Should you get vaccinated against a deadly meningitis outbreak?

Update April 13, 2013: Concern is growing in Los Angeles after a gay 33  y.o. West Hollywood man contracted meningitis this week and quickly went in to a coma.  He felt ill on Monday, went to the emergency room on Wednesday, and by Thursday was in a coma.  He is now brain dead.  He reportedly recently attended the White Party in Palm Springs, though it’s not known if he contracted the disease there.

A 21 y.o. University of Wisconsin-Madison senior has also died of meningitis.  The article does not indicate if he was gay.

It is unknown if either of these cases are related to the outbreak in NYC.  For the details of this latest outbreak, how you contract meningitis, and whether you need to get vaccinated, read on.  Also, I got vaccinated in early April, cost $165 at my doctor (doesn’t look like insurance will cover it), but a friend was able to get it for half that price on his college campus, so your mileage may vary (check local public health clinics etc.).  I had zero reaction to the vaccine – it’s a dead vaccine, not even a full virus, so no risk beyond any other vaccine.

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Everything you need to know about Meningitis

April 2, 2013 – I had a great talk yesterday with Dr. Thomas Clark, an epidemiologist and meningitis expert at the US Centers for Disease Control and Prevention (CDC). Our topic: the recent deadly meningitis outbreak among gay men in New York City.

As you may recall, we’ve been reporting on increasingly scary warnings out of New York that a particularly deadly variant of meningococcal disease (bacterial meningitis) was showing up in gay men in New York. The New York authorities are now recommending vaccinations for gay men in New York City who are either HIV-positive, or HIV-negative and non-monogamous. The vaccination warning also includes men in the two categories above who visited New York City at any time since September of 2012.

As I noted in my earlier post on this topic, the warnings from both New York City and New York State on this matter have been somewhat confusing, so I sought out an expert at the CDC, Dr. Clark, to explain what’s actually going on, and who really needs to get a shot.

Let me walk you through what I learned.

Who should get a meningitis shot?

Vaccine, vaccination, shot, health care, disease, bacteria, sick, meningitis

Vaccine via Shutterstock

Anyone covered by the recommendations from NYC and NY state, if you can make sense of them.  But also, really, anyone who’s concerned enough about the outbreak.  I asked Dr. Clark if there was any downside to the vaccine, and he said no.  The vaccine carries no more risk than any other vaccine you might take.  And to further put one’s mind at ease, the meningitis vaccine does not contain a live bacteria, or even a dead one – it only contains part of the shell of the bacteria, so it’s impossible for it to give you meningitis.  Thus, Dr. Clarks’s recommendation, that if you’re worried at all, get the shot.

How is this variant of meningitis transmitted?

I was quite surprised about how the bacteria is transmitted.  As the NY warnings are targeted at gay men, and specifically at men who seek sex partners online, at a party, or at a bar, I just assumed that this was sexually transmitted.  It’s not.

The bacteria is transmitted through secretions of the mouth, nose and throat – large-sized droplets. What that means is the droplets are far too large to float in the air.  So it’s the kind of thing you’re more likely to get from French kissing, or having someone cough in your face or accidentally spit in your face while talking, or even sneezing – but regular aerosolized drops in sneezes won’t get you sicks, it’s the larger droplets that do it.  That’s why the warnings talked about “close contact.”  What they found was that people living together, even if they’re not in a romantic relationship, we’re at a “very high risk” of contracting the disease from each other.

Can meningitis be transmitted by sex? No, but…

Not only are the mouth, nose and throat instrumental for transmitting the bacteria, they’re also instrumental for receiving the bacteria.  So oral sex isn’t going to transmit it, so long as your mouth doesn’t come into contact with anyone else’s saliva – same goes for any other sex act, the key issue is your mouth (or nose) coming into contact with someone else’s saliva.  I was surprised about that, since I figured this would be transmitted similarly to an STD.  Not so, said Dr. Clark.  Even though the bacteria is a cousin of the bacteria that causes gonorrhea, while gonorrhea adapted to the genital tract as a venue of transmission, this bacteria adopted to the nose and throat.  It is also not, however, as easily spread as an STD.

