Brett Shaad died of bacterial meningitis Friday afternoon, April 12. The 33 year old West Hollywood resident was a lawyer, a real estate broker and very popular among his friends, many of whom surrounded his bed at Cedar Sinai Hospital in shock and disbelief.
“Last weekend I was with him at a local restaurant on Santa Monica Boulevard,” said West Hollywood Councilmember John Duran at a news conference about the meningitis scare. “He was tall and muscular, robust, looking as fit as a fiddle and we notified on Wednesday he was at Cedars and then yesterday, he was in a coma. And now he’s going to be removed from life support.”
For Duran, who is HIV positive, the surprise of Shaad’s death from meningitis is eerily familiar to the shock 30 years ago when friends and lovers started dying from a then-unknown illness that later was identified as HIV/AIDS. But this time it’s different, Duran says, thanks in large part to social media, where the word is spreading quickly about the meningitis scare and what symptoms to look for.
Bacterial meningitis is usually severe, according to the CDC, causing brain damage, hearing loss, disabilities and death. However people can recover if treated early so anyone who suspects they might have been exposed or are at risk of being exposed or are experiencing any symptoms should immediately see their healthcare provider. Symptoms are: a sudden fever, headache, stiff neck, nausea, vomiting, increased sensitivity to light, and mental confusion. These symptoms can appear quickly or up to seven days after exposure and should not be mistaken for the flu.
Meningococcal infection is contagious. You can catch it in larger groups gathered together, or through germs spread through secretions exchanged through kissing, sharing cups or utensils, coughing, sneezing, or being in close contact with someone who has meningitis. People with a compromised immune systems – such as HIV disease – are particularly susceptible. The CDC also says: “Fortunately, most of the bacteria that cause meningitis are not as contagious as diseases like the common cold or the flu. Also, the bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been.”
One can also prevent catching the disease through practicing good hygiene such as washing your hands often with soap and water, covering your mouth and nose when you sneeze or cough, don’t share food or drinks and clean contaminated surfaces with soap and water or a disinfectant.
(West Hollywood City Councilmember John Duran at podium with the LA Gay & Lesbian Center’s Dr. Robert Bolan (right) and Chris Brown (left). Photo by Karen Ocamb)
Duran said that there is no evidence yet to connect this particular strain of meningitis to the strain in New York City that has resulted in 22 cases since 2010, with seven deaths. However, the prevalence of the disease is the same – it is hitting sexually active gay and bisexual men and men who have sex with men.
“Here, in the City of West Hollywood, we obviously have a very large number of gay men in our city and our community. We’re very concerned that two weeks ago, the White Party gathered about 10,000 gay men in the city of Palm Springs – including [gay men] from New York.”
Shaad attended the White Party and the Los Angeles County Department of Public Health is investigating his case and is “proving the necessary preventative treatment to their close personal contacts,” according to an April 11 letter sent to Equinox Gym where Shaad was a member. “Public Health does not believe that exposure in the gym setting poses a risk to other patrons.”
But, Duran suggested, West Hollywood itself is a large gathering of LGBT people who, by nature or design, enjoy hugging, kissing, dancing in a way that produces sweat, and having close contact often without thinking.
“We’re seriously concerned because every weekend in the City of West Hollywood, we host in the neighborhood of 200,000 LGBT people who come here for our nightclubs and night life – so we want to place the community on high alert that we may have an issue,” Duran said. “We’re going to be monitoring this very closely. I asked the personnel here – including [LA County Health Dept. Area Director] Dr. Liggins upstairs: when does an outbreak become an outbreak? I was given the explanation that with the Ebola Virus, one case is an outbreak. With this particular case, we have one reported case here now. We’re hearing from a physician in town there may be one reported case in Palm Springs – so we’re very closely monitoring what’s happening. If we start to hear that there is another case or another case, we’ll be right back on the phone with Dr. Liggins to say, ‘OK, now if we have 2 or 3 cases in the West Hollywood community, do we have an outbreak yet?”
Duran also raised concern about the availability of sufficient vaccine to prevent the spread, if requested by people at risk. “We’re going to be working with our partners at the Gay and Lesbian Center, as well as the pharmacies in town, to make sure we have – if necessary – enough vaccines to get it out there to prevent the spread of meningitis. We learned a very tough lesson 30 years ago that we are not going to go through again here in West Hollywood.”
