BQ Journal Vol 53 - Q4 2023 - 45

Morbidity and Mortality Weekly Report
Notes from the Field
Increase in Meningococcal Disease Among
Persons with HIV - United States, 2022
Amy B. Rubis, MPH1; Rebecca L. Howie, PhD1; Daya Marasini, PhD1;
Shalabh Sharma, MS1; Henju Marjuki, PhD1; Lucy A. McNamara, PhD1
Meningococcal disease, caused by the bacterium Neisseria
meningitidis, is a sudden-onset, life-threatening illness that
typically occurs as meningitis or meningococcemia. The most
common signs and symptoms of meningitis include fever, headache,
and stiff neck; the most common signs and symptoms of
meningococcemia are fever, chills, fatigue, vomiting, diarrhea,
cold hands and feet, and severe aches or pain.* Quadrivalent
meningococcal conjugate vaccination (MenACWY) is routinely
recommended for adolescents and persons at increased
risk for meningococcal disease (1), including those with HIV.
In 2016, a 2-dose series of MenACWY was recommended by
the Advisory Committee on Immunization Practices (ACIP)
for persons with HIV and incorporated into the U.S. immunization
schedule. Coverage among persons with HIV, however,
remains low: in a study of administrative claims data during
January 2016-March 2018, only 16.3% of persons with HIV
received ≥1 doses of MenACWY vaccine within 2 years after
their diagnosis (2). This report describes an increase in meningococcal
disease among persons with HIV in the United States
in 2022. Data are typically finalized in the fall of the next year;
therefore, this report is based on preliminary data for 2022.
Meningococcal disease cases are reported through the
National Notifiable Diseases Surveillance System, with additional
epidemiologic information and isolates obtained through
Enhanced Meningococcal Disease Surveillance. Isolates are
characterized using whole genome sequencing to determine
serogroup and molecular typing information. This activity
was reviewed by CDC and was conducted consistent with
applicable federal law and CDC policy.†
During 2017-2021, five to 15 meningococcal disease cases
were reported each year among persons with HIV, representing
1.5%-4.3% of all meningococcal disease cases annually
(Figure). Based on preliminary data, 29 meningococcal disease
cases have been reported among persons with HIV in 2022,
accounting for 9.8% of all cases. This case count might increase
when reporting is complete.
* https://www.cdc.gov/meningococcal/about/symptoms.html
† 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C.
Sect. 552a; 44 U.S.C. Sect. 3501 et seq.
Among the 29 meningococcal disease cases among persons
with HIV in 2022, 22 had not received MenACWY vaccine,
six had unknown MenACWY vaccination history, and one
had received MenACWY vaccine, but the number of doses
received was unknown. Fifteen of the 29 cases were part of a
large serogroup C outbreak that occurred primarily among men
who have sex with men (MSM); however, after excluding MSM
outbreak-associated cases for all years, a substantial increase in
meningococcal disease cases among persons with HIV in 2022
remained (i.e., 14 cases compared with four to eight cases per
year during 2017-2021) (Figure). Of the 14 cases among persons
with HIV in 2022 that were not related to the outbreak
primarily among MSM, nine were caused by a single strain of
N. meningitidis serogroup Y clonal complex CC174 sequence
type ST-1466. Eight of these nine cases occurred in Black or
African American persons, and seven occurred among MSM.
The nine cases caused by a single strain were reported from
three states with no identified connections among cases. The
remaining five cases were not clustered geographically and had
no identified epidemiologic connections.
MenACWY vaccine coverage among persons with HIV is
low; given the recent increase in meningococcal disease cases
in this population, health care providers should ensure that all
persons with HIV are up to date with MenACWY vaccination
per ACIP recommendations, as well as other vaccines recommended
for this population. Health care providers should also
maintain a high index of suspicion for meningococcal disease
among persons with HIV who have symptoms of meningococcal
disease. CDC recommends that all persons be screened for
HIV at least once in their lifetime (3). Providers should ensure
that patients with meningococcal disease and unknown HIV
status are screened for HIV.
Acknowledgments
Jurisdictions participating in Enhanced Meningococcal Disease
Surveillance; John Brooks, Elizabeth DiNenno, Division of HIV
Prevention, National Center for HIV, Viral Hepatitis, STD, and
TB Prevention, CDC.
Corresponding author: Amy B. Rubis, arubis@cdc.gov.
1Division of Bacterial Diseases, National Center for Immunization and
Respiratory Diseases, CDC.
All authors have completed and submitted the International
Committee of Medical Journal Editors form for disclosure of potential
conflicts of interest. No potential conflicts of interest were disclosed.
US Department of Health and Human Services/Centers for Disease Control and Prevention
MMWR / June 16, 2023 / Vol. 72 / No. 24
663
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https://www.cdc.gov/meningococcal/about/symptoms.html
BQ Journal Vol 53 - Q4 2023

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