You’re not at risk if you work with someone who gets sick

Because the bacteria requires prolonged face-to-face contact, simply working in an office alongside someone who came down with meningitis would not put you at risk, Dr. Clark told me.

Are people with HIV more likely to contract meningitis?

This one is tricky.  What they’ve found is that being HIV-positive does not per se put you at risk of catching this variant of meningitis, as being HIV-positive can for other infections.  So it’s not really a question of having a depressed immune system and thus being more likely to get the disease.  But, they’ve found some kind of correlation between being HIV-positive and becoming infected during this outbreak: Many of those infected are HIV-positive, but not all.

It could be something as simple as HIV-positive people in New York generally having sex with other HIV-positive people in that same community.  Thus, if someone becomes infected in that community, he is more likely to pass it to other members of that community.  So the bacteria stays within the HIV-positive community because it’s a discrete community, not because HIV makes you more prone to catch it.   That isn’t necessarily the reason HIV-positive people in NYC are coming down with this disease, but it is an example of how HIV doesn’t put you at risk of catching the disease, yet your HIV status could still be relevant to whether you’re at a heightened risk.

Will the meningitis vaccine help after you’re exposed? No.

If your doctor thinks you’ve been exposed, or you’re already showing symptoms, they will prescribe antibiotics.  The vaccine is only good before you’re exposed.

How quickly does the vaccine work, how long does it last?

The meningitis vaccine takes two weeks to fully kick in, and should protect you for three to five years.  People with HIV may not respond as well to the vaccine, so it’s recommended that they receive two doses – a booster shot, in essence – two to three months apart.  And regardless of your status, if you remain at risk, they recommend a booster after five years.

Now, having said that, the vaccine doesn’t always work.  I believe I read that it works in 90% of the cases.  The 21 year old University of Wisconsin-Madison student who died of meningitis (unknown if his case is related to the NYC outbreak – so far it’s not) reportedly did get the vaccine, a booster, before starting college.  It didn’t work – or, it didn’t work well enough or long enough.

Can you be exposed and not get sick?  Yes.

Some people are exposed to meningitis and don’t get sick at all.  Others are exposed and develop an immune response to the bacteria without becoming visibly ill, and without even knowing it.  You will not, however, be a “carrier” of the disease if that happens to you.  You would only be contagious during the same time period that anyone else with the disease would be contagious. (Though I didn’t clarify with Dr. Clark how long that would be in the case of someone who didn’t show any symptoms – nonetheless, it didn’t see like a long time, as he said you wouldn’t be a carrier, and you wouldn’t be contagious once you’re body developed the immunity.)

For how long are people contagious?

The good thing and bad thing about this disease is that you generally get sick a day or two after you were exposed, though it’s possible, but unlikely, for it to take up to two weeks.  The bad news is that you can become quite ill quickly, and if you don’t get medical help you can die.  The good news is that the quick onset of the disease makes it harder to spread.  Why?  Because once you’re in bed sick as a dog, you really don’t feel like going online and hooking up, or going to a bar and drinking with your buddies.  So the disease generally only gets a chance to spread in that 24 to 48 hour window after you’re first exposed and still feeling fine, which thus limits the spread of the disease.

Is this a gay disease? No.

I mentioned to Dr. Clark that some of the readers were confused as to why the warning went out to the gay community and not the straight community as well.  How could a disease target only gay people?

He said that it’s not a “gay” disease, and that meningitis usually targets schools, college campuses, and corrections facilities – i.e., a small enclosed community.  Occasionally, the disease can hit a “virtual community,” like the gay community. By “virtual,” he means that gay men are not a geographically-confined community as are kids in the same high school building or college dorm, or men living in the same prison.   So the community is more “virtual,” as the tie isn’t immediate geographic proximity per se (though obviously it’s affecting people within a discrete geography like New York City, but that’s different than actually living together in the same building and thus you all get sick).

Also, 98% of the cases in the US every year are sporadic, they occur by themselves, rather than striking a community.  Only a small fraction turn into “outbreaks” like this one.