As the county public health official at the news conference, Dr. Maxine Liggins stuck to protocol, which was sometimes confusing. Liggins confirmed that the county is investigating Shaad’s death and continuing the lab work. “At this point, we cannot confirm or we don’t know whether this case is related to the cases in New York City. Last year in LA County, we had about 13 cases of meningococcal disease and we are currently not having an outbreak in LA County,” she said. “Currently our procedure is that we give antibiotics – what’s need if you’ve had contact with someone who has meningitis. If have you any symptoms, we encourage you to see your medical provider immediately and not just attribute these symptoms to a flu or some other illness.”
But when pressed about whether the County was prepared with enough meningitis vaccine, Liggins seemed to avoid a straight answer. “Currently the Department is following the CDC and state guidelines and those guidelines state that if an individual comes into contact with somebody with meningococcal meningitis – that we would first of all give them antibiotic prophylaxis. That is the standard of treatment and we’re following that standard,” Liggins said.
But what is the County’s level of readiness? “Our current protocol is that the county does have some vaccine but we use that vaccine for its indicated uses. Meningococcal vaccine is available in California and it’s available at all our medical providers so therefore, since we’re following the protocol for the use of meningococcal meningitis vaccine, we would follow our protocol and only use vaccine in a situation where we think it indicated.”(LA County Department of Public Health’s Dr. Maxine Liggins at podium. Photo by Karen Ocamb)
What indicators for the vaccine would be appropriate? “Normally, our standing procedure is that we use meningococcal meningitis vaccine in high risk situations,” Liggins said, numerating the high risk situation listed on the website such as traveling, “children entering high school,” among others, ignoring a question about what would the County do if gay, bisexual and men who have sex with men ask for the vaccine.
The availability of vaccines is an issue in New York City. Here’s an excerpt from the Gay City News, March 26:
After saying for several months that it has the resources to address a meningitis outbreak among gay men in New York City, a senior official in the city’s health department told the New York Times that staff are “very scared” about the outbreak and are struggling to control it.
And in a March 25 press release, the state health department recommended that all sexually active gay and bisexual men statewide get vaccinated for the bug, noting the 22 cases and seven deaths in New York City since 2010 as well as a 23rd case in a man who lives outside the city, but spent “significant time” here.
“It’s been sort of marching through the community in a way that makes us very scared,” Dr. Jay Varma, a deputy commissioner, said in a March 21 Times story.
“We know there is clearly some kind of social-risk factor, being very socially active with people you’ve met either through online sites or parties,” Varma told the Times. “It’s another big challenge for us to identify how this disease is spreading.”
Despite the alarm now being voiced by health officials, however, a dozen sex party promoters in New York have told Gay City News they have not been contacted to assist in the effort to reach at-risk men….
There have been four new meningitis cases since the start of 2013. Seventeen of the 22 cases occurred since the start of 2012.
In a March 25 email, a city health department spokesperson wrote that the agency had an “ample supply of vaccine” and “will continue to buy as much vaccine as is needed to meet demand.” This has been the agency’s posture consistently.
The spokesperson wrote, “There is sufficient vaccine for those who are at risk to be protected by vaccination. However, many who are at risk in this outbreak do not yet know they are at risk or do not believe that the risk is great enough to get vaccinated.”
Initially, the city health department recommended that sexually active, HIV-positive gay and bisexual men get vaccinated. It effectively expanded that recommendation to all sexually active gay and bisexual men, regardless of HIV status, in November and made that second recommendation explicit on March 6. The state health department has now further expanded the target population.
At the West Hollywood news conference, I asked Dr. Liggins why the LGBT community was only hearing about this case now? “We don’t normally alert the public about each case of meningitis – one of the first things I said was that last year there were 13 case of meningococcal meningitis in LA County so we normally do not put out a public alert with each case of meningococcal meningitis.”
Liggins may not have put out a public alert, per se, but on Sept. 18, 2012 the County did issue an alert about meningitis hitting the homeless population in downtown LA:
The following message is being sent on behalf of Lawrence Hurst, MH Clinical District Chief – DMH/Skid Row & Hollywood MHC Programs ……….
The email below is sent from our partners with L.A. County Public Health – please post the attached flyer in staff and waiting room areas.
