Meningitis Outbreak Accelerates in NYC Gay and Bi Communities
It’s a sweaty Wednesday night at Paddles, Chelsea’s S&M dungeon of spanking chairs, steel ankle restraints and rough oak leg spreaders, and the obligatory clothing-check at the front of the house is thronged with horny men looking to release a little midweek ennui and get their freak on. And then there’s the guy with the hypodermic needles—Cure T-shirt, skinny black jeans, medical ID lanyard slung around his neck, and the eager look of the do-gooder in his eyes—asking each man in turn if he’d like a vaccination. “It’s definitely a buzzkill, I know,” says Dr. Demetre Daskalakis, 39, an assistant professor of medicine at the New York University School of Medicine who works out of Bellevue Hospital.
As Daskalakis walks a 42-year-old Wall Streeter wearing only a jock strap through the consent form attached to a clipboard (keep the top info sheet, sign the bottom one and leave it), the man asks, “Oh, so I’m the top and you’re the bottom?” drawing laughs from the conga line of naked and similarly jock-strap-clad men behind him. “Yes,” says Daskalakis. “And you get a lollipop afterward.”
Few things could dampen the mood of some 80 men having a consensual good time in these dark corners. But a sense of dread and fear has begun to grip the city’s gay and bisexual male community in recent weeks. The New York City Department of Health and Mental Hygiene has sounded an increasingly urgent alarm over a growing bacterial meningitis outbreak. This year alone, four men have contracted the potentially lethal disease, putting it on pace with last year’s record of 13 cases since the outbreak started in 2010. In that time, 22 gay and bisexual men have contracted an insidious strain of the bacteria that inflames the lining of the brain and the spinal cord. Seven have died, including three of the last five cases—practically half of the fatalities in just a matter of months.
It is a gruesome and painful illness. The disease can race from headache and fever to rampant rash and then to death within hours. Health officials are afraid that it could claim many more lives—both in the gay community as well as among straight people. But thus far, the disease, for reasons the health department can’t explain, has remained solely in the gay and bisexual community. “We don’t actually know why it’s only occurring in men who have sex with men,” says Dr. Jay Varma, deputy commissioner for disease control at the health department. “If you look at the subset that is this population, it is occurring at a rate 20 times higher than the overall population and 40 times higher than men who aren’t gay or bisexual. It’s frightening. We’re fearful that if we don’t stop it, it’s going to get worse.”
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On March 6, the health department issued the latest in a series of dire alerts, warning the public and healthcare professionals of the danger. Doctors had not promptly reported some of the recent fatal infections to the department; some waited days until a lab had made a positive diagnosis. “That can make a difference in treatment and containment,” says Varma.
Though the health department does not believe there is a Patient X out there spreading the disease, it tracked nearly half of all its cases to Brooklyn, to areas as varied as DUMBO, Prospect Heights, Brownsville, Clinton Hill, Bed-Stuy, Crown Heights, and Williamsburg. Most of the men reported meeting for anonymous sex via gay social-media sites and phone apps like Grindr, Scruff, Adam4Adam, and Manhunt. The anonymity of such hookups (“Sometimes all a person knows is a screen name,” says Varma) has made tracking down carriers and halting the spread difficult. The department is using cell phone and computer information of known cases to locate others.
Since meningitis resides in the mucous and nasal passages of carriers—20 percent of whom never get sick—it is spread only by close contact, typically in places like schools and military barracks. It can be contracted by kissing or by any sort of shared saliva, or even just using the same drinking glass or utensils as an infected person. Health experts first identified the current strain during a 2006 outbreak, which started with a 47-year-old Bronx woman and circulated among drug users—mainly crack- and pot-smokers, because smoking irritates the lining of the throat and nasal passages, where the bacteria lives. They don’t know why it reappeared and, strangely, “We don’t know why it’s not spreading to other populations,” says Varma—like to heterosexual family members or co-workers whom they might kiss hello or share utensils with. But it could.