One more thing Dr. Clark noted was that this disease tends to strike in specific clusters, in specific communities, and it tends to stay confined to that community, without spreading to other communities.  And that’s another reason why the warnings are only being given to gay men, and only, so far, in NYC.

Just how big is this outbreak?  Not big at all, actually, but big enough to be concerned.

There was one case in 2010, four in 2011, and thirteen in 2012.  Those numbers may look small, but in public health terms, they’re not.  What has experts worried is that they keep hitting the same community, gay men in New York City, and it’s not going away.  Most outbreaks happen quickly, Dr. Clark told me, with usually just a few cases occurring at once in a short period of time, and then they go away.  This has been going on in NYC since 2010 and it’s growing, rather than going away.  Thus the concern.

I just talked to Dr. Clark about some of the comments here, and on Facebook, saying that with these low of numbers, this was blown out of proportion by the authorities in NY.  He says that’s not true at all.  Here’s why….

In public health terms, an “outbreak” is defined as 10 cases per 100,000 people within a short period of time (say, a few weeks).  When you have an “outbreak,” that’s suggestive that the disease has reached a point where it may accelerate and spread to even more people.  In public health circles, it’s their job to stop outbreaks from becoming something bigger.  To the public, these numbers sound small.  But in public health terms, these numbers are statistically significant and worthy of increased concern.

That’s why when they get 2 or 3 cases in a school of 600 kids, or a prison of a few thousand inmates, they vaccinate everyone to prevent the disease’s spread.  That’s enough cases to set off alarm bells.

In NYC, we’re talking more on the order 13 or so cases last year.  But, you might say, hey, that’s 13 cases for 8 million people, so who cares?  But that’s not really correct.  It’s not 8 million New Yorkers.  It’s gay New Yorkers.  And it’s only gay men who are getting sick, not lesbians, so now the number is cut down even fewer. And it’s not all gay men in NYC, it’s gay men in certain boroughs.  And it’s not every gay men in those boroughs, it seems to be gay men in those boroughs who are sexually active and particularly using Web sites, phone apps, bars and partys to meet guys.  That cuts down the number even further.  So you’re now a lot closer to that 100,000 figure than you were when you thought this was about 8 million New Yorkers.

The uncertainty of the size of the community exposed to this disease is part of what worries public health professionals.  It’s not possible to accurately define whether we’re talking 13 cases per 100,000, per 200,000 or per 50,000.  So they err on the side of caution because this is such a particularly deadly variant of the disease, killing 1 in 3 who get it, rather than the normal 1 in 5.   And in public health, you try to cut off disease before they become a huge problem.  Thus you have to look at small numbers, and historically what those numbers tend to mean for the future, and act accordingly.

That’s pretty much it.  I know my concerns were allayed greatly in talking to Dr. Clark.

I got my vaccination last week.  It was $165 or so at my doctor’s, a friend got his on a college campus for around $85.  At least this disease sounds like it should have a much harder time spreading than some others in our history.


Follow me on Twitter: @aravosis | @americablog | @americabloggay | Facebook | Google+ | LinkedIn. John Aravosis is the editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown (1989); and worked in the US Senate, World Bank, Children's Defense Fund, and as a stringer for the Economist. Frequent TV pundit: O'Reilly Factor, Hardball, World News Tonight, Nightline & Reliable Sources. Bio, .

Share This Post

  • WaldoLydecker

    “I got my vaccination last week. It was $165 or so at my doctor’s, a
    friend got his on a college campus for around $85. At least this
    disease sounds like it should have a much harder time spreading than
    some others in our history.”

    The city is providing free vaccinations. The clinic at 9th Avenue and 28th Street is open six days a week. I go my vaccination this morning and the wait was very short.

  • http://www.facebook.com/dirtandmoredirt John Dirtandmoredirt

    We need to address the issue where men have sex with other men at these book store as the owner make money off of these sex act and glory hole and theaters as the gay men wait for the
    young guy to have sex with and the police do nothing about it (dirtandmoredirt com)

  • Mike

    Thank you so much for this detailed information! I’m sharing it with all my friends and I’m going to get vaccinated today.