This is to inform you and to request your assistance in disseminating the following health alert to our collaborative partners. Recently, there has been cases of bacterial meningitis identified in downtown LA possibly among our homeless population. The attached is an educational flyer that includes signs and symptoms of bacterial meningitis. Please ensure you, your staff, and participants are informed for early recognition and care. As you can see from this flyer, symptoms can progress quickly hence the importance of prompt medical attention and care for the case and contacts. Please let me know if you have any questions. Thank you in advance for your help.
I could find no follow up information on what happened to those meningitis cases among the homeless. After the news conference, I tried to convey to Liggins that West Hollywood and Silver Lake and other areas where large numbers of LGBT people gather are like one big embrace and therefore finding out about Shaad’s exposure to meningitis as soon as possible would have been helpful. I think I considered the situation like an antigay hate crime as if by attacking this one gay man, the bug intends to harm and/or frighten as many gays as possible. And the fear is – how do you know who’s got it until symptoms appear three-to-seven days later. But to Liggins, it’s just one case.
Liggins wasn’t alone in trying to tamp down the fear. Dr. Robert Bolan, the Medical Director from the LA Gay & Lesbian Center, didn’t want to minimize the danger but did note that even in New York the number of cases increased but not dramatically. Boland noted that while New York recommended a widespread vaccination campaign, LA County has not.
“The County of Los Angeles is not making that recommendation but vaccinations are available for people who feel they want to take that extra precaution. And if their insurance will cover it – then that’s fine, if you want to avail yourselves of this vaccine. It would probably be close to $120-$200 for the vaccine.”
After a long pause, Bolan said he is not recommending a vaccine program right now “because I still think that we need to have a little bit more collaboration between the Health Department both here and New York and the CDC. Because this is not just a local phenomenon. People travel around. They get on airplanes, they go to big parties and things. And that’s what I’d like to do is hold my recommendations until after I’ve had some conversations.
Chris Brown, Director of the Center’s Health and Mental Services, said that the Center is working closely with the City of West Hollywood and the Publi Health Department “to ensure does not become a public health crisis.” But if a large public health response is needed, including a large vaccination campaign, the Center will work closely with the Health Department “to make sure public health clinics and community health centers that are serving gay, bisexual and men who have sex with men have ample vaccinations to provide to these individuals. But it’s very important to investigate and do all diligence because a rapid response to this is incredibly important.”
The LA Gay & Lesbian Center is staying on top of this – including posting some facts about meningitis on their website.(West Hollywood City Councilmember John Duran with LA Gay & Lesbian Center’s Chris Brown after the news conference. Photo by Karen Ocamb)
Additionally, Dr. Bolan followed up with an email to Public Health Director Dr. Jonathan Fielding about how people without insurance are going to pay for vaccinations if they need them – and bear in mind that people who are HIV positive need to take two doses of the vaccine. Here’s Dr. Bolan’s letter:
Dear Dr. Fielding,
I am very concerned about the local public health implications of the current case of meningococcal meningitis in a gay man in West Hollywood. I think that the plausible, although as yet unproven, epidemiological link with the recent New York cases is the White Party held in Palm Springs over the Easter weekend. The opportunities for significant transmission of N. meningitidis in such venues is obvious.
Even though retrospective and case control studies have not shown an increased incidence for meningococcal disease among college students compared to the general population, the CDC recommends meningococcal vaccination for this population, especially those living in dormitories. I believe the exposure characteristics for gay and bisexual men is several orders of magnitude greater than for college students in general. Currently the number of cases in Los Angeles have not increased above the background prevalence according to the figures Dr. Liggins quoted at today’s press conference in West Hollywood. However, gay and bisexual men are a highly mobile population, and travel back and forth between large metropolitan areas is common. Therefore, we at the L.A. Gay & Lesbian Center believe that meningococcal vaccine should be made available to all gay & bisexual men who want to receive it. We would like the Health Department to provide vaccine for those who either are uninsured or whose insurance does not cover the vaccine and who want to receive it. Finally, if we gear up to make vaccine available on a voluntary basis, as outlined above, if the number of documented cases should increase in Los Angeles, we will already have a response mechanism in place that can be rapidly increased.
We look forward to working with the Health Department on this very important public health issue.
Robert Bolan, M.D.
L.A. Gay & Lesbian Center
But right now, just hours after Brett Shaad died – it still comes back to him, a human being of whom his friend John Duran said: “ He was a beloved member of the West Hollywood community. A brilliant young lawyer who was taken from us too soon.”