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Gonorrhea Surveillance & Control New York State. NYSDOH Bureau of STD Control CDC Gonorrhea Control Meeting New York, NY November 9, 2009. Trends in Reported Gonorrhea Cases by Sex, NYS, 1992-2008*. # Gc Cases. * Excludes NYC. NYSDOH/BSTDC. - PowerPoint PPT Presentation
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Gonorrhea Surveillance & Control Gonorrhea Surveillance & Control New York StateNew York State
NYSDOH Bureau of STD ControlNYSDOH Bureau of STD Control
CDC Gonorrhea Control MeetingCDC Gonorrhea Control Meeting
New York, NYNew York, NY
November 9, 2009November 9, 2009
Trends in Reported Gonorrhea Cases by Sex,Trends in Reported Gonorrhea Cases by Sex,NYS, 1992-2008*NYS, 1992-2008*
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Females Males
# Gc C
as
es
* Excludes NYC NYSDOH/BSTDC
Trends in Reported Gonorrhea Cases by Trends in Reported Gonorrhea Cases by Race/Ethnicity, NYS, 1992-2008*Race/Ethnicity, NYS, 1992-2008*
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
AI/AN Asian/Pacific Islander BlackHispanic White Other/Unknown
# G
c C
as
es
* Excludes NYC NYSDOH/BSTDC
NYSDOH/BSTDC
Rate of Gonorrhea by Age and Sex, NYS*, 2008
*Excludes NYC
Rate( per 100,000 population)
CENTRALCENTRALNEW YORKNEW YORK
REGION REGION
Niagara Orleans
Erie
Chautauqua Cattaraugus
Genesee
Wyoming
Monroe Wayne
Allegany
Sen
eca
Livingston
Sen
eca
Sen
eca
Ontario
Sen
eca
Yates
SteubenChemung
Schuyler
Sullivan
Orange Putnam
Rockland
Suffolk
Richmond
Bronx
Orange
Dutchess
Orange
Ulster
Orange
Westchester
New York
CAPITALCAPITALDISTRICTDISTRICTREGIONREGION
METROPOLITAN METROPOLITAN REGION REGION
WESTERN REGIONWESTERN REGION
St. Lawrence
Jefferson
Oswego
Cayu
ga
Lewis
Oneida
Cortland
Tioga
Madison
Chenango
Broome
Herkim
erTompkins
Onondaga
Clinton
Franklin
Essex
Hamilton Warren
Fulton
Schoharie
Colu
mbia
Wash
ing
ton
Delaware
Saratoga
Albany
Greene
Ren
ssela
er
OtsegoSchenectady
Montgomery
KingsQueens
Nassau
Bronx
NYSDOH/BSTDC
20%
26%
3%7%
35%
3%6%
Gonorrhea Case Reports by Race/Ethnicity and Gonorrhea Case Reports by Race/Ethnicity and Provider Type, NYS*, 2008Provider Type, NYS*, 2008
18%
32%
8%
12%
23%
1% 6%
24%
18%
12%6%
34%
2% 4%
Health Dept Private MD CHC FPHospital Jail/JD Other
26%
20%
17%
10%
20%
2% 5%WhiteHispanic
Black Other
*Excludes NYC NYSDOH/BSTDC
2008 Gonorrhea Cases 2008 Gonorrhea Cases Treatment Verification and Time to TreatTreatment Verification and Time to Treat
94%
6%
TreatmentVerified
No Treatment
Median time to treat =6.0 days
*Excludes NYC NYSDOH/BSTDC
ChallengesChallenges
• Budget Cuts Budget Cuts • County contracts cut by 8% in 2008, 10% in 2009 = reduction in County contracts cut by 8% in 2008, 10% in 2009 = reduction in
local STD serviceslocal STD services• Restrictions on TravelRestrictions on Travel• Loss of StaffLoss of Staff• State budget restrictions impact federally-funded initiativesState budget restrictions impact federally-funded initiatives
• Laboratory CapacityLaboratory Capacity• State laboratory serves primarily as reference labState laboratory serves primarily as reference lab• Limited number of NYS-licensed labs with culture capacity, even Limited number of NYS-licensed labs with culture capacity, even
fewer perform susceptibility testingfewer perform susceptibility testing
• Resource AllocationResource Allocation• Fewer DIS to cover large geographic area or duties not limited to Fewer DIS to cover large geographic area or duties not limited to
STDSTD• Federal IPP dollars prescribed Federal IPP dollars prescribed
Optimizing Partner Management Optimizing Partner Management Strategies Strategies
For Gonorrhea With Limited For Gonorrhea With Limited ResourcesResources
Dennis MurphyDennis MurphyBureau of STD ControlBureau of STD Control
New York State Department of HeathNew York State Department of Heathdpm04@health.state.ny.usdpm04@health.state.ny.us
Gonorrhea-Reported Rates: NYS Gonorrhea-Reported Rates: NYS Exclusive of NYC and United States, Exclusive of NYC and United States,
1992-20081992-2008
0
50
100
150
200
250
1992
1994
1996
1998
2000
2002
2004
2006
2008
Year
Ra
te (
pe
r 1
00
,00
0 p
op
ula
tio
n)
NYS TOTAL
US TOTAL*
*2008 data not available
0
100
200
300
400
500
600
700
Rat
e (p
