Public health officials in big cities and now in Salt Lake City are facing a new challenge: coping with what appears to be a vulnerability to bacterial meningitis in gay communities.
Following the infection and recent death of a young, gay Salt Lake County man, local officials have put gay and bisexual residents on alert, urging anyone with symptoms to seek medical help. Symptoms include nausea, vomiting, fever, sensitivity to light, a headache, stiff neck, altered mental state or rash.
They're treading carefully, spreading their advice to get vaccinated through groups such as the Utah Pride Center, Utah AIDS Foundation and Q Salt Lake Magazine, which published an advisory on its website on Wednesday.
But the targeted approach has drawn some criticism.
"I'm pretty sure the bacteria isn't just targeting [the] gay and bi community ... shame on YOU Salt Lake Co. Health Dept!" wrote one Q Salt Lake Magazine commenter.
The Salt Lake County Health Department says its intent was to warn anyone who might have been exposed without stirring panic.
Meningitis, or meningococcal disease, is rare and outbreaks are usually small and confined, said Lynn Beltran, the county's epidemiology supervisor.
But a deadly strain has popped up in clusters of gay men in cities such as New York and Los Angeles. And the disease, which results in an inflammation of protective membranes around the brain and spinal column, requires immediate medical attention and treatment with antibiotics to prevent brain damage or death, she said.
Salt Lake City's isolated case, confirmed within the past 30 days, is not by definition an outbreak. A public advisory might not have gone out, said Beltran, were it not for the fact that the man died so rapidly, before health officials had a chance to ask him about others who might have been exposed.
"We could only interview people close to him. There was concern if anyone was out there who we may have missed who could be sick," she said, noting anyone with close or long exposure should be treated with antibiotics.
The man was in his 20s, Beltran said. He had no underlying health problems and had not recently traveled to areas where outbreaks have occurred, she said.
There was stigma surrounding rise of HIV-AIDS in the '80s.
But Tyler Fisher, programming director of the Utah AIDS Foundation, said the meningitis case "was such an isolated incident that we weren't worried about people being alienated," said Fisher, who pushed the county's meningitis notice out on the foundation's Twitter feed and Facebook pages.
Michael Aaron, publisher and editor of QSalt Lake, an LGBT magazine, said he did not think it was "homophobic" for the health department to just alert the gay community, instead of the mainstream media.
"The community as far as we can tell is unaware of who it might have been" who died from the meningitis, Aaron said.
"Meningitis is not a gay disease. It could happen to anyone," said Demetre Daskalakis, medical director of Mount Sinai's AIDS program, who helped New York with its prevention efforts.
The bacteria is spread through saliva and kissing or sharing a cigarette, a drink or utensils, according to the U.S. Centers for Disease Control and Prevention. For that reason, the disease is usually confined to a shared space, such as a college dorm or military barracks.
But the epidemiology of a 2010 outbreak in New York City pointed instead to a shared activity: same sex intimacy, said Daskalakis.
In three years the city has documented 22 cases of bacterial meningitis among gay men, nearly half of them fatal, he said. Some were HIV-positive, leaving them with weakened immune systems, which could have put them at risk, he said.
But it's a social network that knit them together, he said. Many were found to have had intimate contact with a man they met on a digital application or website, such as Grindr, Scruff or Manhunt.
"In an urban gay lifestyle you're going out to the same clubs and bars," said Daskalakis. "In some ways an enclosed community, like a gay community, is like a dorm room without walls."
City health officials responded by recommending that some HIV-positive men get vaccinated. Later, they expanded it to include all gay men in New York City, "regardless of HIV status, who regularly have close or intimate contact with men met through an online website, digital application (app), or at a bar or party."
The decision stirred controversy, with some in the gay community accusing the health department of homophobia.
Daskalakis, on the other hand, applauds the department for taking swift, decisive action, and for joining with the gay community to save lives.
The vaccination campaign halted the outbreak, he said. "I liken it to there being a measles or mumps outbreak among a Hasidic community in New York. Would you vaccinate everyone, or focus on those most at risk and maximize your impact, both fiscally and in terms of prevention?"
It's not known why meningitis hasn't been noticed in gay communities before.
"It could be a reporting bias," said Daskalakis. "Ten years ago in Utah they may not have even known the guy was gay."
There have been an annual average of five cases of meningitis in Utah since 2009, according to the Utah Department of Health. Since then, six Utahns have died from the disease.
2009 • 3 cases
2010 • 1 cases
2011 • 11 cases
2012 • 4 cases
2013 • 7 cases
Preventing bacterial meningitis
O The U.S. Centers for Disease Control and Prevention recommends immunization for youths over the age of 11, college freshmen living in dorms, military recruits, adults with certain health problems and some microbiologists and travelers.
Find out more information online. > bit.ly/bactmeningitis
Visit The Meningitis Foundation of America about the diagnosis, treatment and prevention of meningitis at Musa.org.