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Large Gonorrhea Outbreak in a Rural California County, 2003

Large Gonorrhea Outbreak in a Rural California County, 2003. Michael Samuel, Dr.P.H. California Department of Health Services STD Control Branch. Butte County, California. Gonorrhea Rates, 1985 – 2002. United States. California. Butte County. Background.

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Large Gonorrhea Outbreak in a Rural California County, 2003

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  1. Large Gonorrhea Outbreak in a Rural California County, 2003 Michael Samuel, Dr.P.H. California Department of Health Services STD Control Branch

  2. Butte County, California

  3. Gonorrhea Rates, 1985–2002 United States California Butte County

  4. Background • County Health Department detected increases in gonorrhea in early 2003 • County alerted local medical community in March and May • Requested assistance of State STD Control Branch in September • Outbreak investigation • Control measures

  5. Methods • Case series • Confidential Morbidity Report (CMR) • Laboratory report • Interviews • Standardized interview record (IR) • Health educators & Disease Intervention Specialists (DIS) • In-person and by-phone • Network analysis • Ask all cases and contacts to name all sexual and social contacts in prior 3 months

  6. Methods - Software • Case series and interviews • Access • SAS • Mapping • ArcView 3.1 • Network analysis • Ucinet 6 for windows • NetDraw 1.0

  7. Results 1: Demographics and Risk Data

  8. GC Cases by Month Butte County, 2001-2003 2001 2002 2003

  9. GC Cases by Month Butte County, 2001-2003 2001 2002 2003

  10. GC Cases by Month Butte County, 2001-2003 2001 2002 2003

  11. Gonorrhea GC CasesButte County, 2003

  12. GC Cases by Gender, Age and Race/Ethnicity-Oroville, 2003 Male 38% (N=36) Female 62% (N=59) Race Age

  13. GC Cases “Socioeconomic Status” Oroville, 2003

  14. Where GC Cases Met New Partners Oroville, 2003

  15. GC Cases Drug Use Oroville, 2003

  16. GC Cases – Race/Ethnicity of PartnersOroville, 2003

  17. GC Case and Partner Incarceration History, Oroville, 2003

  18. Variables with Low Frequencies • Exchange of money or drugs for sex • Specific venues (e.g., X Bar) • Men, sex with men

  19. Results 2: Visual and Network Analysis

  20. Geographical Determine geographic distributions Visual Analysis • Network • Determine sexual and social connections

  21. Butte County – “Broken Windows” Environment

  22. Oroville Gonorrhea CasesJanuary, 2003

  23. Oroville Gonorrhea CasesJanuary–February, 2003

  24. Oroville Gonorrhea CasesJanuary–March, 2003

  25. Oroville Gonorrhea CasesJanuary–April, 2003

  26. Oroville Gonorrhea CasesJanuary–May, 2003

  27. Oroville Gonorrhea CasesJanuary–June, 2003

  28. Oroville Gonorrhea CasesJanuary–July, 2003

  29. Oroville Gonorrhea CasesJanuary–August, 2003

  30. Oroville Gonorrhea CasesJanuary–September, 2003

  31. Oroville Gonorrhea CasesJanuary–October, 2003

  32. Oroville Gonorrhea CasesJanuary–November, 2003

  33. Oroville Gonorrhea CasesJanuary–December, 2003

  34. Original DIS Network Diagram

  35. Sex link Male Case Male Uninfected Male Unknown Arrowhead indicates directionality of naming Sex link ? Female Case Female Uninfected Female Unknown Social link Butte County Gonorrhea Outbreak, 2003Sexual and Social Network Diagram

  36. Sex link Male Case Male Uninfected Male Unknown Arrowhead indicates directionality of naming Sex link ? Female Case Female Uninfected Female Unknown Social link Butte County Gonorrhea Outbreak, 2003Sexual and Social Network Diagram

  37. Sex link Male Case Male Uninfected Male Unknown Arrowhead indicates directionality of naming Sex link ? Female Case Female Uninfected Female Unknown Social link Butte County Gonorrhea Outbreak, 2003Sexual and Social Network Diagram

  38. Characteristics of Core Cases

  39. Butte Gonorrhea OutbreakNetwork Cluster Cases Note: The address for one of the network cluster cases was a PO Box, thus that case is not included above.

  40. “Network” DiagramMonth of Diagnosis and Age 60 45 AGE 15 1 52 WEEK

  41. Conclusions • Large gonorrhea outbreak in rural California County • Large proportion GC cases: • White, female • Unemployed, uneducated • Lacked private health insurance • Incarceration history • Only venue of note was casinos • Re-infection among African-American males • Delay in initiating investigation was problematic

  42. Conclusions - Network Analysis • Detected one large network with very diverse race/ethnicity, age, and geography • Included casino and travel history • Beyond traditional field investigation, comprehensive network analysis requires systematic collection of data using uniform procedures

  43. Limitations – General • Study Design • No comparison group • Incomplete data • Not provided • Not recorded consistently • Limited Local Health Department resource • Rotating State staff

  44. LimitationsNetwork Analysis • Lack of experience with formal network analysis • Incomplete data • Connections • Infection status Mapping • Missing, incorrect and P.O. box addresses not geocodeable • Address is residence and not necessary location of sexual contact(s)

  45. Potential Value of Network Analysis • Nature of individuals in specific clusters • Nature of network structure • May help control future outbreak

  46. California Department of Health Services, STD Control Branch Roxanne Aguirre Gail Bolan George Camarillo Jennifer Chase Stewart Coulter Juan Cruz Denise Gilson Brian Hughes Jan King Marcella Lemus Terry Lo Manny Olivas Shaheed Salahudin Butte County Health Department Sherry Bloker Charlotte Freer Mark Lundberg Alice Kienzle Carmen Ochoa Eric Sawtelle Lorna Andreatta Jim Gamez University of California Berkeley Ben Bellows Zurab Koberidze CDC David Callahan Stu Burman Acknowledgements

  47. GC Cases in by Month Butte County, 2001-2004 2004 2001 2002 2003

  48. For more information contact:Michael C. Samuelmsamuel@dhs.ca.gov510-540-2311orJan Kingjking@dhs.ca.gov510-883-6643

  49. GC Cases Partner Characteristics Oroville, 2003

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