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Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting July 2009

Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting July 2009. Mark Stenger Epidemiologist III Washington State Department of Health Infectious Disease & Reproductive Health Assessment Unit. Overview. Historical trends Trends by gender Trends by age group

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Trends in Neisseria gonorrhoeae Incidence in Washington State Region X GC Meeting July 2009

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  1. Trends in Neisseria gonorrhoeae Incidence in Washington StateRegion X GC MeetingJuly 2009 Mark Stenger Epidemiologist III Washington State Department of Health Infectious Disease & Reproductive Health Assessment Unit

  2. Overview • Historical trends • Trends by gender • Trends by age group • Trends by race & Ethnicity • Trends by care setting • Partner services • Selected Behavioral data • HIV-GC coinfection • Challenges/Opportunities

  3. Gonorrhea Cases and Incidence Rate* per 100,000, Washington State, 1992 - 2008 *Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervals Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  4. Gonorrhea Incidence Rate* per 100,000 by Gender, Washington State, 1992 - 2008 *Crude case incidence rate per 100,000, with 95% Poisson exact confidence intervals Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  5. Gonorrhea Incidence Rate* per 100,000 by Age Group, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  6. Gonorrhea Incidence Rate* per 100,000 by Race**, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 **Missing race (~25%) redistributed by known proportions Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  7. Gonorrhea Incidence Rate* per 100,000 by Hispanic Ethnicity**, Washington State, 2000 - 2008 *Crude case incidence rate per 100,000 ** Missing ethnicity (~28%) redistributed by known proportions Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  8. Gonorrhea Incidence Rate* per 100,000 by Gender & Age Group Washington State, 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  9. Gonorrhea Incidence Rate* per 100,000 by County Washington State, 2008 *Crude case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  10. Gonorrhea Incidence Rate* per 100,000 by Census Tract Washington State, 2008 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  11. Gonorrhea Cases Diagnosed by Provider TypeWashington State, 2008 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  12. Proportion of GC Cases with Treatment Reported by Year of Diagnosis , Washington State, 1992 - 2008 *Proportion of GC case reports with treatment indicated Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  13. Proportion of Treated Cases by Antibiotic Class* Washington State, 1992 - 2008 *Antibiotic class of treatment reported on case reports – may include CT dual treatment Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  14. Proportion of Gonorrhea Cases Interviewed Washington State, 1992 - 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  15. Proportion of Male Gonorrhea Cases Reporting MSM by Age Group Washington State, 2008 *Crude age and gender-specific case incidence rate per 100,000 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  16. Self-Reported Reason for Exam* Male GC Cases Washington State, 2008 *Of 478 cases randomly selected for interview, 306 cases interviewed (64% completion rate) Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  17. Self-Reported Reason for Exam* Female GC Cases Washington State, 2008 *Of 411 cases randomly selected for interview, 284 cases interviewed (69% completion rate) Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  18. Site of Infection* Female GC Cases Washington State, 2008 *N=1490 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  19. Site of Infection* Male GC Cases Washington State, 2008 *N=1588 Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  20. Incidence of GC among HIV+ Males Washington State, 1996 - 2007 Data based on HIV/STD Registry matching Source: Washington State Dept. of Health, IDRH Assessment Unit & STD Services Section

  21. Challenges to GC Control in Washington State • 2 separate epidemics: • younger heterosexuals • Older MSM • Monitoring for emergent antibiotic resistance • Categorical STD clinic capacity eroding • Culture capacity rapidly disappearing • Infrastructure for traditional DIS activities at risk

  22. Opportunities for GC Control in Washington State • Enhanced behavioral surveillance • Improving case surveillance infrastructure • More timely • GIS capacity • Electronic reporting of lab data • EPT and more appropriately targeted traditional partner management

  23. Questions?

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