Increased Risk for Invasive Meningococcal Disease Among Persons with HIV in Florida, 2004-2012

BACKGROUND: Meningococcal disease vaccine is not currently recommended for HIV-infected adults, and studies of vaccine effectiveness in this group are lacking. Recent studies in the United States have provided evidence suggesting a 10-fold increased risk of invasive meningococcal disease (IMD) among persons with HIV/AIDS. The purpose of the study is to estimate the risk of IMD among persons with reported HIV/AIDS in Florida 2004-2012.

METHODS: Reported invasive meningococcal disease cases among persons ≥13 years old in Florida from 2004 through 2012 were aggregated from the Florida reportable disease database.  All IMD cases were matched to the Florida HIV/AIDS surveillance database to identify co-infections. The annual estimate of persons living with HIV/AIDS (PLWHA) was determined from the surveillance database.  Incidence rates of IMD among PLWHA and HIV-uninfected persons were compared. A sensitivity analysis was conducted by adding a national estimate of HIV under-diagnosis (15.8%) to the population of PLWHA with no additional IMD.  

RESULTS: From 2004 through 2012, 443 IMD cases were reported among persons ≥13 years old.  The average annual incidence rate of IMD was 0.32 cases per 100,000 persons. Twenty-five (6%) IMD cases were co-infected with HIV.  The average annual estimate of the total population of persons ≥13 years old living with HIV was 79,242 (Range 54,046-98,291). As compared to persons without HIV/AIDS, the relative risk for developing IMD among PLWHA was 11.7 (95% CI, 7.8-17.5) times greater. This increased to 16.1 (95% CI, 10.4-24.9) times greater among persons ever reported as having AIDS. When an estimate of 15.8% undiagnosed PLWHA were added, the adjusted RR for IMD among PLWHA was 10.1 (95% CI, 6.7-15.1).  Among PLWHA, the average rate of IMD was highest among those 20-29 and 30-39 years old: 10.5 and 5.5 per 100,000, respectively.  Neisseria meningitidis serogroup distribution was similar between the groups. No co-infected cases reported receiving vaccination for meningococcal disease. 

CONCLUSIONS: Consistent with previous investigations, this study of a large population of PLWHA suggests that they have an elevated risk for developing IMD. The risk is greater among HIV-infected persons that have been reported with AIDS. Although we were unable to control for known risk factors (e.g. smoking or comorbidities), similar studies have demonstrated that these factors do not explain the large observed increase in risk of IMD among PLWHA. Recommendations for meningococcal disease vaccine effectiveness studies and the routine vaccination of HIV-infected adults should consider the mounting evidence of the increased risk for IMD in PLWHA.