gonorrhea in new york city epidemiology, disease control activities, and challenges
DESCRIPTION
Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges. Presented by: Julia A. Schillinger, MD, MSc CAPT USPHS Bureau of STD Control New York City Department of Health and Mental Hygiene [email protected]. Gonorrhea rates, by sex New York City, 1995-2009*. - PowerPoint PPT PresentationTRANSCRIPT
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Gonorrhea in New York City Epidemiology, Disease Control Activities, and
Challenges
Presented by: Julia A. Schillinger, MD, MScCAPT USPHS
Bureau of STD ControlNew York City Department of Health and Mental Hygiene
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Gonorrhea rates, by sex New York City, 1995-2009*
0
50
100
150
200
250
Year
Cas
e R
ate
per
100,
000
male female overall
Data based on cases reported to the NYC DOHMH;
* Annualized based on half-year 2009 data
April 2007:
CDC alert: Discontinue FQ use
September 2006:
NYC joins GISP
2004: NYC STD clinic QRNG prevalence exceeds 5%
April 2004: NYC DOHMH QRNG health alert
January 2008:
NYC makes AST for GC reportable
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Gonorrhea reported to the NYC DOHMH. Case rates (per 100,000 population) by age and sex*, full year 2008
-800 -600 -400 -200 0 200 400 600 800
Ag
e (y
ears
)
Case rate per 100,000 population
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
N=80
N=1724
N=1508
N=685
N=328
N=176
N=92
N=54
N=32
N=16
N=2
N=5
N=24
N=950
N=1607
N=1199
N=717
N=476
N=379
N=212
N=89
N=34
N=15
N=14
400 200 600 800
*excludes persons for whom sex or age were not reported
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Male GC reported to the NYC DOHMH, 2000-2008, case rates, by age
0
100
200
300
400
500
600
700
2000 2001 2002 2003 2004 2005 2006 2007 2008
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
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Female GC reported to the NYC DOHMH, 2000-2008, case rates, by age
0
100
200
300
400
500
600
700
800
900
1000
2000 2001 2002 2003 2004 2005 2006 2007 2008
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
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0
50
100
150
200
250
Cas
e ra
te p
er 1
00,0
00
Black NH AmInd/AN
Hispanic White NH API
Race/ethnicity
Male Female
GC reported to the NYC DOHMH (n=10,483); case rates by race/ethnicity and sex, 2008
5
13
2844
1,665
2,186
378560
58
347
Other = 187Unknown race/eth = 5,011
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Male GC reported to the NYC DOHMH, 2000-2008, case rates, by race
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008
Black NH
White NH
Hispanic
Asian NH
Am Ind/Al Nat
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Female GC reported to the NYC DOHMH, 2000-2008, case rates, by race
0
50
100
150
200
250
2000 2001 2002 2003 2004 2005 2006 2007 2008
Black NH
White NH
Hispanic
Asian NH
Am Ind/Al Nat
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Male GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race
0
50
100
150
200
250
300
350
400
450
500
2000 2001 2002 2003 2004 2005 2006 2007 2008
Black NH
White NH
Hispanic
Asian NH
Am Ind/Al Nat
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Female GC reported to the NYC DOHMH, 2000-2008, case rates, ages 15-19, by race
0
100
200
300
400
500
600
700
800
900
1000
2000 2001 2002 2003 2004 2005 2006 2007 2008
Black NH
White NH
Hispanic
Asian NH
Am Ind/Al Nat
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14 13 10 13 10 10 12 12 14
43 43 40 4135
30 31 32 32
010
2030
4050
6070
8090
100
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
% G
C c
ases
rep
orte
d fr
om N
YC
ST
D c
linic
s
0
50
100
150
200 GC
case rate per 100,000
Females% males% Malesrate Femalerate
Case rate (per 100,000 population) of Neisseria gonorrhea reported to the New York City DOHMH, with percent reported from Bureau of STD clinics,
2000-2008, by sex
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New York City United Hospital Fund (UHF) Neighborhoods
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Percent fluoroquinolone resistance among gonorrhea isolates detected among BSTDC clinic patients,
2001-2008
0.1 0.3 3 8 9 17 17 150%
20%
40%
60%
80%
100%
2001 2002 2003 2004 2005 2006 2007 2008
Year
% Q
RN
G (
of
GC
iso
late
s)
QRNG
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NYC Bureau of STD ControlCurrent GC Activities I
• GC (& CT) screening in NYC high schools
• Partner notification– GC cases dx’d in NYC school screening program– HIV-GC coinfected at select NYC facilities– InSPOT
• EZ Pass/VIP Program for core transmitters– HIV-GC co-infected, or 2 GC/12 mos eligible
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NYC Bureau of STD ControlCurrent GC Activities II
• Sentinel surveillance for antimicrobial resistance– Culture at Fort Greene clinic– Gonococcal Isolate Surveillance Project (GISP)
• Routine surveillance for antimicrobial resistance
• Sentinel surveillance network– Extract behavioral and clinical information on GC
cases diagnosed in BSTDC clinics– Interview sample of non-BSTDC dx’d cases (SSuN
project)
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Challenges in GC control
• Large number of infections– Universal interventions unsustainable– Focused interventions staff-intensive
• Syphilis & HIV interview and PN consume staff resources
• NAATs commonly used test– Provide no information on resistance– Not approved for anorectal specimens
• Antibiotic resistance– Opted not to pursue EPT legislation for GC