  • jkuge

    Thanks for the information, John. While possibly pre-dating this particular outbreak, my former boyfriend was also a gay man living in NYC who died from contracting bacterial meningitis in January 2006. He was returning from a trip to London, and felt like he was coming down with a cold or flu before boarding the plane. He died in his seat before the plane landed in NYC. This is serious stuff indeed.

  • http://musephotos.wordpress.com/ GarySFBCN

    Actually, no, your muddled post is not clear. And I’ll ‘address’ whatever the hell I want to address. Given that you thought that John was mocking you, I’m in good company.

  • Sweetie

    “Lordy, there’s a conspiracy under every rock. MSM includes gay men,
    bi-sexual men and self-identified ‘heterosexual’ men who have have had
    sex with a man. It is not ‘heterosexist’ or homophobic.”

    Next time, address the substance of my post. “Lordy, there’s a conspiracy” is not a rebuttal. It’s empty rhetoric.

    The fact is that MSM is a category that treats monogamous couples in a long term relationship as if their sexual practices are equivalent to guys who have extremely unsafe sex in large groups. The rest of my post is also clear enough when it comes to heterosexuals.

  • http://www.facebook.com/profile.php?id=661563563 Walter Delmar

    LA Gay & Lesbian center is giving vaccinations in LA starting tomorrow.

  • http://AMERICAblog.com/ John Aravosis

    Wow.

  • http://AMERICAblog.com/ John Aravosis

    Right, different outbreaks affect different discreet communities. Sometimes kids in the same dorm, sometimes prisoners in same prison, this time it’s gay people in specific NYC communities (so far).

  • http://AMERICAblog.com/ John Aravosis

    No. Unless Big Pharma killed all the gay people who got the disease and died. This is real.

  • http://musephotos.wordpress.com/ GarySFBCN

    True. One point to clarify: The factors that determine ‘outbreak’ status are different for each disease and can be different for each situation.

  • http://musephotos.wordpress.com/ GarySFBCN

    Lordy, there’s a conspiracy under every rock. MSM includes gay men, bi-sexual men and self-identified ‘heterosexual’ men who have have had sex with a man. It is not ‘heterosexist’ or homophobic. And with this meningitis outbreak, the could be having safe sex and still be exposed to meningitis.

  • http://musephotos.wordpress.com/ GarySFBCN

    No. It isn’t ‘only gays’ getting the disease, it is an outbreak in the gay communities, just as there are outbreaks of this disease in high schools or prisons – anywhere where there can be ‘close contact.’ And it is a well understood disease so it is NOTHING like HIV.

  • skwcw2001

    also could just could this also be hyped up by the pharma companies so that the income high gays go out and spend big bucks on their cure theirs only vaccine?

  • skwcw2001

    I wonder if the timing of this new gay labeled out break is in any way like the timing of aids, or grid, see the gays where becoming known and accepted and out then bam we get blamed in this country for this new evil disease, now we fast forward we are getting landmark rights and bam a new disease with us as the label again. Aids wasnt a gay disease, it was a gays in the media disease, it was around long before the great patient zero, and the sole focus of the cdc was on gays, they say because it showed up in them first yet they negate the fact that gay men at the time where more likely to seek medical care than straight people and had the income to do so, so we wont know the truth and history will just gloss over the sickening treatment in the 80’s gay folks recieved and hiv and aids folks got. So now we have this new, only gays are getting it disease, if we fall for this are we not repeating history.

  • 2patricius2

    Thanks for the info, John.

  • AnitaMann

    I’m in West Hollywood too. I’ve heard that the city is thinking of giving out 100 shots for free – that’s not a lot if there’s a mass demand for it. The city and the LAGLC are taking this seriously.

  • sdguppy

    John,
    Thank you for the information, keep beating the drum. Had a very dear friend’s 18 yo run away, living in close quarters with other runaways in poor hygienic conditions. He didn’t feel well, came into the clinic where she worked and died in the waiting room – of meningitis.

