Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges Presented by:...
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Transcript of Gonorrhea in New York City Epidemiology, Disease Control Activities, and Challenges Presented by:...
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
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
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
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
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
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
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
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
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
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
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
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
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
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)
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