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

NYSDOH/BSTDC

Rate of Gonorrhea by Region, NYS*, 1992-2008

*Excludes NYC

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

Gonorrhea Core Epidemiologic Tracts, Monroe County, NYS, 2007

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

DATA SOURCES

New York State Department of Health, Bureau of STD Control

Division of STD Prevention. STD Surveillance, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention