Meningitis—More Research Needed

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Left Field by Patricia Nell Warren

With gay and bi men on high alert, the “threat” leaves us with more questions than answers.
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On April 12, a West Hollywood gay lawyer named Brett Shaad died of bacterial meningitis. Enough political panic and media misinformation has erupted around this case that I’m returning to the subject, having done a column last year that discussed New York City meningitis cases between 2010–12.

When I analyzed the news coverage in New York City, I noticed the relentless focusing on gay male cases, especially those who were HIV-positive. Some news stories, notably those coming from right-wing sources like Fox News, didn’t even mention the three women and a child whose cases swelled the local statistics. So rightist reporting left the impression that all local cases were gay and bi men. Later, NYC health authorities made their own move that looked politically suspicious. In March 2013, despite a long-established fact that HIV-positive gay and bi men are more vulnerable to meningitis because of their depressed immune systems, authorities recommended vaccination for all sexually active MSMs, regardless of their HIV status. This gave the impression that NYC meningitis was being sexually transmitted, even though this disease is not a sexually transmitted disease.

As I write this column in late April, there’s more breaking news. After an alarm sounded by West Hollywood city councilmember John Duran, the AIDS Healthcare Foundation arranged for thousands of gay and bi men to get free meningitis vaccinations. Fuel is added to the fire by late admissions from L.A. health officials that three other Southern California gay men died of meningitis starting in December 2012. Late mention has even been made of some cases last summer—total not given—of meningitis among L.A.’s homeless population. The alert about these cases was ignored till now.

I continue to notice how some media continue positioning bacterial meningitis as if it is a “gay disease,” since they mention only the gay male cases of meningitis. Even some indie media, and activists, are comparing this alleged outbreak to the emergence of AIDS in the gay community in the 1980s—which creates an impression that bacterial meningitis is edging towards being a new AIDS.

However, looking beyond these inflammatory and problematical statements, we do have to verify if a gay/bi vulnerability to meningitis might in fact be growing—at least in urban areas like New York City and L.A., where there are large LGBT populations.

According to medical literature, bacterial meningitis can be caused by three main organisms: Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. On top of this, there are identifiable strains of these bacteria. NYC health authorities mentioned a virulent strain of bacteria that kills one in three patients rather than the usual one in five. We have to look at the CDC, the agency in charge of our national definitions, protocols, and recordkeeping. Here’s what the CDC says about meningococcal disease:

“It is a leading cause of bacterial meningitis in children 2 through 18 years old in the United States. Meningitis is an infection of the covering of the brain and the spinal cord. Meningococcal disease also causes blood infections. About 1,000–1,200 people get meningococcal disease each year in the U.S. Even when they are treated with antibiotics, 10-15% of these people die….Anyone can get meningococcal disease. But it is most common in infants less than one year of age and people 16–21 years. Children with certain medical conditions, such as lack of a spleen, have an increased risk of getting meningococcal disease. College freshmen living in dorms are also at increased risk.”

The CDC’s mortality figure on this disease translates into 100 to 150 deaths a year. In this description, CDC says nothing about gay and bi men, or MSMs, as a risk group based on sexual activity or even HIV status.

Medical literature mentions that the bacteria can’t live outside the human body for very long. Nevertheless it is contagious—spreadable by coughing, sneezing or social kissing, or even shared use of dishes and cigarettes—which is what makes meningitis such a danger in student situations like college dorms and cafeterias, according to Brown University student information. For this reason, a growing number of states now mandate that students must be vaccinated against meningitis, or at least informed about the importance of vaccination.

The Meningitis Foundation of America emphasizes this significant fact: “The bacteria which cause bacterial meningitis live in the back of the nose and throat region and are carried at any given time by between 10% and 25% of the population. It causes meningitis when it gets into the bloodstream and travels to the meninges. What triggers this movement in a small number of unfortunate people remains the subject of research.”

This interesting fact of meningococcal bacteria living right in the noses of one quarter of Americans explains why a cluster of bacterial meningitis cases can appear seemingly out of nowhere, leaving public health authorities looking in vain to find the “index case.”

