Meningococcal infections among HIV-infected people are soaring due to low vaccination coverage

recently Morbidity and Mortality Weekly Report (MMWR), The US Centers for Disease Control and Prevention (US-CDC) has released preliminary data showing an increase in meningococcal disease among people with human immunodeficiency virus (HIV) infection in the United States in 2022.

study: Notes from the field: Increase in meningococcal disease among people living with HIV — United States, 2022. Image credit: NovikovAleksey/Shutterstock.com

Background

Meningococcus It usually causes meningococcal disease manifesting as meningitis or meningococcemia. The most common signs and symptoms of meningitis and meningococcemia include fever, chills, headache, stiff neck, malaise, and severe pain.

The American Advisory Committee on Immunization Practices (ACIP) recommended the use of a quadrivalent, two-dose series meningococcal conjugate vaccine (MenACWY) for HIV-infected persons in the country.

Then in 2016, the United States included it in its immunization schedule. Similarly, regular use is recommended for young people and those at high risk for meningococcal disease.

However, according to an analysis of administrative claims data conducted between January 2016 and March 2018, MenACWY vaccination rates among HIV-infected persons remain low, with one or more doses of the MenACWY vaccine within 2 years of diagnosis. Only 16.3% of people were vaccinated.

The Notified Disease Surveillance System (NDSS) has reported all cases of meningococcal disease in the United States with additional epidemiological data and isolates obtained through enhanced surveillance.

They used whole-genome sequencing (WGS) to characterize and determine serotype and molecular typing information from these isolates, and the CDC has reviewed this activity in accordance with applicable federal laws and policies. .

observation

Preliminary data show that between 2017 and 2021, 5–15 cases of meningococcal disease occur annually among people living with HIV, accounting for 1.5%–4.3% of all disease cases. Equivalent to

By 2022, this number will surge to 29, representing 9.8% of all cases of HIV infection for the year. However, more such cases are likely as data are reported.

The CDC found that only one of 29 meningococcal patients in the 2022 HIV-infected population received the MenACWY vaccine, but even its schedule was unknown. . The remaining 22 had not received the MenACWY vaccine, and 6 had an unknown MenACWY vaccination history.

Additionally, during the serogroup C outbreak, 15 of the 29 cases occurred in men who had sex with men (MSM). In 2022, compared with the period 2017–2021, cases of meningococcal disease remained higher among HIV-infected persons, even after excluding cases associated with the outbreak of MSM (4 ~8 versus 14).

The remaining 14 cases were unrelated to the outbreak, 9 of which were due to a single infectious disease. Meningococcus Strains confirmed in three US states, but no links between all confirmed cases.

Of note, 8 of these 9 cases occurred in African Americans (black Americans) and 7 in MSM. CDC identified this as serogroup Y clone complex CC174 sequence type ST-1466. The remaining 5 cases were not epidemiologically related and did not cluster geographically.

Conclusion

A current CDC report highlights that MenACWY vaccination coverage among people living with HIV in the United States will be low through 2022.

Therefore, cases of meningococcal infection increased in this population. The report raises the need to encourage people living with HIV to stay up to date with MenACWY and other vaccinations as recommended by ACIP.

Healthcare providers must help achieve these goals while maintaining a high index of suspicion of meningococcal disease among HIV-infected people in the United States.

HIV testing of patients with meningococcal disease is extremely important. In fact, the CDC strongly recommends that everyone be tested for HIV.