So far this year Florida has confirmed 21 cases of meningococcal disease, far outpacing annual averages, according to state health officials. They are encouraging high-risk groups — including gay and bisexual men, people with HIV and college students — to get vaccinated against the often severe and sometimes deadly illness.
An outbreak advisory from the Centers for Disease Control and Prevention says Florida has a “large, ongoing outbreak of meningococcal disease,” primarily among gay, bisexual, and men who have sex with men, including those living with HIV.
But in recent months, there have also been cases reported among college students, including an April 1 announcement that Florida’s health department was investigating three confirmed cases in Tallahassee among people ages 18 to 22. At this time, though, there is no evidence linking the cases among college students to the larger outbreak.
Florida’s 21 cases of meningococcal disease in 2022 are on track to eclipse prior years if the outbreak is not contained. Compared to 2022, Florida had 27 cases in 2021, 17 cases in 2020 and 23 in 2019.
“Obviously that rings alarm bells with epidemiology and they want to start making sure that it’s known there’s a vaccine available for this,” said Jeremy Redfern, press secretary for the Florida Department of Health. Redfern said some of the Florida cases have resulted in deaths but that he did not know how many.
In addition to the three cases in Leon County, which is home to Florida State University, the health department has confirmed six cases in Orange, three in Lake, two each in Miami-Dade and Brevard, and one each in Hardee, Hillsborough, Osceola, Polk and Seminole counties.
Redfern said Florida epidemiologists are actively investigating cases and trying to identify which ones might be related. But, he said, “a for sure cause” for the outbreak is not known.
“This is just something that happens periodically,” he said, “and we just get an outbreak every now and then and it’s usually among the men who have sex with men community and sometimes it’s just random.”
STDs also rising
Meningococcal disease is caused by bacteria that are not as contagious as airborne viruses and typically require close contact over a period of time, or direct contact such as kissing or sharing drinks, to spread. It can first appear as a flu-like illness and worsen rapidly to include infections of the lining of the brain and spinal cord, known as meningitis, and bloodstream.
Florida’s outbreak is occurring at the same time that the CDC is reporting significant increases in sexually transmitted diseases or STDs, including gonorrhea, syphilis and congenital syphilis transmitted from pregnant women to their newborns.
The CDC’s national 2020 STD Surveillance Report released Tuesday found that reported cases of gonorrhea were up 10 percent and syphilis cases increased 7 percent compared to 2019 in the United States. Syphilis among newborns spiked nearly 15 percent from 2019 and about 235 percent compared to 2016. And though reported cases of chlamydia declined 13 percent from 2019, CDC officials said the drop is likely due to reduced screening during the pandemic.
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Leandro Mena, director of the CDC’s Division of STD Prevention, said during a media briefing that the federal agency is following the meningococcal disease outbreak in Florida but does not yet know what’s driving the spike in cases.
“Over the years there have been several outbreaks similar to this that have happened,” Mena said. “We don’t know yet what is the cause. Meningococcal disease typically happens to college-aged kids and that’s why vaccination for this population is recommended.”
Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, added that inoculation with one of two available vaccines for meningococcal disease appears to also reduce the risk of contracting gonorrhea.
“There’s recent research that was just published that indicated ... one vaccine for meningococcal disease can have collateral benefits and reduces the risk of gonorrhea by about 30 percent,” Mermin said. “There’s more research going into that, but it does show at least some hope that in the future we could be developing effective and safe vaccines against gonorrhea.”
The pandemic effect
One factor driving the increase in STDs, and likely contributing to Florida’s outbreak of meningococcal disease, is the pandemic.
STD increases reported by the CDC for 2020 likely were due to deferred in-person and routine medical care, less frequent screening for sexually transmitted diseases, shortages in testing and laboratory supplies, and lapses in health insurance coverage due to unemployment, Mermin said.
The pandemic also has forced state health departments in Florida and elsewhere to divert staff, such as contact tracers who specialize in containing the spread of infectious diseases, away from STDs and toward COVID-19 response.
“The COVID-19 pandemic came at a very difficult time for STD control,” Mermin said. “We had already a strained, kind of crumbling public health infrastructure. Many communities do not have STD specialty clinics. So what that led to was an exacerbation of the already increasing trends.”