L.A. attorney Brent Shaad was alleged by several media sources to have attended the White Party in Palm Springs—an event well known for its frenzy of MSM sexual activity. Shaad’s family were furious at the media allegations. In an Instinct magazine interview, Shaad’s brother Brian pointed out that the L.A. Times never contacted the family about Brett’s case. So, according to Brian, the Times got various facts wrong, “including the time of his death; day admitted to hospital; status of life support; and the strain of meningitis in question. In fact,” Brian Shaad went on, “the strain mentioned has killed heterosexuals and homosexuals alike since cases in NYC were first reported in 2010. This is not a gay disease. With regards to his attendance at the White Party in Palm Springs we have no evidence he even attended the party.”

Then, days after his death, headlines broke that L.A. health authorities had neglected to mention the death of another L.A. gay man, Rjay Spoon, on December 16, 2012. He, and two other cases, are now said to be among thirteen cases of meningitis in L.A. County last year. But Spoon’s death was hardly a secret. Back in December, his partner, Casey Hayden, had posted about it on his Facebook page, asking if any Friends had information on how Spoon might have contracted it. No public attention was paid to Spoon’s case until Shaad’s death hit the news.

The L.A. Department of Health is now being accused by some community commentators of not being forthcoming about Spoon’s death, as well as the other two fatal cases, and of not being proactive enough on recommending vaccinations for large numbers of men. At a press conference, DPH’s Dr. Maxine Liggins insisted that they were merely following the protocols for this disease. Which brings us back to the CDC, which establishes these protocols.

As I go to press with this story, the Los Angeles gay community is demanding that local health authorities start specific reporting on gay/bi meningitis cases. But more questions need to be answered as well. Exactly how many cases have occurred in southern California in the last year, including those 2012 homeless cases that most people ignored till now? Have gay/bi/MSM cases of meningitis increased enough nationally since 2010 that the CDC and local authorities should start mentioning them as an at-risk group, along with infants and college students?
What do we really know about any relationships among these gay/bi cases? L.A. health authorities insist they don’t use the word “outbreak” unless they can connect cases. Do we know which of the three types of bacteria, and strains of bacteria, caused each case? How many of the deaths were HIV-positive men? Can a gay or bi man develop a weakened immune system from some cause unrelated to HIV, that might render him more vulnerable to bacteria right in his own nose? Does he have a history (some gay and bi men do) of frequent antibiotics treatment for STDs, that might have caused his own nasally resident strain of bacteria to mutate into a more virulent strain like the one mentioned in New York City?

Clearly, as the Meningitis Foundation has said, more research is needed on this still-somewhat-mysterious disease.

Meanwhile, certain media, health authorities, commentators and activists should stop profiling meningitis in terms of gay men only. For sure, meningitis is scary because its source isn’t always known and it can kill with such speed. But comparing it to the historic emergence of AIDS is politically dangerous and medically inaccurate. In a recent commentary, gay activist John Aravosis points out the danger of religious-right forces now adding meningitis to their list of arguments that gays are a public-health menace and shouldn’t be allowed to marry.

The danger will be especially sharp if new research proves that MSMs still constitute only a fraction of the nation’s cases for a single year.

Further reading:

Meningitis Foundation of America:
www.meningitisfoundationofamerica.org/templates/section-view/18/index.html

“Killer at College”: www.nbcnews.com/id/20519953/ns/health-infectious_diseases/t/killer-college-meningitis-threatens-students/#.UW18fyucXJs

NIH on changes in meningitis epidemiology 1998-2007: www.ncbi.nlm.nih.gov/pubmed/
20001736

WebMD on meningitis vaccinations:
www.webmd.com/vaccines/meningococcal-vaccine-for-adults

Author of fiction bestsellers and provocative commentary, Patricia Nell Warren has her writings archived at www.patricianellwarren.com. Reach her by e-mail at [email protected]

Copyright © 2013 by Patricia Nell Warren. All rights reserved.

Read this article in the May 2013 digital issue by clicking here.