Transcript Gonorrhea Epidemiology and Control Efforts in Louisiana

Gonorrhea Epidemiology and
Control Efforts in Louisiana
Lisa Longfellow, MPH
October 14, 2009
Gonorrhea Rates
Louisiana 1988 - 2008
400
350
300
250
200
150
100
50
0
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Reported Cases of Gonorrhea
Louisiana 2000 - 2008
14000
12000
10000
8000
6000
4000
2000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
GONORRHEA – COUNTIES AND
INDEPENDENT CITIES, UNITED STATES, 2007
Rank
County / City
Cases
Rate
1
St. Louis (City), MO
2,577
742.3
2
Orleans County, LA
1,529
684.5
3
Montgomery County, AL
1,434
641.4
4
Richmond (City), VA
1,183
613.2
5
Caddo County, LA
1,496
591.0
30
East Baton Rouge
County, LA
1,229
286.4
U.S. Total = 355,991 cases or 118.9 cases per 100,000 population
Gonorrhea Case Rates by Parish – Louisiana, 2008
Gonorrhea Rate per 100,000
27.6 – 95.7
95.7 – 157.2
157.2 – 233.7
233.7 – 310.8
310.8 – 521.6
Gonorrhea By Region
4500
4000
1
2
3
4
5
6
7
8
9
3500
3000
2500
2000
1500
1000
500
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
936.66
988.93
886.32
828.27
730.15
492.86
544.17
415.58
Year
20
08
20
07
20
06
20
05
20
04
20
03
20
02
258.78
20
01
1200
1000
800
600
400
200
0
20
00
Case Rate per 100,000
population
Case-Rate for Gonorrhea by Year for Orleans Parish 2000-2008
Number of GC Cases
Gonorrhea Cases in Orleans Parish by Year and Sex
2000-2008
2000
1500
Female
1000
Male
500
0
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Gonorrhea Cases by Year and Age Group for Orleans
Parish 2000-2008
65 +
45--64
35--44
25--34
20--24
15--19
10--14
0--9
3000
2500
2000
1500
1000
500
0
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
Number of GC Cases
3500
Year
Number of GC Cases
Gonorrhea Cases by Year and Race for Orleans
Parish 2000-2008
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
White
Other/Unknown
Multiracial
Black
Asian/PI
American Indian
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Percentage of GC cases
Percentage of Gonorrhea Cases in Orleans Parish by
Provider Type 2000-2008
100%
80%
60%
Other
Charity
PMD
STD
40%
20%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Case Rate per 100,000
population
Case Rate for Gonorrhea by Year for EBR Parish
2000-2008
500
400
399.9
375.15
330.33
300
310.95
301.62
255.39
287.61
234.62
229.01
200
100
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
Gonorrhea Cases by Year and Sex for EBR
Parish 2000-2008
Number of Cases
1000
800
600
400
Female
200
Male
0
2000
2002
2004
Year
2006
2008
Gonorrhea Cases by Year and Age Group for
EBR Parish 2000-2008
1800
Number of GC Cases
1600
65 +
1400
45--64
35--44
1200
1000
25--34
800
20--24
600
15--19
10--14
400
200
0--9
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
Gonorrhea Cases by Year and Race for EBR
Parish 2000-2008
Number of GC Cases
100%
80%
Other/Unknown
White
Multiracial
60%
Black
40%
Asian/PI
American Indian
20%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Number of GC Cases
Percentage of Gonorrhea Cases in EBR
Parish by Provider Type
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Other
Charity
PMD
STD
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Gonorrhea Case Rate for Caddo Parish by Year 20002008
900
Case Rate per 100,000
population
800
800.33
765.14
684.08
700
605.39
600
576.13
578.11
572.17
588.39
521.56
500
400
300
200
100
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
Gonorrhea Cases by Year and Sex for Caddo
Parish 2000-2008
Number of Cases
1200
1000
800
600
Female
400
Male
200
0
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Gonorrhea Cases by Year and Age Group for
Caddo Parish 2000-2008
2500
65 +
Number of Cases
2000
45--64
35--44
1500
25--34
1000
20--24
15--19
500
10--14
0--9
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
100%
Gonorrhea Cases by Year and Race for
Caddo Parish 2000-2008
White
Number of Cases
80%
Other/Unknown
60%
Multiracial
Black
40%
Asian/PI
20%
American Indian
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Percentage of Gonorrhea Cases in Caddo
Parish by Provider Type 2000-2008
Percentage of GC Cases
100%
80%
60%
Other
Charity
40%
PMD
STD
20%
0%
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
Gonococcal Isolate Surveillance
Project (GISP)
• New Orleans has participated in the GISP as a sentinel
site since 1998.
• Monthly submission of:
– (a) male urethral gonococcal isolates to its assigned GISP
Regional Laboratory, and
– (b) clinical/demographic data on GISP patients to CDC.
• At regional laboratories, the susceptibilities of these
isolates to penicillin, tetracycline, spectinomycin,
ciprofloxacin, ceftriaxone, cefixime, and azithromycin are
determined by agar dilution. Minimum inhibitory
concentrations (MICs) are measured, and values are
interpreted according to criteria recommended by the
National Committee for Clinical Laboratory Standards
(NCCLS).
STD Surveillance Network (SSuN)
• Collect enhanced STD surveillance data not previously
available in New Orleans since July 2009
– Increase understanding of risk behaviors associated with STDs
– Detect and respond rapidly to emerging trends in STDs
• Phone interviews with gonorrhea patients diagnosed
outside of the STD clinic
• Types of enhanced surveillance data collected:
–
–
–
–
Education and employment status
Sexual orientation
Partner information (number of partners, sex of partners)
Risk behaviors (drug use, internet use to meet sex partners,
anonymous sex)
– And much more…
Expedited Partner Therapy
Act 449 - 2008
A. The purpose of this Section is to allow for the provision of
medications or prescriptions by any physician licensed to practice
medicine in this state or any advanced practice registered nurse who
is licensed to practice nursing in this state, or any physician assistant,
who is licensed to practice in this state, provided such physician or
nurse or physician assistant has the authority to write prescriptions in
this state, to individuals who may have been exposed to gonorrhea or
chlamydia. Expedited partner therapy is hereby authorized absent a
doctor-patient relationship and absent clinical assessment.
B. Notwithstanding any other provisions of law to the contrary, any
physician or any advanced practice registered nurse who diagnoses
or does a nurse clinical assessment or any physician assistant who
performs an examination of a case of chlamydia or gonorrhea in an
individual patient may prescribe, furnish, or otherwise provide
prescription antibiotic drugs to that patient's sexual partner or
partners absent a doctor-patient relationship or absent an advanced
practice registered nurse-patient relationship and without examination
or nurse clinical assessment or physician assistant examination of
that patient's sexual partner or partners.
Expanded Screening
• Sites Targeted
– School Based Health Clinics
– Juvenile Detention Centers
– Pregnancy Test Only Visits