trends in neisseria gonorrhoeae incidence in washington state region x gc meeting july 2009
DESCRIPTION
Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting July 2009. Mark Stenger Epidemiologist III Washington State Department of Health Infectious Disease & Reproductive Health Assessment Unit. Overview. Historical trends Trends by gender Trends by age group - PowerPoint PPT PresentationTRANSCRIPT
Trends in Trends in Neisseria gonorrhoeaeNeisseria gonorrhoeae Incidence Incidence in Washington Statein Washington StateRegion X GC MeetingRegion X GC MeetingJuly 2009
Mark StengerEpidemiologist III
Washington State Department of HealthInfectious Disease & Reproductive Health
Assessment Unit
OverviewOverview
Historical trends Trends by gender Trends by age group Trends by race & Ethnicity Trends by care setting Partner services Selected Behavioral data HIV-GC coinfection Challenges/Opportunities
Gonorrhea Cases and Incidence Rate* per 100,000, Gonorrhea Cases and Incidence Rate* per 100,000, Washington State, 1992 - 2008Washington State, 1992 - 2008
*Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervalsSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
1000
2000
3000
4000
5000
6000
7000
8000
1992 1994 1996 1998 2000 2002 2004 2006 2008
Year of Diagnosis
Cas
es
0
10
20
30
40
50
60
70
80
90
Rat
e pe
r 100
,000
Cases Rate
Gonorrhea Incidence Rate* per 100,000 by Gender, Gonorrhea Incidence Rate* per 100,000 by Gender, Washington State, 1992 - 2008Washington State, 1992 - 2008
*Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervals
Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
10
20
30
40
50
60
70
80
90
100
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Rat
e pe
r 100
,000
Male Female
Gonorrhea Incidence Rate* per 100,000 by Age Group, Gonorrhea Incidence Rate* per 100,000 by Age Group, Washington State, 2000 - 2008Washington State, 2000 - 2008
*Crude case incidence rate per 100,000
Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9
Year of Diagnosis
Rat
e pe
r 100
,000
<15 15 - 19 20 - 24 25 - 29 30 - 3435 - 39 40 - 44 45+
Gonorrhea Incidence Rate* per 100,000 by Race**, Gonorrhea Incidence Rate* per 100,000 by Race**, Washington State, 2000 - 2008Washington State, 2000 - 2008
*Crude case incidence rate per 100,000**Missing race (~25%) redistributed by known proportionsSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year of Diagnosis
Rat
e pe
r 100
,000
WHITE BLACK AIAN API MULTI
Gonorrhea Incidence Rate* per 100,000 by Hispanic Ethnicity**, Gonorrhea Incidence Rate* per 100,000 by Hispanic Ethnicity**, Washington State, 2000 - 2008Washington State, 2000 - 2008
*Crude case incidence rate per 100,000** Missing ethnicity (~28%) redistributed by known proportionsSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
20
40
60
80
100
120
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year of Diagnosis
Rat
e pe
r 100
,000
Hispanic Non-Hispanic
Gonorrhea Incidence Rate* per 100,000 by Gender & Age Group Gonorrhea Incidence Rate* per 100,000 by Gender & Age Group Washington State, 2008Washington State, 2008
*Crude age and gender-specific case incidence rate per 100,000Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
50
100
150
200
250
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45+
Age Group
Rat
e pe
r 100
,000
Male Female
Gonorrhea Incidence Rate* per 100,000 by County Gonorrhea Incidence Rate* per 100,000 by County Washington State, 2008Washington State, 2008
*Crude case incidence rate per 100,000Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
YAKIMA
OKANOGAN
KING
GRANT
LEWIS
CHELAN
FERRY STEVENS
ADAMSKITTITAS
LINCOLN
SKAGIT
WHITMANPIERCE
BENTON
WHATCOM
CLALLAM
KLICKITAT
DOUGLASSPOKANE
SNOHOMISH
SKAMANIA
JEFFERSON
COWLITZ
FRANKLINPACIFIC
CLARK
WALLA WALLA
MASON
GRAYS HARBOR
PEND OREILLE
ASOTINCOLUMBIA
GARFIELD
THURSTON
WAHKIAKUM
SAN JUAN
ISLAND
KITSAP
Rate Per 100,000
2 - 10
10 - 2
0
20 - 3
0
30 - 5
0
50 - 8
5
Gonorrhea Incidence Rate per 100,000by County, Washington State, 2008
¹0 40 80 120 16020
Miles
YAKIMA
OKANOGAN
KING
GRANT
LEWIS
CHELAN
FERRY STEVENS
ADAMSKITTITAS
LINCOLN
SKAGIT
WHITMANPIERCE
BENTON
WHATCOM
CLALLAM
KLICKITAT
DOUGLASSPOKANE
SNOHOMISH
SKAMANIA
JEFFERSON
COWLITZ
FRANKLINPACIFIC
CLARK
WALLA WALLA
MASON
GRAYS HARBOR
PEND OREILLE
ASOTINCOLUMBIA
GARFIELD
THURSTON
WAHKIAKUM
SAN JUAN
ISLAND
KITSAP
Rate per 100,000
<20 60
>200¹
2008 incidence rate per 100,000 by Census Tract based on residence of patient at diagnosis. Smoothed by Kriging method.