  • http://AMERICAblog.com/ John Aravosis

    Yeah, they recommend a booster after five years.

  • http://AMERICAblog.com/ John Aravosis

    Wow that’s great.

  • http://AMERICAblog.com/ John Aravosis

    Correct – I think I may have mentioned that in the piece – this strain is far more deadly than normal, which still isn’t great. I believe normal is 1 in 5 die, with this it’s 1 in 3.

  • http://AMERICAblog.com/ John Aravosis

    Well, hopefully it’s not related to what happened in NYC, but I got the shot nearly two weeks ago anyway.

  • Sweetie

    more saliva sharing?

  • Sweetie

    Ever notice how the US medical acronym “MSM” is homophobic/heterosexist?

    It’s not men who have unprotected/unsafe sex with men. It’s ALL men who have sex with men. I suppose this is convenient so they don’t have to pay attention to heterosexuals who have unsafe sex, like men who fly to Thailand for A2M.

  • Sweetie

    It has been traced to Haiti. I believe 1920s or 1930s.

  • nicho

    You could also get it from sipping communion wine that has been “slobbered over” by an infected person.

  • http://twitter.com/Scytherius Jonas Grumby

    Thank you for this info. Tweeted immediately. Also live in WeHo. Wow.

  • tealeclipse

    Thank you, John, also. This was my first read on the outbreak.

  • http://twitter.com/bigolpoofter David Phillips

    Please learn HIV history correctly. HIV killed tens of thousands of heterosexuals in Africa and the Caribbean before the first case in a Gay man in urban America was noted: in fact, biological evidence of HIV in America exists are early as the 1960s (an African American teen male). The HIV started with Gay men meme is used to stigmatize and scapegoat, though it has absolutely no basis in fact, just the ignorant and insistent timing of the epidemic by government agencies and community groups.
    http://en.wikipedia.org/wiki/History_of_HIV/AIDS

  • pappyvet

    GET THE SHOT !!!

  • UncleBucky

    Yeah, man, grok has been a word at least since the 70s. It means to suddenly and completely understand a thing to its full extent. http://en.wikipedia.org/wiki/Grok

  • rerutled

    This is a really good article. Thanks for researching this. I think the recommendations for vaccination are well-founded.

    It’s worth knowing that the CDC says the annual number of infections in the US for garden variety bacterial meningitis is 4100, with 500 fatalities (years 2003-2007 — the last years statistics are available). That’s a 12.5% mortality rate, about 1/2-1/3 of the claimed mortality rate for this strain. http://www.cdc.gov/meningitis/bacterial.html

  • http://heimaey.us/ jim morrissey

    Getting a shot is free in NYC just call 311 for locations.

  • http://www.facebook.com/people/Melvin-Dean-Baker/1345608091 Melvin Dean Baker

    Remember outbreaks like these occur frequently on college campuses. The disease is also oddly more dangerous for both young children and then people in their early 20s. Rates of infection and very serious progression of the disease tends to be highest among those two groups. It’s unclear why this is the case. Nonetheless it certainly doesn’t hurt to get vaccinated or to get a booster shot whatever your age.

  • http://AMERICAblog.com/ John Aravosis

    And everyone knows a “gay disease” would be far more fun, with little umbrellas and go-go boys :-)

  • http://www.rebeccamorn.com/mind BeccaM

    I feel differently about it.

  • UncleBucky

    Bingo. ;)

  • UncleBucky

    Now, now… Bigots might be saying “gay to gay” which perhaps John is quoting. But seriously, a “gay disease” description emanating from John? I think not. To me, this is like polio. Close proximity, “splush” onto a mucous membrane and there you are.

  • http://www.facebook.com/monoceros.forth Monoceros Forth

    It’s a reminder to me of a poor book from a poor writer and it doesn’t mean anything that a half-dozen real words don’t already mean. What can I say?

  • nicho

    Here’s how it works. Diseases — say Legionnaires or AIDS — are usually identified as a discrete community-related disease when they appear in clusters. For example, HIV/AIDS existed for a long time before CDC identified a cluster in SF and then in NYC. I know someone who died in the mid-’70s from what was later identified as AIDS. Doctors just thought the strange symptoms were a one-off type of infection.

