L.A. County Meningitis Stats Raise More Questions -- County Only Recently Began Tracking Sexual Orientation
Updated at the bottom: Health experts say only some types of bacterial meningitis are spread person-to-person, these types are not as contagious as flu and are not sexually transmitted. The CDC says there is no increased risk among gays and no rationale for county officials to alter their approach. Brett Shaad's family, meanwhile, condemns media hysteria over his death.
UCLA Public Health Director Jonathan Fielding
Updated at the bottom: The Los Angeles County Department of Health Services has announced today that it will be providing free meningococcal vaccines for low-income and uninsured residents in Los Angeles County.
The Los Angeles Gay & Lesbian Center has released new figures for the total number of gay or bisexual men who have been recently infected with meningitis in Los Angeles County. The center received that information from the Los Angeles County Department of Public Health and its director, Dr. Jonathan Fielding, late yesterday.
Fielding and county health officials also disclosed to the Gay & Lesbian Center that they've only been tracking meningitis cases among gay and bisexual men since November 2012 -- five and a half months.
Yet in New York City, health officials have been tracking sexual orientation during their investigations as a matter of policy for years.
And without that specific data over a longer period of time in Los Angeles, it's difficult to clearly understand if gay and bisexual men here have been more impacted by meningitis than the rest of the general population.
L.A. Weekly contacted county health officials on Tuesday afternoon to discuss the situation further. We have yet to receive a reply.
But the data does suggest at minimum that the rate of meningitis among men who have sex with men in Los Angeles County is higher than expected -- and that further study is warranted.
The New York City Health Department has been tracking sexual orientation during its investigations for a number of years, a spokesperson tells the Weekly. That allowed the agency to identify a growing problem of meningitis among men who have sex with men going back to August 2010 -- 22 cases in total between 2010 and 2013.
As that trend increased, New York health officials first released a recommendation in November 2012 for men who have sex with men in certain New York City neighborhoods to get a meningitis vaccine.
In March, New York health officials recommended that all men who have sex with men in New York City should get a vaccine. The New York City Health Department is offering free vaccines for those men who can't afford one.
Los Angeles Gay & Lesbian Center medical director Dr. Bob Bolan has now called on the Centers for Disease Control and Prevention to require health departments to include data on sexual orientation for cases of meningitis.
The New York City Health Department says L.A. County health officials have reached out to the agency.
There have been questions of just how many meningitis vaccines L.A. County has to offer. On Monday, AIDS Healthcare Foundation, a non-profit group based in Los Angeles, stepped up and offered 10,000 free meningitis vaccines.
According to the county public health figures, L.A. County averages 25 cases of meningococcal meningitis every year. Meningitis is not a gay disease. Anyone can get it, although some people -- toddlers and college students, for example -- are more at risk than others.
In 2012, there were 12 cases. At least two of the 12 involved a gay or bisexual man, but since the county was not tracking sexual orientation among victims until November 2012, that number is only a minimum.
In 2013, there have been 9 cases, and two of them involved gay or bisexual men, including West Hollywood resident Brett Shaad.
Two of the four cases involving gay or bisexual men between November 2012 and today resulted in death: downtown L.A. resident Rjay Spoon, 30, in 2012 and Shaad, 33, in 2013. Both men were high achievers with bright futures.
County health officials told the Gay & Lesbian Center that "they have not been able to establish a connection among any of them."
According to Gary Gates, a highly regarded researcher at UCLA's Williams Institute, a gay think tank, there are approximately 130,000 adult men (18 years old or older) who self-identify as gay or bisexual in Los Angeles County. Gates also says that including men who have sex with men but don't self-identify as gay or bisexual doubles that number, to approximately 260,000 men.
Within a five-and-a-half-month period between November 2012 and April 2013, four of those roughly 260,000 have contracted bacterial meningitis. Two of them died.
Is that 4 out of 260,000 ratio considered abnormal in public health circles?
Dr. Paul A. Offit, chief of the division of infectious diseases at the Children's Hospital in Philadelphia, told the New York Times that by "the time you graduate from college and are in your 30s, meningococcal [meningitis] disease goes down to about one-half case per 100,000 population." Or, one case per 200,000. That suggests four cases in a population of 260,000 is higher than the norm.
And that ratio might actually be higher; we simply don't know because county health officials have only been tracking bacterial meningitis cases among this specific population since November.
This raises all sorts of questions for the county health department. Is it concerned about the rate of infection? Why did it only begin tracking the cases by sexual orientation less than six months ago? Should it take an epidemiological look at the cases prior to November to determine the actual rate of infection among men who have sex with men?
We'll have more on this story as it develops.
UPDATE: The Los Angeles County Department of Health Services has announced it will be providing free meningococcal vaccines for low-income and uninsured residents in Los Angeles County.
"Amid the growing concern in the community," a county press statement says, "residents without health insurance may visit one of the health care facilities listed below for a free vaccination."
Dr. Jonathan Fielding says in a press statement, "Public Health and Health Services are sympathetic to the growing concerns of the community."
The county will offer the free vaccines at seven health care facilities in L.A. County:
-- Harbor-UCLA Medical Center in Torrance,
-- High Desert Multi-Service Ambulatory Care Center in Lancaster,
-- LAC+USC Medical Center in Los Angeles,
-- Hubert H. Humphrey Comprehensive Health Center in Los Angeles,
-- H. Claude Hudson Comprehensive Health Center in Los Angeles,
-- MLK Multi-Service Ambulatory Care Center (MACC) in Los Angeles,
-- Olive View-UCLA Medical Center in Sylmar.
UPDATE: In an effort to calm fear and speculation, the Centers for Disease Control has strongly reiterated that there is no increased risk of contracting meningitis based on sexual orientation, that the contagious forms have plunged in occurrence nationwide since 1990 and that such close-living groups as college students and sports teams face the greatest risk.
The Huffington Post reports:
Epidemiologist Dr. Amanda Cohn of the U.S. Centers for Disease Control and Prevention cautioned against characterizing meningococcal disease (a deadly strain of bacterial meningitis and the culprit behind Shaad's death, as well as the New York outbreak) as a risk to gay communities.
"We know a lot about meningococcal disease, and at this point in time, we're not worried about a large epidemic among the gay community -- or any community." ... "Right now we're seeing less than 1,000 cases per year, and in the 1990s there were over 3,000 cases per year."
Moreover, Huffington Post reports, the CDC will this week compare the strain that killed Shaad to the New York City cases, but even if the bacteria on the two coasts proves to be the same strain, Cohn explained:
"... it wouldn't necessarily mean the infections are linked or that the county health department should change its response."
The New York City strain "is very common, and one that frequently causes death," said Cohn. "But that same strain has circulated in other communities in the past."
"It's also important to understand that one's sexual orientation doesn't increase the risk of meningococcal disease," Cohn said, adding that bacterial meningitis is spread through close or "household contact" with infected people's respiratory droplets or secretions, like kissing.
Eight days have now passed since Brett's first symptoms, and this still remains an isolated case. My brother is not the Patient Zero to an epidemic that [West Hollywood City] Councilman [John] Duran made him out to be. ... The irresponsibility of Councilman Duran, the LA Times and the Associated Press in announcing the death of my brother before we even had the chance to tell family members and his friends outside of Los Angeles is outrageous.
Brian Shaad also announced, without elaborating, that:
There are a number steps we will be taking to ensure that politically-driven actions by politicians and reckless reporting by the media can never do this to another grieving family again.
For more information, go to the county Health Services website.
Contact Patrick Range McDonald at firstname.lastname@example.org.