Gonorrhea Incidence Rate* per 100,000 by Census Tract Gonorrhea Incidence Rate* per 100,000 by Census Tract Washington State, 2008Washington State, 2008
Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
Gonorrhea Cases Diagnosed by Provider TypeGonorrhea Cases Diagnosed by Provider TypeWashington State, 2008Washington State, 2008
Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
13%
14%
25%13%5%
4%
13%
13%
STD Clinic Family PlanningPrivate Provider Emergent/Urgent CareCorrections MilitaryOther Unknown
Proportion of GC Cases with Treatment Reported Proportion of GC Cases with Treatment Reported by Year of Diagnosis , Washington State, 1992 - 2008by Year of Diagnosis , Washington State, 1992 - 2008
*Proportion of GC case reports with treatment indicatedSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
90
91
92
93
94
95
96
97
98
99
100
1992 1994 1996 1998 2000 2002 2004 2006 2008
Year of Diagnosis
Perc
ent o
f Cas
es
Proportion of Treated Cases by Antibiotic Class* Proportion of Treated Cases by Antibiotic Class* Washington State, 1992 - 2008Washington State, 1992 - 2008
*Antibiotic class of treatment reported on case reports – may include CT dual treatmentSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1992 1994 1996 1998 2000 2002 2004 2006 2008
Year of Diagnosis
Perc
ent o
f Tre
ated
Cas
es
Cephalosporins Macrolides Tetracyclines Fluoroquinolones
Proportion of Gonorrhea Cases Interviewed Proportion of Gonorrhea Cases Interviewed Washington State, 1992 - 2008Washington State, 1992 - 2008
*Crude age and gender-specific case incidence rate per 100,000Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0
5
10
15
20
25
30
35
40
45
50
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year of Diagnosis
Perc
ent o
f Cas
es
Proportion of Male Gonorrhea Cases Reporting MSM by Age Group Proportion of Male Gonorrhea Cases Reporting MSM by Age Group Washington State, 2008Washington State, 2008
*Crude age and gender-specific case incidence rate per 100,000Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
<19 20-24 25-29 30-34 35-39 40-44 45+Age Group
0
100
200
300
400
500Male GC Cases
0
5
10
15
20
25
30
35Percent MSM
MSM NON-MSM* Percent MSM
Self-Reported Reason for Exam* Self-Reported Reason for Exam* Male GC Cases Male GC Cases
Washington State, 2008Washington State, 2008
*Of 478 cases randomly selected for interview, 306 cases interviewed (64% completion rate)Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0% 15%
78%
1% 6%
Annual PhysicalRoutine STD CheckSymptomsPartner w/STDOther
Self-Reported Reason for Exam*Self-Reported Reason for Exam* Female GC Cases Female GC Cases
Washington State, 2008Washington State, 2008
*Of 411 cases randomly selected for interview, 284 cases interviewed (69% completion rate)Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
6% 9%2%4%
4%
12%
42%
2%11%
8%Pap/Pelvic ExamPregnancy TestFam. PlanningAbortionAnnual PhysicalRoutine STD CheckSymptomsRescreeningPartner w/STDOther
Site of Infection*Site of Infection* Female GC Cases Female GC Cases
Washington State, 2008Washington State, 2008
*N=1490Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
71%
1%
27%
0% 1%
CervicalUrethralUrineRectalPharyngeal
Site of Infection*Site of Infection* Male GC Cases Male GC Cases
Washington State, 2008Washington State, 2008
*N=1588Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
38%
51%
6% 5%
UrethralUrineRectalPharyngeal
Incidence of GC among HIV+ Males Incidence of GC among HIV+ Males Washington State, 1996 - 2007Washington State, 1996 - 2007
Data based on HIV/STD Registry matchingSource: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section
0.0500.0
1000.01500.02000.02500.03000.03500.0
Year
Rate
per
100
,000
GC Rate/100,000 Linear Trend
GC Rate/100,000 1057.2 680.9 1003.3 972.5 874.6 1294.7 1508.9 1340.0 1726.4 2848.3 1970.1 1376.0
HIV+ Male Population 6054 6462 6877 7301 7775 8187 8549 9851 9326 9725 10152 10756
HIV+ GC Cases 64 44 69 71 68 106 129 132 161 277 200 148
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Challenges to GC Control in Washington StateChallenges to GC Control in Washington State
2 separate epidemics:– younger heterosexuals– Older MSM
Monitoring for emergent antibiotic resistance– Categorical STD clinic capacity eroding– Culture capacity rapidly disappearing
Infrastructure for traditional DIS activities at risk
Opportunities for GC Control in Washington StateOpportunities for GC Control in Washington State
Enhanced behavioral surveillance
Improving case surveillance infrastructure– More timely– GIS capacity– Electronic reporting of lab data
EPT and more appropriately targeted traditional partner management
Questions?