
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Additional Meningitis Resources
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This Advisory was sent by Dr. Sharon Balter, Chief, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health.
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