er 1
00,0
00 p
op
ula
tio
n)
2003 2004 2005 2006 2007
Year
AmercianIndian/AlaskanNativeAsian/PacificIslander
Black, Non-Hispanic
Hispanic
White, Non-Hispanic
Gonorrhea-Rates by Race/Ethnicity: Gonorrhea-Rates by Race/Ethnicity: United States, 2003-2007United States, 2003-2007
0
100
200
300
400
500
600
Ra
te (
pe
r 1
00
,00
0 p
op
ula
tio
n)
2003 2004 2005 2006** 2007
Year
AmercianIndian/AlaskanNative
Asian/PacificIslander
Black, Non-Hispanic
Hispanic
White, Non-Hispanic
* These data should be interpreted with caution; 30% of NYS Race/Ethnicity data are missing
** 2006 American Indian Rate not included
Gonorrhea-Rates by Race/Ethnicity: Gonorrhea-Rates by Race/Ethnicity: NYS Exclusive of NYC, 2003-2007*NYS Exclusive of NYC, 2003-2007*
Key TermsKey Terms
Core - Census tract with 50% of Core - Census tract with 50% of morbidity morbidity
Adjacent - Census tract with 30% of Adjacent - Census tract with 30% of morbiditymorbidity
Peripheral - Remaining Census tracts Peripheral - Remaining Census tracts with 20% of morbiditywith 20% of morbidity
Key Terms (cont.)Key Terms (cont.)
Self Selection - core infected patients Self Selection - core infected patients are most likely to have selected their are most likely to have selected their partners from the core area. Adjacent partners from the core area. Adjacent cases are most likely to become cases are most likely to become infected due to exposure with a core infected due to exposure with a core residentresident
Force of Infectivity - the time period Force of Infectivity - the time period between infection and treatmentbetween infection and treatment
Characteristics of a Core AreaCharacteristics of a Core Area
Small population compared to adjacent Small population compared to adjacent and peripheral areasand peripheral areas
High population densityHigh population density
Low socioeconomic status of residentsLow socioeconomic status of residents
Frequently, but not necessarily Frequently, but not necessarily minority residentsminority residents
High number of repeat infectionHigh number of repeat infection
New York State’s Approach to New York State’s Approach to Gonorrhea Partner ServicesGonorrhea Partner Services
For transmission purposes all For transmission purposes all gonorrhea cases are not equal, gonorrhea cases are not equal, therefore:therefore:– Intensely interview core residentsIntensely interview core residents– Only interview adjacent or peripheral Only interview adjacent or peripheral
cases if resources allow cases if resources allow – Target gonorrhea screening to facilities Target gonorrhea screening to facilities
and providers that serve the core and providers that serve the core populationpopulation
New York State’s Approach to New York State’s Approach to Gonorrhea Partner Services Gonorrhea Partner Services
(cont.)(cont.)
Interview as many core gonorrhea Interview as many core gonorrhea positive cases as possible, but at a positive cases as possible, but at a minimum 65% of the totalminimum 65% of the total
Target STD clinic services to meet the Target STD clinic services to meet the needs of the core populationneeds of the core population
Don’t be afraid to “tweek” the typical Don’t be afraid to “tweek” the typical gonorrhea interviewgonorrhea interview
Look for social networkLook for social network
EvaluationEvaluation
Reason for ExaminationReason for Examination– Voluntary / SymptomaticVoluntary / Symptomatic– ScreeningScreening– Epi InvestigationEpi Investigation
Reported Gonorrhea Cases and Core Epi Reported Gonorrhea Cases and Core Epi Interventions, Monroe County: Interventions, Monroe County:
2002-20072002-2007
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2002 2003 2004 2005 2006 2007
Year
Ca
se
s
0
10
20
30
40
50
60
70
Ca
se
s
Reported Gonorrhea Cases
Proportion of Core Cases with Epi Intervention
Data Source: New York State Department of Health, Bureau of STD Control
Gonorrhea-Reported Rates: NYS Gonorrhea-Reported Rates: NYS Exclusive of NYC and Monroe County, Exclusive of NYC and Monroe County,
1992-20071992-2007
0
100
200
300
400
500
600
1992
1994
1996
1998
2000
2002
2004
2006
Year
Ra
te (
pe
r 1
00
,00
0 p
op
ula
tio
n)
NYS RATE
MONROE RATE
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