This story has been updated with new information from health officials regarding the risk to transgender Southern Californians, below.

A health advisory from the Los Angeles Department of Public Health urgently recommends meningitis vaccinations for all gay and bisexual men in Southern California, and “other men who have sex with men,” as well as everyone — no matter their gender — who is HIV positive.

The threat is Invasive Meningococcal Disease, according to the statement issued Tuesday. The disease is a “rare, but serious disease that can lead to swelling in the brain and spinal cord, loss of a limb, deafness, brain damage or even death,” say health officials.

“There has been an increase above the typical number of reported cases for this time of year across southern California. Excluding cases from Long Beach and Pasadena (which have their own health departments), in LA County there have been 13 cases (seven of these cases are gay/MSM). No deaths have occurred in LA County due to these infections.”

The statement says the Centers for Disease Control and Prevention is working with the California Department of Public Health to assist local health departments “with the investigation and management of this outbreak,” which has spread significantly enough to warrant inclusion of “all gay/MSM rather than only those in ‘high risk’ groups,” according to the statement.

What about trans men and women? LGBTQNation reached out to the Public Health media office for clarification, and received the following email from the Office of Communications & Public Affairs this afternoon:

“Currently, there have been no self-identified transgender cases. Without a better understanding of the factors contributing to elevated cases of Invasive Meningococcal Disease in MSM, it is difficult to determine whether transgender individuals should also be recommended for meningococcal vaccination; they should talk to their doctor to make a decision that makes the most sense for them.”

In addition to vaccination, health officials advise those at risk limit activities that spread saliva:

Don’t share drinks, utensils, food, or toothbrushes.

Don’t have multiple kissing partners.

Don’t share things you smoke, like cigarettes, e- cigarettes, cigars, pipes and hookahs.

The disease can be spread to others, according to the advisory, through the respiratory secretions of people who carry the bacteria without symptoms in their nose and throat. Meningococcal disease can start with flu-like symptoms, and progress to high fever, headache, stiff neck, confusion and rash.

Vaccinations are free of charge at Public Health clinics for all people at higher-risk, regardless of health insurance status. Vaccination can also be obtained from providers as well.

For more information, click here to read the full advisory.