GC Outbreak in Philadelphia Greta Anschuetz, MPH Philadelphia Department of Public Health...
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Transcript of GC Outbreak in Philadelphia Greta Anschuetz, MPH Philadelphia Department of Public Health...
GC Outbreak in Philadelphia
Greta Anschuetz, MPH
Philadelphia Department of Public Health
Reported Cases of GC: Philadelphia1990 – 2010
11,914
10,580
6,565 6,415 6,5047,271
7,776 8,0617,277
5,7315,206 5,053 5,218 5,246 4,950 4,823
6,533
19,554
8,1708,026
15,429
0
3,000
6,000
9,000
12,000
15,000
18,000
21,000
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Year
Nu
mb
er
of
Ca
ses
36% increase from 2009
GC Reports by Specimen Collection Date 2009-2011
0
100
200
300
400
500
600
700
Ja
n-0
9
Fe
b-0
9
Ma
r-0
9
Ap
r-0
9
Ma
y-0
9
Ju
n-0
9
Ju
l-0
9
Au
g-0
9
Se
p-0
9
Oc
t-0
9
No
v-0
9
De
c-0
9
Ja
n-1
0
Fe
b-1
0
Ma
r-1
0
Ap
r-1
0
Ma
y-1
0
Ju
n-1
0
Ju
l-1
0
Au
g-1
0
Se
p-1
0
Oc
t-1
0
No
v-1
0
De
c-1
0
Ja
n-1
1
Fe
b-1
1
Ma
r-1
1
Month, Year
Nu
mb
er
of
Ca
ses
1st Increase2nd Increase
Reported GC in Philadelphia, PA 2009 2010 % Change
Total 4,823 6,533 +36%
Gender
Male 2,460 3,240 +32%
Female 2,363 3,293 +39%
Age Group
15-19 years 1,541 2,127 +38%
20-24 years 1,521 2,173 +43%
25+ years 1,696 2,144 +26%
0%
10%
20%
30%
40%
50%
60%
15-19 20-24 25-29 30-34 35+
% Increase Males% Increase Females
Pe
rce
nt
Inc
rea
se
Age Group (Years)
Percent Increase by Age and Gender
Ongoing GC Control Efforts• Comprehensive city-wide GC/CT screening program
(includes IPP funded sites, prison and High School screening) – 100K females annually (8% CT pos; 2% GC pos)– 65K males annually (8% CT pos; 3% GC pos)
• Partner services & rescreening for GC/CT infected HS students
• GISP• SSuN site since July 2009: interview subset of GC cases
– 743 interviews (~7% of GC reports)– No changes in reported risk factors/markers over time
• 22% of male GC cases identify as MSM• Anonymous partner in last 12 mos.: 35% MSM vs. 24% MSW
vs. 10% among females
ZIP Cases RatePer 100,000
19132 326 855.3
19138 146 738.3
19121 246 655.8
19143 390 595.8
19139 269 510.6
19140 308 498.1
19124 235 375.6
2009-2010 GC Targeted Initiatives
• August 2009: Added screening for asymptomatic ED patients in a high GC prevalence area (ZIP 19143)– Initially high CT positivity (6%) and GC positivity (4%)
– Very slow uptake by ED staff
– March 2011: Gained support of ED Director• More specimens in past 3 weeks than in all of 2010!
• August 2010: Initiated Partner Services for all GC patients reported in same target area (ZIP 19143) for one month
2009/10 Area of Interest
Includes ZIP codes with more than 50 cases reported in 2010
2011 GC Targeted Initiatives
• March 2011: Approached ED in ZIP with high % increase (19124) about screening asymptomatic patients– Still in development
• April 2011: Applied for CDC community approaches grant. Proposed case finding in social networks of the public high school
• April 2011: Launched youth oriented intervention in collaboration with Philadelphia AIDS Activities Coordinating Office:– Comprehensive media campaign (including social media) targeting
youth
– Expansion of condom availability
– HIV subsequent to teen STD data analysis
Media Campaign and Condom Availability
• Launched Take Control Philly, a comprehensive youth targeted STD/HIV Prevention Initiative
• Unveiling of a consumer designed Philly labeled condom
• Adolescent oriented website (www.takecontrolphilly.org)– Educational component – Mail me condoms
• ~800 condom orders shipped via USPS
HIV Subsequent to Teen STD
1 1 ,52 5 (32 % )S T D +
2 4 ,78 0 (68 % )S T D -
3 6 ,3 0 5 fem a lesb o rn be tw e en 1 9 85 a n d 19 93
w /reco rd a t a g e 1 1 to 19 ye a rssc re en e d in H S S c re e n ing P ro g ram
4 ,9 53 (13 % )S T D +
3 4 ,08 2 (87 % )S T D -
3 9 ,0 3 5 m a lesb o rn be tw e en 1 9 85 a n d 19 93
w /reco rd a t a g e 1 1 to 19 ye a rssc re en e d in H S S c re e n ing P ro g ram
Females Males
Cohort Selection
Question: How many teens with an STD diagnosis are diagnosed with HIV in the future?
STD+: Case of CT/GC or Syphilis as a teen from any provider/lab received by PDPH
STD-: >1 negative from HS Screening Program, never a case as a teen
HIV Risk by Teen STD HistoryRisk Ratios and 95% CIs
*Adjusted for race/ethnicity and birth year
3.01.7
5.8
3.02.1
5.74.1 4 4.2
0.1
1
10
100
Ever 1 to 2 3+ Ever 1 to 2 3+ Ever 1 2+
Fem
ales
2.3 1.9
4.1
1.4 1.5
4.82.7
1.0
11.4
0.1
1
10
100
Ever 1 to 2 3+ Ever 1 to 2 3+ Ever 1 2+
Mal
es
All STDs CT GC
All STDs CT GC
Conclusions• GC increase in 2010 is widespread and not localized to
any group/region in Philadelphia
– Small percent of increase can be explained by one lab not reporting in 2009 (~200 cases)
• New initiatives focus on increasing condom availability and awareness among adolescents via media
• Large cohort analysis shows that having an STD as a teen increases the risk of a subsequent HIV diagnosis