Understanding Barriers to Meningitis Vaccination Among Populations Most Impacted By the Meningitis Outbreak in Chicago

Background: A sustained outbreak of serogroup C invasive meningococcal disease (IMD) occurred in Chicago in 2015-16, accounting for 10 cases and 2 deaths. Men who have sex with men (MSM) who are Black and/or HIV-positive were disproportionately impacted. Currently, two-thirds of MSM in Chicago are not vaccinated against IMD. We launched a mixed-method study in late 2016 to explore barriers and facilitators to vaccination uptake and potential interventions to increase awareness and acceptability of IMD vaccination within these populations.

Methods: We conducted focus groups with individuals who identified with one or more of the affected populations – young MSM (n=11), Black MSM (n=25), and HIV-positive MSM (n=20). These focus groups probed accessing health information, knowledge of IMD and the vaccine, perceived risk, and barriers and facilitators to vaccine uptake. Additionally, we administered a 13-item quantitative survey to participants in a cohort study “RADAR” of 16 to 29-year-old MSM in Chicago (n=486). This survey assessed baseline knowledge of health information, vaccination and IMD, and prior experiences with IMD vaccination.

Results: Approximately half of the sample correctly identified how IMD is spread and 58.6% accurately responded that vaccination was the best prevention method; however, more than 60% of participants felt they were at no risk of getting meningitis and only 49% reported vaccination. Additionally, White YMSM were significantly more likely to be vaccinated and to have accurate knowledge and risk perception of IMD compared to Black YMSM. Preliminary focus group themes related to vaccine uptake barriers that emerged included: lack of knowledge about IMD, lack of awareness of an effective vaccine, stigma, and distrust of the medical system.

Conclusions: Vaccination is the most effective strategy to prevent and control community outbreaks of meningitis. The results of this study suggest public health interventions need to target Black MSM and those who are not engaged in primary health care (e.g., non students, older YMSM as they are less likely to be on parents’ insurance). We plan on developing an intervention focused on diffusion of information in networks of MSM in order to increase awareness and acceptability of IMD vaccination. This information will be relayed to the Chicago Department of Public Health in order to better inform outbreak response and future vaccination campaigns.