The health department originally thought the disease was spreading primarily among gay men with HIV—a risk factor for the disease—who had met anonymously online or through digital phone apps. But early this year it became clear the disease had invaded a much wider population. On March 6, the department expanded its vaccine recommendations to include all men who had sex with men, regardless of HIV status or where and how they met, and noting the shifting geography of recent cases, with four of the last five occurring in Manhattan. It also noted that several men in the outbreak had not self-identified as gay. The department urged medical professionals to perform complete sexual histories on their male patients to identify those at risk, and specifically urged it for men of color.
To prevent further infections, and to stop the disease from exploding, the department originally targeted 10,000 people for vaccination—then boosted the number once more in March to 103,000, its estimate of the gay population in New York City—and is giving shots away for free. Daskalakis, an HIV and infectious diseases expert who does HIV outreach testing in gay bars and sex clubs, is the only doctor in New York giving out vaccinations in the field. “The disease has spread beyond social media and gone into the bars and sex clubs,” says Daskalakis, a slender, youthful, and energetic man who has personally given out some 300 vaccinations, including the 44 he will give tonight in a three-hour period.
Several men standing in line at Paddles said their doctors told them that they didn’t have the vaccine, or that it was too expensive to keep in stock (a reported $700 or more for five doses). In addition, some insurance policies won’t cover it. The men said that they heard about Daskalakis by way of social media alerts on Facebook and Twitter. “I think the city can be doing a hell of a lot more to alert people,” says Mark Warfel, a plastic surgeon who had come to the club just for the vaccination. “People are carrying it and don’t know it. Scary.”
In fact, when the disease gained momentum last fall, the city’s efforts to publicize it were drowned out, first by Hurricane Sandy and then by an outbreak of an unrelated fungal meningitis, which was spreading by way of tainted cortisone shots to patients with lumbar spine pain. “A lot of people are still confused by what’s going on,” says Sue Weiss, clinical director for HIV at the Callen-Lorde Community Health Center for people with HIV, who adds that the center has since vaccinated some 5,000 or more of its patients. “Unfortunately, this one kind of got lost in the shuffle.”
As with the emergent HIV crisis in the 1980s, some gay men have been quick to blame themselves, even though the outbreak is not a sexually transmitted disease. When Brooklyn blogger and medical writer Michael Broder first wrote about the topic in early March, his comments section filled with the vitriol of warring camps. “It was like the HIV wars, when Larry Kramer spoke of sex-negative ideas, like, ‘shut down the apps, our promiscuity is killing us,’ and the sex-positive ideas of Richard Berkowitz, who literally wrote the book on condoms and safe sex,” says Broder.
That debate will likely intensify in coming weeks as experts identify more cases or find them elsewhere. Last week, Southern California health officials reported bacterial meningitis deaths among three men (two of whom identified as gay). The most recent death was on April 13—a 33-year-old West Hollywood lawyer who had attended the annual Easter weekend White Party in Palm Springs, which draws gay men from around the country. The Centers for Disease Control and Prevention says the New York City and Los Angeles County health departments have contacted its officials about their cases, but no direct link has been made. The CDC says it is monitoring the outbreaks.
In the meantime, the efforts of groups like Gay Men’s Health Crisis, which has led the charge in educational Twitter and Facebook blasts to the gay community and has given out hundreds of free vaccinations, is proving effective. In March, following its advisory, the NYC health department counted an estimated 1,182 people vaccinated in that month alone, either by the department or by groups and doctors reporting to it, since its recommendations in October. As of April 15, that number totaled 6,668. “Groups like the GMHC have done crazy good promotion,” says Daskalakis, as he cotton-swabs the bare shoulder of a graphic designer swaddled in what looks like a diaper beneath the black lights of the club. “It’s to the point that we have private doctors referring insured people here for the vaccine because it’s free.”
But as an infectious disease expert, he worries about what will happens if a few asymptomatic carriers go unvaccinated. “You look at the social network that we’ve identified that is at risk,” he says, tossing a used needle in a large red sharps box. “We’re all a big dorm here, with no walls and with these anonymous pairings. We need to be careful. This thing could break out into a regional outbreak. That’s why we’re trying to get to as many people as we can. We can’t let it get out of control.”
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