A Rise in Meningococcal Disease Among People With HIV, 2022

This page describes a CDC report based on preliminary 2022 data and the vaccine recommendations of that time.

Meningococcal disease, caused by the bacterium Neisseria meningitidis, is a sudden, life-threatening illness that usually takes the form of:

• meningitis — most often fever, headache and stiff neck; or
• meningococcemia — most often fever, chills, fatigue, vomiting, diarrhea, cold hands and feet, and severe aches or pain.

The quadrivalent meningococcal conjugate vaccine (MenACWY) is routinely recommended for adolescents and for people at higher risk, including people with HIV. In 2016 the Advisory Committee on Immunization Practices recommended a 2-dose MenACWY series for people with HIV. Coverage has stayed low: in insurance claims from January 2016 to March 2018, only 16.3% of people with HIV got at least one dose within 2 years of diagnosis.

What changed in 2022

Cases are reported through the National Notifiable Diseases Surveillance System, with extra detail and bacterial samples from Enhanced Meningococcal Disease Surveillance; whole genome sequencing identifies serogroups and strains.

The 2022 count could still rise as reporting is completed.

Meningococcal disease cases among people with HIV, by year, 2017–2022. CDC figure.

Who was affected

• Vaccination: of the 29, 22 had not received MenACWY, six had unknown vaccination history, and one had been vaccinated with an unknown number of doses.
• An outbreak: 15 cases were part of a large serogroup C outbreak, mainly among men who have sex with men (MSM).
• Beyond the outbreak: even excluding those outbreak cases in every year, cases among people with HIV rose to 14 in 2022, compared with four to eight a year in 2017–2021.
• • Nine of those 14 were caused by a single strain — serogroup Y, clonal complex CC174, sequence type ST-1466. Eight of the nine were in Black or African American people and seven in MSM. They came from three states with no known links between them.
  • The other five were not clustered and had no known connections.

What CDC recommended

• Health care providers should make sure everyone with HIV is up to date on MenACWY, and on the other vaccines recommended for them.
• Providers should keep meningococcal disease in mind when people with HIV have its symptoms.
• CDC recommends that everyone be screened for HIV at least once, and that patients with meningococcal disease whose HIV status is unknown be tested.

Sources

• Rubis AB, Howie RL, Marasini D, Sharma S, Marjuki H, McNamara LA. "Notes from the Field: Increase in Meningococcal Disease Among Persons with HIV — United States, 2022." Morbidity and Mortality Weekly Report 72(24), Centers for Disease Control and Prevention.