    Legionnaires Disease is extremely common — no one knows how common, but probably over 100,000 cases (not deaths) a year in the US — because they don’t even test for it (even today) unless there is a cluster. If one old person shows up at the hospital with pneumonia, they just treat it as pneumonia. If six people who work or live in the same place show up with it, they start looking for Legionnaires.

    So it is with this outbreak. An individual here or there might come down with it — and they would just treat it as a severe form of meningitis. However, when five gay men from the same zip code show up with it, they start identifying it as an outbreak.

  • http://AMERICAblog.com/ John Aravosis

    I thought grok was a typo. It’s a word?

  • http://AMERICAblog.com/ John Aravosis

    Yes but it doesn’t tend to spread beyond the community it strikes. It’s not “easy” to get without kissing or being in the person’s face for a prolonged period like a roommate

  • UncleBucky

    Don’t worry, I grok you thoroughly. ;o)

  • UncleBucky

    Hey, so if it’s more than sexually transmitted – ANYONE (gay, straight, man, woman, boy, girl) could get it. This is like polio in a way?

  • http://www.rebeccamorn.com/mind BeccaM

    Sorry, but the word is in my vocabulary — and has been ever since the 1970s — and very few other than yourself ever object.

  • http://www.facebook.com/monoceros.forth Monoceros Forth

    Don’t say “grok” >_< It bugs me more than any other fake-sounding neologism dreamt up by a sci-fi writer. Worse than "tanj", worse than "frack".

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  • Indigo

    Me too! I’m actually worrying this time because I’m trying to get an alert out into my local community and the response is . . . there is no response. Oh, people! I’m not saying “Panic!” I’m saying, “Be aware!”

  • http://adgitadiaries.com/ karmanot

    There’s never an urgency when ‘those people’ get it. I was there at ground zero when a gay cancer was killing gay men. Now the world has millions of HIV infected people. Expect nothing from national health institutions, until a few hundred thousand have died.

  • dmhlt_66

    Hear, Hear
    Pithy – to the point – and spot-on

  • http://AMERICAblog.com/ John Aravosis

    Good point. I edited the post. Didn’t quite explain it the way you did, but hope I got the point across ;-)

  • http://AMERICAblog.com/ John Aravosis

    Yep. Because for $165, that’s a hell of a lot of money.

  • KEVIN MURPHY

    John:

    I think you might clarify something. Despite what you wrote, gay men who attend sex parties may be at risk from oral sex. If I chow down on a guys dick after someone else has slobbered over it, I will expose myself to saliva which may carry the bacteria.

  • KT

    Thanks for the info. I am pretty upset at the high cost of the vaccine though. They want us to get it but they expect us to cough up a pretty penny for it. That pretty much means the disease will spread because a lot of guys will not get it due to cost issues.

  • Joe knows who I am.

    I would surmise, and I believe correctly, the more these numbers tick up, the more this will expand coast to coast. I expect physicians on the west coast to begin a call for vaccinations.

  • http://AMERICAblog.com/ John Aravosis

    But if I got meningitis, they’d pay – unless I died. I’m sure they did a cost-benefit.

  • http://AMERICAblog.com/ John Aravosis

    I didn’t mock you, I gave you a straight answer. It’s been three years and only gay people in specific neighborhoods are getting sick, and most seem to have HIV, and most seem to be using online sites and apps to hook up (in addition to bars and parties). So naturally they’re focusing on that community – especially since meningitis that affects one community doesn’t historically tend to break out of that community. Thus no need to warn heteros about it right now.

    And part of the reason, even if it’s not an STD, but still tends to spread when we have sex, simply because people kiss, what percentage of gay people are bi? A small percentage. In order for this to spread to straight people, you’d need that small percentage of the 13 cases last year to have then french kissed a woman just coincidentally during the one or two days that you’re infectious before you get so sick that you don’t want to kiss anyone.

    It’s a simple mathematical and historical look at the data.

