Report Shows Rise in Meningococcal Disease Cases Among People With HIV in 2022

There has been a concerning increase in meningococcal disease cases among individuals living with HIV in the United States over the past few years, according to the CDC’s latest Morbidity and Mortality Weekly Report.

Meningococcal disease is a severe and potentially life-threatening illness caused by Neisseria meningitidis bacteria, typically manifesting as meningitis or meningococcemia. In the case of meningitis, it is characterized by symptoms such as fever, headache, and a stiff neck, while meningococcemia presents with fever, chills, fatigue, vomiting, diarrhea, cold hands and feet, and severe aches or pain.

To combat the spread of meningococcal disease, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends vaccination with the quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents and individuals at a heightened risk of contracting the disease, including individuals living with HIV.

In 2016, ACIP incorporated a 2-dose series of the vaccine into the US immunization schedule for individuals living with HIV. However, vaccination coverage among this population remains low. Research analyzing administrative claims data from January 2016 to March 2018 revealed that only 16.3% of individuals living with HIV received at least 1 dose of the MenACWY vaccine within 2 years of receiving their diagnosis.

The current report demonstrates an increase in meningococcal disease among people with HIV in 2022, according to the authors. They also explained, as data are typically finalized in fall of the next year—in this case, fall 2023—this report is based on preliminary data for 2022.

The National Notifiable Diseases Surveillance System is responsible for collecting meningococcal disease case reports, and Enhanced Meningococcal Disease Surveillance reports provide additional epidemiologic information and isolates for analysis. By utilizing whole genome sequencing, isolates are thoroughly examined to determine serogroup and molecular typing information.

Looking at data between 2017 and 2021, there were typically 5 to 15 cases of meningococcal disease reported each year among individuals with HIV, accounting for 1.5% to 4.3% of all US cases annually. However, preliminary data for 2022 indicate a substantial increase, with 29 meningococcal disease cases reported among individuals with HIV, reflecting 9.8% of the total cases. It's important to note that this number may further increase as reporting becomes more comprehensive.

Among those 29 reported cases, 22 individuals had not received the MenACWY vaccine, 6 had an unknown vaccination history, and 1 had received the vaccine, but the number of doses was unclear.

Notably, 15 individuals with meningococcal disease were part of a larger serogroup C primarily affecting men who have sex with men (MSM). However, even after excluding the MSM outbreak-associated cases from the analysis, 2022 still saw a significant increase in meningococcal disease cases among individuals with HIV, with 14 cases compared with 4 to 8 annual cases between 2017 and 2021.

Among the other 14 cases not linked to the MSM outbreak, 9 were caused by a single strain of N meningitidis belonging to serogroup Y, clonal complex CC174 sequence type ST-1466. Eight of these cases occurred in Black or African American individuals, with 7 of these patients being MSM. Interestingly, these 9 cases caused by the same strain were reported across 3 states with no identified connections, the authors noted. The other 5 cases were not geographically clustered, and any epidemiologic connections have yet to be identified.

“MenACWY vaccine coverage among persons with HIV is low; given the recent increase in meningococcal disease cases in this population, health care 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,” the report authors said. “Health care providers should also maintain a high index of suspicion for meningococcal disease among persons with HIV who have symptoms of meningococcal disease.”

The authors reminded of the CDC recommendation that everyone should be screened for HIV at least once in their lifetime, and called on providers to ensure their patients with meningococcal disease are screened for HIV if their status in unknown.

Reference

Rubis AB, Howie RL, Marasini D, Sharma S, Marjuki H, McNamara LA. Notes from the field: increase in meningococcal disease among persons with HIV - United States, 2022. MMWR Morb Mortal Wkly Rep. 2023;72(24):663-664. doi:10.15585/mmwr.mm7224a4