It is a variant of a disease that can go from a fever and headache to a galloping rash and then to death within hours — so quickly that some victims have been found dead in bed before they could even get to a doctor. Over the last two years, it has appeared only among men, and they often got it, health officials say, through anonymous sexual encounters with other men found through Internet chat rooms or digital apps or at parties, making it all but impossible to trace the path of infection.
It is a unique strain of bacterial meningitis, so new it has not even been named, and it is particularly lethal — killing one out of three people instead of the one out of five who succumb to other strains of meningitis.
New York City health officials are growing increasingly worried that this strain of meningitis, which is an inflammation of the lining around the brain and the spinal cord, is so insidious that it could suddenly mushroom into a major outbreak, claiming many lives before anything can be done to stop it.
"It's been sort of marching through the community in a way that makes us very scared," Dr. Jay Varma, the deputy commissioner for disease control at the city's health department, said on Thursday.
The department issued a warning this month recommending the standard meningitis vaccination for a particular subset of the population: "men, regardless of H.I.V. status, who regularly have intimate contact with other men through a Web site, digital application or at a bar or party."
There have been 22 cases, all among men, of the unique strain since 2010, 13 of them last year and 4 this year, Dr. Varma said. Seven of them have died. Twelve were H.I.V.-positive, a possible risk factor. Ten of the cases were in Brooklyn — in neighborhoods as varied as Bedford-Stuyvesant, Brownsville, Bushwick, Clinton Hill, Crown Heights, Downtown Brooklyn, Dumbo, East New York, Prospect Heights and Williamsburg.
The meningitis vaccine is available at many health clinics, hospitals and private doctors' offices, and is effective against the new strain. But it has not been easy for health officials to get the word out.
Many of men who are at risk may not identify themselves as either gay or bisexual, even though they are having sex with other men, health officials said. So it is hard to reach out to them through gay organizations, and it is hard to get them to come forward to be vaccinated.
The health department and the medical examiner have found that the current strain may have first surfaced in 2005 and 2006, in an outbreak that began with a 47-year-old woman from the Bronx. It circulated among drug users, especially crack-cocaine and marijuana users, because smoking disturbs the lining of the throat where the bacteria reside. Then it died down.
Meningitis is traditionally spread in places where many people come into close contact, like military barracks and schools. It was only in the second outbreak, which began in 2010, that epidemiologists made the connection with sex and realized the variant was circulating exclusively among men. "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," Dr. Varma said.
Many of those with the disease, he said, could not identify their sexual partners. "All they know is a screen name and a physical description," he said, adding, "It's another big challenge for us to identify how this disease is spreading."
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