Atlanta—Results of a new study have raised the question of whether people experiencing homelessness (PEH) should be targeted with meningococcal vaccination.

The researchers from the CDC's Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases reported that several invasive meningococcal disease (IMD) outbreaks caused by Neisseria meningitidis have occurred recently in the homeless.

In the Journal of Infectious Diseases, the authors pointed out that overall IMD risk among PEH has not been well described. In response, the study team compared incidence and characteristics of IMD among PEH and persons not known to be experiencing homelessness (non-PEH) in the U.S.

The study team analyzed 2016 to 2019 IMD data from the National Notifiable Diseases Surveillance System (NNDSS) and enhanced meningococcal disease surveillance. They calculated the incidence using U.S. census data and Point-in-Time counts from the U.S. Department of Housing and Urban Development.

The study noted that of the 1,409 cases from states participating in enhanced surveillance from 2016 to 2019, 45 (3.2%) cases occurred among PEH.

The results indicated that annual incidence was higher among PEH (2.12 cases/100,000) than non-PEH (0.11 cases/100,000; relative risk: 19.8, 95% CI: 14.8-26.7). "Excluding outbreak-associated cases (PEH n = 18, 40%; non-PEH n = 98, 7.2%), incidence among PEH remained elevated compared to incidence in non-PEH (relative risk: 12.8, 95% CI: 8.8-18.8), the CDC noted. Serogroup C was identified in 68.2% of PEH cases compared to 26.4% in non-PEH (P < .0001)."

The authors concluded that homeless people "are at increased risk for IMD. Further assessment is needed to determine the feasibility and potential impact of meningococcal vaccination for PEH in the United States."

The CDC currently recommends that all children aged 11 to 12 years should get a MenACWY vaccine, with a booster dose at age 16 years, adding that teenagers and young adults aged 16 through 23 years old also may get a MenB vaccine.

While the CDC also recommends meningococcal vaccination for other children and adults who are at increased risk for meningococcal disease, no specific mention is made for the homeless. The agency calls for vaccination for specific groups when an outbreak occurs, however.

For example, the recommendation states, "In response to an ongoing outbreak of serogroup C meningococcal disease in Florida, CDC is encouraging gay, bisexual, and other men who have sex with men to get a MenACWY vaccine if they live in Florida and talk with their healthcare provider about getting a MenACWY vaccine if they are traveling to Florida."

In addition, the CDC has emphasized that MenACWY vaccination is routinely recommended for all people with HIV in the U.S.

In Florida, the CDC responded to a cluster of serogroup B meningococcal disease cases by recommending that college and university undergraduate students, students living in on-campus housing, and students who participate in a fraternity or sorority in Leon County—where Florida State University, Florida A&M University, and others are located—consider getting an MenB vaccine series.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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