Rapid Risk Assessment: invasive meningococcal disease among men who have sex with men

Risk assessment

​This rapid risk assessment provides a series of conclusions and recommendations based on the analysis of several European cases of invasive meningococcal disease among men who have sex with men caused by N. meningitidis serogroup C.

Executive summary

​In this rapid risk assessment, ECDC concludes there is an increased risk in Europe of invasive meningococcal disease (IMD) among men who have sex with men (MSM), particularly in metropolitan settings.


Three EU countries, Germany, France and Belgium, have so far reported a total of seven cases of IMD of the Neisseria meningitidis serogroup C strain among MSM. This strain was also associated with an outbreak, with fatal cases, among MSM in New York City from 2010 to 2013.


Further studies are needed to establish how the infection has been transmitted. However, increased travel and international contact at mass gathering events such as Gay Pride and other festivals may be factors facilitating the spread of the disease among MSM.


To date, the cases in Europe have been sporadic or small clusters. There is no evidence of links between the two clusters and the sporadic cases, nor has any evidence of links to the MSM community in New York City yet been established.

Suggested actions for Member States 


Member States should consider retrospective investigations of cases of serogroup C IMD in young men in order to identify similar occurrences. Increasing awareness among MSM, through the use of social media and community networks, as well as among healthcare providers is essential for the prevention and early identification of further cases.


Vaccination with conjugate meningococcal vaccine against serogroup C constitutes an effective prevention intervention, and Member States should consider vaccination as a means of outbreak control where clusters in specific target populations are identified.


Since 2000, 14 EU Member States have introduced meningococcal vaccines in their routine immunisation programmes. Few countries conducted catch-up campaigns at the time of introduction and vaccine-induced immunity in the adult population is likely to be low in most countries.

 About the disease


Meningococcal disease is caused by Neisseria meningitidis, a bacterium with human carriers as the only reservoir. It is carried in the nose, where it can remain for long periods without producing symptoms.


IMD is a severe infection with a high fatality rate. It occurs either as sporadic cases or in small outbreaks among people who have had direct contact. A limited number of outbreaks among MSM have been reported worldwide. So far, none have occurred in Europe. However, IMD among MSM is probably under-reported because sexual orientation and sexual activities may not be widely recognised as risk factors for this disease.