Low Meningococcal Vaccine Completion Rates Among HIV-Infected Men-Who-Have-Sex-with-Men Attending New York City Sexually Transmitted Disease Clinics, 2012-2015

Background: Recurrent outbreaks of invasive meningococcal disease (IMD) among men-who-have-sex-with-men (MSM) suggest increased transmission among certain sexual networks. Outbreaks have high case-fatality rates and have disproportionately affected HIV-infected individuals. New York City public STD clinics have responded by providing one dose of the meningococcal vaccine to all MSM and advising HIV-infected patients to return for a second dose.

Methods: Using medical record data, we measured receipt of second meningococcal vaccine dose at STD clinics within one year among HIV-infected MSM who received the first dose between 10/1/12 and 12/31/14. We examined temporal trends and reasons for visit associated with receipt of second vaccine dose, and compared HIV-infected patients who received two doses to those who received one dose by race/ethnicity and age. We also assessed whether two-dose coverage was higher among residents of neighborhoods affected by IMD outbreaks.

Results: Of 1,212 HIV-infected MSM who received one dose of meningococcal vaccine, 26.6% (322/1,212) received a second dose within one year; however, second dose receipt rates peaked in 2012 (38.6%), and then decreased dramatically over subsequent years (p<0.001). At time of second dose receipt, 44.7% (144/322) presented specifically for their second dose, 21.4% (69/322) requested a second dose as well as other STD services, and 33.9% (109/322) were opportunistically vaccinated while presenting for other services. Compared to MSM aged <30 years, older MSM were 2-3 times more likely to receive a second dose (ages 40-49: OR=2.24, 95% CI: 1.56-3.21; ages 50+: OR=3.06, 95% CI: 2.06-4.55). Second dose receipts did not vary by race/ethnicity (p=0.780) or neighborhood (p=0.182).

Conclusions: Receipt of second meningococcal vaccine dose was low among HIV-infected persons at increased risk for IMD. Given continuing IMD outbreaks among MSM, STD clinics may be good venues to achieve more widespread vaccination; however, clinic staff may need to perform additional outreach to ensure vaccine series completion.