Meningococcal Disease Cases Roughly Doubled in Patients with HIV

A CDC Morbidity and Mortality Weekly Report (MMWR) published last week revealed an increase in meningococcal disease among individuals with HIV in 2022. The report estimated that, compared to cases in 2017–2021, patients in 2022 had doubled.

The report analyzed data from the National Notifiable Disease Surveillance System and the Enhanced Meningococcal Disease Surveillance. The data included information on epidemiology, the diseases’ serogroups, and molecular typing.

According to the data, from 2017 to 2021, meningococcal disease cases among patients with HIV ranged 5–15 per year. These cases accounted for 1.5–4.3% of incidences across all patients in the United States. However, in 2022, the surveillance information counted 29 meningococcal disease cases in people with HIV, accounting for 9.8% of all cases.

A deeper analysis revealed that 15 of the 29 cases in 2022 were attributed to a serogroup C outbreak among men who have sex with men (MSM). However, even excluding cases related to an outbreak, the incidence rate was significantly higher in 2022 than in previous years.

Neisseria meningitidis serogroup Y clonal complex CC174 sequence type ST-1466 predominantly caused the 14 cases not linked to a serogroup C outbreak. 

The CDC identifies two common types of meningococcal disease: meningococcal meningitis and meningococcal septicemia. Meningococcal meningitis can cause fever, headache, stiff neck, nausea, vomiting, and altered mental status. Meningococcal septicemia, also called meningococcemia, is characterized by fever, chills, fatigue, vomiting, muscle pain, diarrhea, and rash.

The best way to prevent these conditions is to get vaccinated. In the US, there are two FDA-approved meningococcal vaccines: meningococcal conjugate vaccine (MenACWY) and serogroup B meningococcal vaccines.

The MenACWY vaccine is a two-dose series given between 11 and 12 years old and again at 16 years old. The meningitis B vaccine is given between 16 and 23, with doses depending on the vaccine brand.

Patient demographic information indicated disparities in vaccination rates among individuals with HIV. Of the 29 meningococcal disease cases identified in 2022, 22 patients had not received the MenACWY vaccine. For six patients, vaccination status was unknown. Only one patient had reported receiving the MenACWY vaccine; however, researchers are unsure how many doses that patient had.

“MenACWY vaccine coverage among persons with HIV is low; given the recent increase in meningococcal disease cases in this population, healthcare providers should ensure that all persons with HIV are up to date with MenACWY vaccination per ACIP recommendations, as well as other vaccines recommended for this population,” concluded the CDC report.