ADHS AND COUNTY STD CONTROL AND PREVENTION PROCESSES AND ACTIVITIES

Kerry KenneyADHS/STDP

STATEWIDE STD MEETINGApril 25, 2008

Topics

• Reporting • Chlamydia, Gonorrhea, Chancroid, LGV and Syphilis

Case Follow-up• Inter-jurisdictional Case Transfers• Outbreak Detection and Follow-up• STD Training Opportunities• Performance Measures

Reporting

• Updated Administrative Rules for Provider Reporting (R9-6-202)– http://www.azdhs.gov/phs/oids/code.htm

• New Communicable Disease Reports– http://www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_fill3.pdf

Reporting• Updated Administrative Rules for Provider Reporting

(R9-6-202)• New Communicable Disease Reports

– http://www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_fill3.pdf

• So Who Reports to Whom?– Administrative Code requires Health Care Providers to report

STDs to the Local Health Agency.

• "Local health agency" means a county health department, a public health services district, a tribal health unit, or a U.S. Public Health Service Indian Health Service Unit.

– Administrative Code requires Local Health Agencies to report to the State STD Program.

Reporting

• What Do We Want?– Providers report directly to their county health

department– Other local health agencies receiving reports forward

or copy and forward the report to the county health department

– County health departments report to the STD Program and also to other local health agencies (i.e., tribal health units, IHS health units)

STD Case Follow-up

• Updated Administrative Rules for STD Control Measures

and STD Related Testing and Notification – Control Measures for Communicable Diseases and Infestations

(R9-6-313, 314, 332, 375)– STD Related Testing and Notification (R9-6-1102-1104)

STD Case Follow-up Chlamydia and Gonorrhea

• Review CDRs received from providers for completeness and accuracy

• Offer or arrange for treatment for each chlamydia or gonorrhea case that seeks treatment from the local health agency

• Inform case that they must notify all sexual contacts within 60 days of symptoms or diagnosis up to the date of treatment of the need for testing/treatment

STD Case Follow-up Chlamydia and Gonorrhea (cont’d)

• Provide each case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures

• Offer or arrange treatment for each contact of a case who seeks treatment from the local agency (consider EPT)

• Provide contact with same health information as provided to a case

STD Case Follow-upSyphilis, LGV and Chancroid Investigations

• State STD Program requires chancroid, LGV, and syphilis case management activities be conducted only by individuals who have completed CDC Employment Development Guide module training and attended CDC Introduction to STD Intervention or Fundamentals of STD Intervention course

• State STD Program has assigned Program staff to assist counties with syphilis, LGV and chancroid investigations

STD Case Follow-up Lymphogranuloma Venereum (LGV)

• Notify State STD Program immediately and follow instruction for collection and shipment of swab and serum specimens to State/CDC

• Conduct an epidemiologic investigation of each reported or suspect LGV case and submit a detailed written report– Enhanced Interview Record– CDC Lymphogranuloma Venereum (LGV) Suspected Case-

Patient Information (ver.12.0, revised 5/4/2005) – Must be submitted to State/CDC along with specimens collected

STD Case Follow-upLGV (cont’d)

• Offer or arrange for treatment for each LGV case that seeks treatment from the local health agency

• Inform LGV case that they must notify all sexual contacts within 60 days preceding treatment

• Provide each LGV case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures

STD Case Follow-upLGV (cont’d)

• Notify each contact to a LGV case of exposure to the disease and of the need for testing/ treatment

• Offer or arrange treatment for each contact of a LGV case who seeks treatment from the local agency

• Provide contact with same health information as provided to a case

STD Case Follow-up Syphilis

• Conduct an epidemiologic investigation of each reported or suspect syphilis case and submit a detailed written report (R9-6-206(D)) – Enhanced Interview Record– Congenital Syphilis Case Investigation and Report (CDC 73.126)

• Offer or arrange for treatment for each syphilis case that seeks treatment from the local health agency

• Inform syphilis case that they must notify all sexual contacts within the appropriate time frame preceding treatment based on the stage of disease as follows:

STD Case Follow-upSyphilis (cont’d)

• Syphilis Interview Periods for Contacts– Primary Syphilis

• 4 months and 1 week prior to date of treatment

– Secondary Syphilis • 8 months prior to date of treatment

– Early Latent Syphilis • 1 year preceding date of treatment

– Latent Syphilis of Unknown Duration • 1 year prior to date of treatment

– Late Latent Syphilis • 1 year prior to date of treatment

STD Case Follow-upSyphilis (cont’d)

• Syphilis Disease Stages– Primary

• Chancre or other appropriate symptom(s) of primary syphilis present at time of first examination

– Secondary• Rash or other symptom(s) appropriate for secondary syphilis

present at time of first examination AND a titer ≥ 1:4 – Early Latent

• History of primary or secondary syphilis symptoms in the preceding 12 months OR negative syphilis serology in the preceding 12 months OR 4-fold increase in titer in the preceding 12 months OR epidemiologic link to an independently confirmed early syphilis case

STD Case Follow-upSyphilis (cont’d)

• Syphilis Disease Stages (cont’d)

– Latent Syphilis of Unknown Duration• Case does not meet early latent criteria AND patient is 35 or

younger AND titer is 1:32 or higher

– Late Latent Syphilis • Latent syphilis in a patient with no evidence of having acquired the

disease within the preceding 12 months AND whose age and titer

do not meet criteria for latent syphilis of unknown duration Note: All diagnoses of syphilis must be associated with a reactive treponemal

test (FTA or TP-PA) OR positive darkfield exam.