  • Skeptical Cicada

    You can mock my comment if you want, but this still doesn’t add up.

    It’s not even transmitted sexually, yet the assumption is that it spreads only “gay to gay”? Don’t gay men ever interact with any non-gays or in anyway but through Grindr? WTF?

    So no heterosexual who rooms with a sexually active gay man needs a vaccine for a disease that isn’t spread sexually?

  • http://www.rebeccamorn.com/mind BeccaM

    LOL. I think you meant ‘grog.’ ;-)

    Also caught a typo above and fixed it. Meant to say ‘now grok’ not ‘not grok.’

  • Indigo

    Yup. And I’m having a heck of time getting the word out here in Orlando. I was at my doctor’s office today; he hadn’t heard about it and didn’t feel any urgency about it.

  • http://AMERICAblog.com/ John Aravosis

    And don’t grok much. It’s hell on the liver.

  • http://AMERICAblog.com/ John Aravosis

    At the very least, when the public health authorities put out a warning, and your doctor says “yes, you should get it,” it should be covered. AGreed.

    Reminds me of my yellow fever shot for going to Africa, and then later the Amazon. Insurance wouldn’t pay. But they would pay if I caught yellow fever. (Then again, maybe they’d say I got it in africa so it doesnt’ count, I never thought of that!)

  • http://www.rebeccamorn.com/mind BeccaM

    Thanks for the very informative post, John. I not grok much that I didn’t before. They’re targeting a small social community because that’s where this particular outbreak is right now, and presumably trying to keep it from spreading further, whether geographically or socially.

    Here’s my new question, which I touched upon below: Why are we depending on people paying for their own non-covered vaccinations, given the seriousness of this particular disease? Why the heck are health insurance policies allowed to refuse coverage for a CDC-recommended preventive measure? Should we not have free vaccination programs for just these kinds of eventualities? Or have we as a country resigned ourselves to the basic Darwinian philosophy of “If you’re poor and you get sick, you die, and we won’t even help you avoid getting sick in the first place”?

  • http://www.rebeccamorn.com/mind BeccaM

    I’m with you: If this is a serious public health concern, and the CDC certainly seems to think it is, this is the kind of situation that ought to trigger a free vaccination program and/or require mandatory coverage by one’s insurance. As it is, this response depends on people either having insurance that covers it or, as John found out, having enough cash himself to pay for it entirely out-of-pocket.

    That’s just frickin’ wrong. I mean, how the heck do we justify, “Oh yeah, we’re having a serious pandemic because not everybody in the small originally affected social community could pay $165 for the vaccine”?

  • http://AMERICAblog.com/ John Aravosis

    And got my shot this morning. It was $165 at my doctor’s, and insurance won’t cover it, but what the hell.

  • http://AMERICAblog.com/ John Aravosis

    I just talked to Dr. Clark again, asking him about the concerns that these numbers aren’t that big a deal, and that NY may have overblown this outbreak. He explained why there’s concern – it’s in the post, but here’s what I wrote after speaking with him:

    There was one case in 2010, four in 2011, and thirteen in 2012. Those numbers may look small, but in public health terms, they’re not. What has experts worried is that they keep hitting the same community, gay men in New York City, and it’s not going away. Most outbreaks happen quickly, Dr. Clark told me, with usually just a few cases occurring at once in a short period of time, and then they go away. This has been going on in NYC since 2010 and it’s growing, rather than going away. Thus the concern.

    I just talked to Dr. Clark about some of the comments here, and on Facebook, saying that with these low of numbers, this was blown out of proportion by the authorities in NY. He says that’s not true at all. Here’s why….

    In public health terms, an “outbreak” is defined as 10 cases per 100,000 people within a short period of time (say, a few weeks). When you have an “outbreak,” that’s suggestive that the disease has reached a point where it may accelerate and spread to even more people. In public health circles, it’s their job to stop outbreaks from becoming something bigger. To the public, these numbers sound small. But in public health terms, these numbers are statistically significant and worthy of increased concern.

