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Meningococcal disease and men who have sex with men

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Several European countries report cases of invasive meningococcal disease serogroup C among sexually active men who have sex with men (MSM). Similar cases have previously been reported in the United States. MSM in Norway should be aware of the risk of developing the disease. An effective vaccine is available, and MSM who engage in casual sex and intimate contact with many partners in Norway or abroad should consider being vaccinated

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The Norwegian Institute of Public Health previously reported on May 24, 2013 of an outbreak of invasive meningococcal disease among MSM in New York City.  Since then, similar cases have been reported from various European countries (three in Germany, three in France and one in Belgium). All the European cases were between 20 and 45 years of age. In Europe, as well as in USA, the fatality rate of the MSM cases has been higher than in other groups. There is a possibility that the seven reported cases in Europe were caused by the strain that is circulating in the MSM community in New York City, which may indicate that a strain of meningococcal bacteria with a high mortality rate is presently circulating among MSM both in USA and Europe. In Norway, there have been no cases of serogroup C meningococcal disease reported to the Norwegian Institute of Public Health among adult males in 2013. However, one can be a carrier of the bacterium in the throat without developing disease. Healthy carriers can transmit the bacteria to others who may become sick.

Sexual orientation and sexual behaviour itself have no influence on the risk of developing meningococcal disease. The reason some MSM are more at risk than others is probably related to having intimate contact with many partners, which may result in transmission of the meningococcal bacteria. In addition, partying and lack of sleep may increase the risk of developing the disease. These are behavioural factors that are known to increase the risk of developing meningococcal disease in other groups as well.

Many Norwegian MSM engage in casual sex abroad. An online study conducted among Norwegian MSM in 2010 showed that 33 per cent of respondents had had sex abroad during the last 12 months.

Recommendations for men who have sex with men

It is important that MSM in Norway are aware of the risk of developing meningococcal disease and are able to recognize the symptoms. There is an effective vaccine, and Norwegian MSM who engage in casual sex or intimate contact with many partners, in Norway or abroad, should consider being vaccinated. This applies regardless of HIV status. It is recommended to use the meningococcal C conjugate vaccine (NeisVac-C). It takes approximately two weeks to provide protection following vaccination. Vaccines are available at general practitioners or vaccination clinics. The vaccine costs about 300 kr. 

Clinicians who treat cases of meningococcal disease in men should consider whether these cases can be associated with MSM and state this in the notification to local (municipality) public health doctors and the Norwegian Institute of Public Health.

Invasive meningococcal disease

Neisseria meningitidis is a common bacterial commensal of the pharyngeal mucosa. The organism can cause invasive meningococcal disease (IMD), which can present as septicaemia, meningitis, or both.Carriage of the bacteria is common and ranges from below 5% in young children to a peak of 20–30% in young adults. Carriage is usually asymptomatic, can last for months, and generally leads to immunity. If illness results, this usually occurs within a few days of acquisition. The bacteria are transmitted from person to person through droplets. The bacteria do not survive well outside the human body. Symptoms of meningococcal disease are non-specific but may include sudden onset of fever, headache, neck stiffness, joint pain, a rash of red-purple spots or bruises, aversion to bright lights, nausea and vomiting. People who have symptoms of meningococcal disease should see a doctor urgently, especially if there is persistent fever, irritability, drowsiness or lethargy.