Transcript Slide 1

The Picture regarding STIs in the
Republic of Ireland
CAWT April 27th 2012
Dr. Aidan O’Hora
Health Protection Surveillance Centre
Dublin
Outline
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Notifiable STIs in Republic of Ireland
Trends and notifications in 2010
Contrasting selected infections with Europe
Recent HIV data
Conclusions
GUM Services in Republic of Ireland
Key
Consultant led services
Satellite/NGO/non-Consultant led services
What is notifiable?
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Ano-genital warts
Genital chlamydia infection
Gonorrhoea
Infectious Hepatitis B
Non-specific Urethritis
(NSU)
• Trichomoniasis
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Chancroid
Genital herpes simplex
Granuloma inguinale
Lymphogranuloma
venereum (LGV)
• Syphilis
• HIV
STI notifications in Ireland; 1995-2010
STIs in Ireland, 2010
STI Ireland, 2010
n=5,016
n=6,657
STI in Ireland 2010 by age-group
% %
5.3 6.4
5.1 5.0
6.3 6.3
7.6 7.6
8.0 8.4
6.3 6.3
10.9 10.4
Chlamydia
Gonorrhoea
Syphilis
Trends in Europe and Ireland
Indicators 2010
Rate per 100,000
Europe
Ireland
Chlamydia Gonorrhoea Syphilis
Chlamydia Gonorrhoea Syphilis
186.0
9.8
4.4
116.5
13.6
13.2
Trend: 2006-2010 (%)
+41
-10
-17
+170
+145
+450
Male : Female ratio in reported
cases
0.7
2.5
3.7
0.8
3.1
3.2
Percentage in young people:
15-24 yrs
76
43
17
N/A
N/A
N/A
862.0
28.8
5.5
N/A
N/A
N/A
5
23
55
N/A
N/A
N/A
Rate for 20-24 yr olds
per 100,000 population
Percentage in MSM
22 July 2011
14
22 July 2011
15
Herpes Simplex
HIV in Republic of Ireland
Q1&Q2 2011
HIV Trend by risk group: 2003-2011
Total
MSM
Heterosexual
IDU
Probable country of infection and mode of
transmission
CD4 count at time of diagnosis
Median CD4 count by risk group
Conclusions
• Chlamydia is the most commonly notified STI:
46% of total
• Young adults aged 20-29 years account for
59% of notifications
• Significant increases in gonorrhoea, syphilis
• HIV transmission persists
• The majority of new diagnoses are late
presenters
The Health Protection Surveillance Centre wishes to sincerely thank all
who have provided data for this report – the National Virus Reference
Laboratory, microbiology laboratories, the Departments of Public Health,
Consultants in Infectious Disease/GUM and all other clinicians involved.
THANK YOU
Chlamydia notifications and hospital discharges
for tubal ectopic pregnancy, 1997-2010
Patient
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Clinician/GP
4b
5b
2b
2a
Health Protection
Surveillance Centre
Director of Public Health
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3(x2)
NVRL
Laboratory
4a
5a
Patient
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NVRL
4a
5b
Clinician/GP
4b
2b
2a
3(x2)
Director of Public Health
Laboratory
KEY Action
1 Patient attends clinician/GP for HIV test
is sent to local laboratory for analysis, and if
2 (a) Specimen
positive a second specimen is requested
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6
Health Protection
Surveillance Centre
5a
(b)
In some instances, the clinician/GP may send specimens
directly to the NVRL. In such instances, the NVRL is both
the “local laboratory” and the “reference laboratory”
The local laboratory sends a second specimen to the NVRL for confirmation of HIV diagnosis. If the NVRL is the “local laboratory”,
the need for a second sample will be communicated directly to the requesting clinician
From January 1st 2012, when a HIV diagnosis is confirmed core notification data are collected through CIDR
and supplementary clinical data specific to HIV are collected using a paper surveillance form
CIDR (electronic)
NVRL send result confirming HIV diagnosis to local
laboratory via CIDR
Clinical Laboratory Director notifies Public Health via CIDR
Surveillance Form (paper)
(b)
The NVRL send a surveillance form to the clinician for
completion
The completed form is returned to the Director of Public
Health
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(a)
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(a)
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At the Department of Public Health, notification data and supplementary clinical data are linked and anonymised using CIDR. The
data are then available to the HPSC for analysis and use in national reports.
(b)
Surveillance of STIs: 2005
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Priority should be given to collecting
timely disaggregate, person-based data
on the major bacterial infections;
syphilis, gonorrhoea, genital chlamydia
and infectious hepatitis B
The notifying clinician should indicate;
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Whether partner notification (PN) has been
carried out within the STI clinic or general
practice, Family Planning Clinic or Student
Health Service
Whether the patient is attending or been
referred to an STI clinic
If not attending or referred, the notifying
clinician should indicate if PN has been
discussed
Primary & Reference Laboratory
Facilities
General Practice
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Access, free at the point of delivery
Guidelines and protocols
Training
Priorities
Surveillance
• CIDR implementation
• Improve Clinical,
laboratory and Public
Health
• Behavioural
Surveillance
• Enhanced partner
notification and contact
tracing
Action
• Chlamydia Control
• Detection of Gonococcal
AMR resistance
• Syphilis Control
• Undiagnosed HIV
• HIV patients in care