    That’s why when they get 2 or 3 cases in a school of 600 kids, or a prison of a few thousand inmates, they vaccinate everyone to prevent the disease’s spread. That’s enough cases to set off alarm bells.

    In NYC, we’re talking more on the order 13 or so cases last year. But, you might say, hey, that’s 13 cases for 8 million people, so who cares? But that’s not really correct. It’s not 8 million New Yorkers. It’s gayNew Yorkers. And it’s only gay men who are getting sick, not lesbians, so now the number is cut down even fewer. And it’s not all gay men in NYC, it’s gay men in certain boroughs. And it’s not every gay men in those boroughs, it seems to be gay men in those boroughs who are sexually active and particularly using Web sites, phone apps, bars and partys to meet guys. That cuts down the number even further. So you’re now a lot closer to that 100,000 figure than you were when you thought this was about 8 million New Yorkers.

    The uncertainty of the size of the community exposed to this disease is part of what worries public health professionals. It’s not possible to accurately define whether we’re talking 13 cases per 100,000, per 200,000 or per 50,000. So they err on the side of caution because this is such a particularly deadly variant of the disease, killing 1 in 3 who get it, rather than the normal 1 in 5. And in public health, you try to cut off disease before they become a huge problem. Thus you have to look at small numbers, and historically what those numbers tend to mean for the future, and act accordingly.

  • http://AMERICAblog.com/ John Aravosis

    No. It’s a disease that can pop up in discrete communities and when it does it tends to stay in those communities. It just so happens that the disease has hit gay people in certain NY boroughs and seems to be spreading gay to gay. Thus they are warning gay people. When we’re talking about mass death and destruction, concerns about profiling go out the window. This disease is centered on the gay community in NYC and seems to be spreading via the gay community in NYC. I am perfectly fine with them putting out a warning to gay people.

    We can argue all we want that AIDS is not a gay disease either, but if you’re gay and sexually active, and you don’t pay special attention to concerns about HIV/AIDS, you’re a fool IMHO.

  • Skeptical Cicada

    This still doesn’t add up.

    It’s not an STD. It is often transmitted between non-romantic roommates. Yet the CDC is, in fact, shrieking that it’s a “gay disease,” an “online gay sex disease,” in fact.

  • Hue-Man

    Here’s the B.C. Medical Journal article from 2004/5 about the meningitis outbreak in the Metro Vancouver gay community, vaccination, and results. http://www.bcmj.org/bc-centre-disease-control/new-cases-meningococcal-group-c-infections-gay-men-bc

    “The rate of disease in the gay population was estimated at between 13.9 to 48.4 cases per 100 000. This rate was sufficiently high to warrant a vaccination campaign to provide free meningococcal group C conjugate vaccine to all gay and bisexual men in BC.” (When you have a public vaccination system in place – for kids and for seasonal influenza, etc. – and the government funds it, you can avoid the questions raised about who should get the vaccine – just do it.)

  • http://AMERICAblog.com/ John Aravosis

    I doubt he’d know about the particulars of insurance. It’s quite an expensive vaccine – a friend got it for $85 at his campus health center yesterday, at a midwest college. It’s more like twice that normally I believe.

  • Freday63

    Maybe I missed it, but I didn’t see anything relating to the cost of the vaccine…Is it covered by insurance? Is it similar in price to the flu vaccine? How long will it be before we can expect it to hit Atlanta?

  • nicho

    Thank you, John. Very informative, well-researched article. A real public service.

  • http://AMERICAblog.com/ John Aravosis

    Well, as the doc from CDC said, it’s odd that the outbreak has lasted this long, and increasingly, albeit slowly, so there is legit concern.

  • http://AMERICAblog.com/ John Aravosis

    LOL ha! Trust me, it took a hell of a search not to find another bacteria.

  • Miket298

    I had a doctors appointment yesterday and got the vaccine just in case. even though I’m not in NY. The nurse giving it to me seemed to know about it when i mentioned meningitis in NY, but it is a health clinic geared towards GLBT people.

  • Drew2u

    I take it back: love the shutterstock, now.

  • Indigo

    Oh, I see. Next question: what was the NYC health board trying to prove?

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