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Should you get vaccinated for meningitis?

L.A. outbreak stokes new fears among gay men

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vaccine, meningitis, gay news, Washington Blade
vaccine, syringe, gay news, Washington Blade

If you believe you have been in close contact with an established IMD case, a vaccine will not acutely protect you. Rather, you should consult your provider regarding a one-time antibiotic dose to prevent developing the disease.

Anxiety has again increased this past week following reports of new cases of invasive meningococcal disease (IMD), i.e. meningitis and/or sepsis caused by the bacteria Neisseria meningitidis, among gay men in Los Angeles County. IMD cases are typically scant and sporadic with little cause for broad public health concern. But this recent spate of apparently connected cases, concentrated in the gay community resonates with us differently, given our long history with a certain other disease.

Several burning questions remain for gay men amid the fear and uncertainty of what this new outbreak means for them: What is my personal risk? What can I do to protect myself from infection? And should I get vaccinated?

Since 2010, an outbreak in New York has been tracked among men who have sex with men (MSM), identifying 22 cases through April 2013, which led to seven deaths. Even so, the absolute number of annual cases within the U.S. general population remains vanishingly small, at less than half of what it was two decades ago.

Curiously, despite the recent escalation of IMD in MSM, the disease was still not on many of our radars until last spring, when four cases were detected in Los Angeles. At that time, there was much confusion over apparently conflicting messages from different departments of health and false insinuation that this was another “gay disease,” which government officials were dragging their heels on addressing. The frenzy of media coverage left many of us without clear answers on whether getting vaccinated or even worrying about the disease appearing in D.C. next was merited.

And now, following news of eight confirmed IMD cases in LA County this year – half among MSM, of which three were HIV-positive and reported residence in or socializing around West and North Hollywood – the LA County Department of Public Health last week broadened its previous recommendation for vaccination.

Health officials there now advise that all MSM be vaccinated if their residence, travel or social interactions have put them or will put them in regular close contact with other MSM. “Close contact” is defined as kissing, sexual contact, sharing eating utensils or drinking containers, sharing cigarettes, or being within a three-foot distance for more than eight hours.

Because the recent cases in LA appear to be linked, a push to increase local vaccination to include almost all MSM is indicated to prevent secondary cases in the setting of an epidemic. However, the question is more nuanced for gay men in other major cities like D.C.

Notably, Seattle’s public health officials discouraged expanded vaccination among local gay men last spring, stating that doing so would be an overreaction. Meanwhile, health departments in San Francisco and D.C., advised vaccination for sexually active gay men, who connect through social networking applications or planned to attend parties, clubs or other venues where gay men meet.

Broad vaccination for IMD is not practical in places where there is no ongoing epidemic; and to date, D.C. has had no reported cases. No real herd immunity would result from such an effort anyway, considering after several years the vaccine’s effectiveness wants, requiring a booster at five-year intervals.

So what about vaccination now? In short, it still depends on your HIV status, current and anticipated sexual practices, and most importantly, one’s tolerance for risk. So if you’re on the fence, just visit your primary care provider if interested.

For now, simple recognition of symptoms that suggest infection followed by prompt medical attention is more powerful than any vaccine. Some of the vague constitutional symptoms that may precede the onset of IMD include sudden fever, nausea, confusion, headache, sensitivity to light and sound, severe muscle aches, and rash in a previously healthy person.

Although these initial clinical features are similar to many common, self-limited viral illnesses, left untreated one’s condition may rapidly decompensate to more ominous and specific symptoms of neck stiffness, mottled or discolored skin, and cold or painful extremities.

If you believe you have been in close contact with an established IMD case, a vaccine will not acutely protect you. Rather, you should consult your provider regarding a one-time antibiotic dose to prevent developing the disease. Beyond 14 days from a suspected exposure the evidence suggests no need for antibiotic prophylaxis.

For those interested in vaccination, either of the two recommended quadrivalent conjugate vaccines (Menactra or Menveo) would cost you about $85-150 at either your local CVS pharmacy or as a walk-in at Whitman-Walker Health, with insured patients paying less. HIV-positive individuals should receive both an initial and booster shot 2 months apart.

Daniel O’Neill, MD is an internal medicine resident at Virginia Mason Medical Center in Seattle and plans to move back to D.C. this summer to continue his training.

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Health

Gilead awards $5 million grant to HRC’s HIV and health equity programs

Money to support efforts to end the epidemic and combat stigma

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Human Rights Campaign headquarters in D.C.(Washington Blade photo by Michael Key)

The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combatting stigma in Black and Latino communities.

Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges and Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021.

The organization said its HIV and Health Equity Program plans to develop a “benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches” while defining “best practices, policies and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.”

HRC President Kelley Robinson said, “Since the beginning of the HIV epidemic, racism and anti-LGBTQ+ discrimination have created dangerous hurdles for those seeking prevention or treatment.”

“With the generous support of Gilead Sciences, we’ll be able to continue providing critical
resources to help overcome these hurdles, especially focusing on Black and Latine communities in the U.S. South,” Robinson added. “We’ll also be able to expand our efforts, as we seek to remove institutional barriers often unknowingly created by HIV service providers. We must decrease the disparities that place an unnecessary burden on Black and Latine LGBTQ+ people and people living with HIV.”

Gilead Executive Vice President of Corporate Affairs and General Counsel Deborah Telman said the company “is committed to advancing health equity, particularly in Black communities and other communities of color that are disproportionately affected by HIV.”

“This grant will build on the impactful work HRC has done with community partners and HBCUs to increase awareness of HIV treatment and prevention options and reduce health disparities, combat discrimination and fight stigma,” Telman said.

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Health

New CDC data shows HIV infections dropped, but mostly among whites

Socioeconomic factor into disproportionate rates

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Data published Tuesday by the Centers for Disease Control and Prevention shows a significant decline in new HIV infections, but suggests the impact of prevention efforts was far less substantial for Black and Latino populations.

From 2017-2021, as rates of HIV testing, treatment and the use of pre-exposure prophylaxis (PrEP) medication rose, new cases dropped by 12 percent overall and by as much as 34 percent among gay and bisexual males aged 13-24.

The numbers show a “move in the right direction,” CDC Director Rochelle Walensky said in a press release.

However, when broken down by race, the CDC found new infections were down by 27 percent and 36 percent, respectively, among Black and Latino populations, compared with 45 percent of whites.

Similarly, by 2021 about one third of those who are considered eligible were taking PrEP for HIV prevention, but the CDC noted this number includes “relatively few Black people or Hispanic/Latino people” despite the significant increase in prescriptions up from just 13 percent in 2017.

“Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation,” Walensky noted, continue to act as barriers “between highly effective HIV treatment and prevention and people who could benefit from them.”

She added, “Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, said that “At least three people in the U.S. get HIV every hour — at a time when we have more effective prevention and treatment options than ever before.”

“These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups,” she said.

The HIV+Hepatitis Policy Institute issued a press release following the CDC’s announcement of the new data, noting both the encouraging progress and need for improvement.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” said the group’s executive director, Carl Schmid.

President Joe Biden’s FY24 budget requested $237 million for a national PrEP program along with $850 million to support the U.S. Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.

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Health

Officials eye mpox prevention, vaccination initiatives for this summer’s LGBTQ events

New cluster of cases reported in Chicago

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Drs. Robert Fenton and Demetre Daskalakis, coordinator and deputy coordinator for the White House national mpox response, during a briefing in August 2022 (Official White House Photo by Cameron Smith)

Federal health agencies, in coordination with their state and local counterparts and community partners, are exploring opportunities to offer mpox prevention initiatives and vaccinations at LGBTQ events this summer, Dr. Demetre Daskalakis said on Thursday.

Daskalakis, the deputy coordinator for the White House’s national mpox response, described these deliberations in response to a question from the Washington Blade during a media telebriefing on mpox that was hosted by the Centers for Disease Control and Prevention.

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases.

Since the peak of about 460 cases per day in August 2022, new cases have steadily declined, but following the cluster recently reported in the Chicago area, the update warns, “spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events.”

“We have the vaccine, and we have organizations that are willing to do it,” Daskalakis said during Thursday’s call, adding that resources are available and can be deployed flexibly because they are built into existing “HIV and STI funding to allow for this work.”

And the Mpox Crisis Response Cooperative Agreement, Daskalakis said, “provides even more resources locally for such efforts.”

Daskalakis and CDC Mpox Response Incident Manager Dr. Christopher R. Braden also briefed reporters on findings from new studies on the efficacy of the JYNNEOS vaccine for the prevention of mpox.

That data, per the CDC’s Morbidity and Mortality Weekly Report, reveals that “Among gay, bisexual, and other MSM and transgender adults aged 18-49 years, two doses of the JYNNEOS vaccine were 86 percent effective against mpox, indicating substantial protection against mpox.”

Additionally, “All routes of vaccine administration provided similar protection.”

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