STD Case Follow-upSyphilis (cont’d)

• Provide each syphilis case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures

• Notify each contact to a syphilis case of exposure to the disease and of the need for testing/ treatment

• Offer or arrange treatment for each contact of a syphilis case who seeks treatment from the local agency

• Provide contact with same health information as provided to a case

STD Case Follow-upChancroid

• Conduct an epidemiologic investigation of each reported or suspect chancroid case and submit a detailed written report (R9-6-206(D) – Enhanced Interview Record

• Offer or arrange for treatment for chancroid case that seeks treatment from the local health agency

• Inform case that they must notify all sexual contacts within 10 days of symptom onset of the need for testing/treatment

STD Case Follow-upChancroid (cont’d)

• Provide each case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures

• Notify each contact to a chancroid case of exposure to the disease and of the need for testing/ treatment

• Offer or arrange treatment for each contact of a case who seeks treatment from the local agency

• Provide contact with same health information as provided to a case

STD Case Follow-upSTD Case Management Forms

• New 6-page CDC Enhanced Interview Record

• Effective January 1, 2008, required report form for syphilis and chancroid cases

• Forms, instructions, and PowerPoint training program available from the STD Program

STD Case Follow-upSTD Case Management Forms (cont’d)

• CDC Field Record (CDC 73.2936

• Used to conduct positive laboratory report and contact investigations

• required form for syphilis, chancroid and outbreak investigations

• Forms and instructions available from the STD Program

STD Case Follow-upSTD Case Management Forms (cont’d)

• CDC Visual Case Analysis (VCA) form

• Required form for syphilis, chancroid and outbreak investigations

• At-a-glance tool for determining exposure gaps and performing source spread analysis

STD Case Follow-upSTD Case Management Forms (cont’d)

• CDC Congenital Syphilis Case Investigation and Report form (CDC 73.126)

• Used to evaluate congenital syphilis status

• Required Report form for State STD Program and CDC

• Forms and instructions available from the STD Program

STD Case Follow-upSTD Case Management Forms (cont’d)

• CDC LGV Case-Patient Information form (5 page)

• Required form for reporting confirmed or suspected LGV to State/CDC

• Form must be submitted to State/CDC along with specimens

Inter-jurisdictional Case Transfers

• All STD case investigations with actionable locating information belonging to another jurisdiction, whether in-state or out-of-state, should be sent to State STD Program’s ICCR (Inter/Intra-state Communication Control Record) Desk for forwarding– Positive laboratory reports– STD contact investigations

• State ICCR Desk Contact Information:– Phone: (602) 364-4654 FAX: (602) 364-2119

Outbreak Detection and Follow-up• Local health agencies are responsible to report any

syphilis outbreak to the STD Program, conduct an epidemiologic investigation of the outbreak, and submit an outbreak investigation report to the STD Program [AAC R9-6-206 (F), R9-6-375 (C)]

• The STD Program has developed an STD Outbreak Response Plan that can be used/adapted by local health agencies– Includes recommended outbreak threshold criteria– Includes recommended response organization and activities

• The STD Program will provide outbreak assistance to local health agencies

STD Training Opportunities

• California STD/HIV Prevention Training Center

(CA PTC)– On or off-site and online training available

• Clinical

• Behavioral

• Partner Services

– Several courses hosted by the State STD Program

• Contact Information:– http://www.stdhivtraining.org

STD Training Opportunities

• Examples of Courses Offered Through CA PTC– Introduction to STD Intervention (9 days)– Fundamentals of STD Intervention (4 days)– Training Operating for Safety around Field Encounters (2 days)– Using Surveillance and Data for STD/HIV Programs (2 days)– HIV Disclosure & Partner Services Training for PCRS (2 days)– Bridging Theory and Practice: Applying Behavioral Theory to

STD/HIV Prevention (2 days)– Fundamentals of STDs in Clinical Practice (3 days)– 28th Annual Reproductive Health Symposium (2 days)– Comprehensive Risk Counseling and Services (3 days)

STD Training Opportunities• CDC Resources

– CDC STD Program Tools• http://www.cdc.gov/std/program

– Public Health Training Network• http://www2.cdc.gov/phtn

– HIV/AIDS Training and Resources• http://www.cdc.gov/hiv/conferences.htm

• Other Resources– National Coalition of STD Directors

• http://www.ncsddc.org

– STD Prevention Online• http://www.stdpreventiononline.org

Performance Measures

• CDC Required Performance Measures beginning with 2005 grant cycle– Medical and Lab Services (1 measure)– Partner Services (6 measures)– Surveillance and Data Management (3 Measures)– Clinical Services (4 Measures)– Syphilis Elimination - Enhanced Surveillance (1Measure)

• STD Program staff may call on County STD staff to request information necessary to respond to the CDC performance measures

Contact Information

Kerry M. KenneySr. Public Health AdvisorArizona STD Control Program50 North 18th Avenue, Suite 140Phoenix, Arizona 85007Phone: (602) 364-2124Fax: (602) 364-2119E-Mail: kenneyk@azdhs.gov