In a scary update to an already scary story, the New York state Department of Health is warning any man in the state who had sex in the last six months with a man from New York City to immediately get vaccinated against a particularly deadly variant of meningitis. (The warning is, sadly, a bit confusing – read on.)
A recent article in in the NYT notes that while typically meningitis kills one in five people it strikes, this strain kills one in three.
Last fall, the recommendation to vaccinate was limited to non-monogamous gay men who lived in NYC and were HIV-positive, or who were HIV-negative and lived in specific areas of Brooklyn.
And now, it’s been expanded even further to include any man who has visited NYC since September 1, 2012 and had sex with another man while there. There’s also a vague line about gay men who are HIV-positive, but it’s not clear from the way the warning is written whether even HIV-positive men who visited NYC and didn’t have sex while there should get a shot.
First off, take these warnings seriously. I plan on getting my shot this week, even though I live in DC. As a doctor recently told me when I asked him about whether I should get a shot: It’s better than dying. (Note that insurance may not cover it.)
Here’s a bit on the symptoms from NY Department of Health:
Meningococcal disease is a severe bacterial infection of the bloodstream. Common symptoms include high fever, headache, vomiting, stiff neck, and a rash. Symptoms may occur two to 10 days after exposure, but usually within five days.
Other things I’ve read have said that people have been found dead before they even had a chance to go to a doctor.
I think I have to say a word about the poor manner in which these warnings are written. I’m a lawyer and it’s taken me fifteen minutes to understand exactly what the new recommendation is actually saying, and honestly, parts of it still don’t make sense, like the part about HIV-positive gay men.
For example, the warning says “all HIV-infected MSM” living in NYC should be vaccinated. MSM is a term of art meaning “men who have sex with men.” It’s a way of covering men who don’t think they’re gay, but still sleep with men. So they’re saying that if you’re HIV+ and you stepped foot in NYC since last September, and even if you didn’t have sex, you should still get a shot? Judging by the fact they talk about non-monogamous HIV-negative men in the next bullet, the clear suggestion is that it doesn’t matter if you’re celibate, if you’re HIV-positive you need the shot. But it’s not clear.
The language about those who are HIV-negative is just as confusing. Let me first quote it:
MSM, regardless of HIV status, who regularly have close or intimate sexual contact with men met through an online website, digital application (“app”), or at a bar or party. (Previously, meningococcal vaccination was recommended only for those with contact in certain high risk areas in New York City)
Define “regularly”? I’m quite serious. I have no idea what “regularly” means – a few times a week, a few times a month, or what?
And what is “close” contact? Again, I have no idea what that word even means – is a hug close contact? Is hanging out every day with someone, “close contact”? Is living with them, even if you’re not sleeping with them? Sharing a tooth brush? What about a sneeze? I dunno. And if you have sex, does it matter what kind of sex, or is anything risky with someone who’s infected? Warning doesn’t say.
Then there’s the weird line: “met through an online website, digital application (“app”), or at a bar or party” that these warnings keep using. That’s awfully specific. I suspect many of the cases must have been contracted from men met either online, or at a bar or party – thus the warning. The problem is that the warning is an “i.e.” rather than an “e.g.” Meaning, the way it’s currently phrased says you should only get a shot if you met someone online, at a bar or a party. If you met them any other way, it’s okay, no shot is needed – or is it? Are closeted guys going to gay parties and gay bars? I doubt it. As for the Internet, probably more likely, but still. They might be going to prostitutes, bathhouses (which aren’t bars or parties), forests, or lots of other locales where you might look for love if you’re not openly gay, or even if you are. Is that what they meant to say – that only if you met someone at one of those specific venues should you get a shot?
And what about the rest of us. Lots of guys in DC visit NYC. In the past six months, what if one of those guys comes back here and sleeps with someone in DC. The rest of us here shouldn’t get shots too? I realize the NY State Department of Health doesn’t have jurisdiction in DC, but their warning does talk about men in the rest of the state of NY:
The recommendation by DOH has been expanded to include MSM residing outside NYC who have traveled to the City and engaged in the risk behaviors described below since September 1, 2012.
What if a guy living in Albany sleeps with someone who had relations with someone in NYC since last September? That’s not a problem? Under the way this is written, it’s not.
Lives are at stake, and it might be nice for public health people to stop writing documents in the lingo of other public health people, and start writing them for human beings. You shouldn’t need a law degree — strike that, a law degree isn’t helping — a public health degree in order to understand whether your life is potentially in danger.
Honestly, at this point, as we’re talking about something that can easily cross state boundaries through the visit of one man to New York City, we ought to be getting more clarification from the CDC and HHS. I’ll be asking the administration for more guidance on this on Monday.
I’m getting the shot regardless.