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Sexually Transmitted Disease (STD) Surveillance Report, 2004

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  1. Sexually Transmitted Disease (STD) Surveillance Report, 2004 Minnesota Department of Health STD Surveillance System

  2. Introduction • This slide set describes new cases of chlamydia, gonorrhea, and syphilis in Minnesota by person, place, and time. • The slides display data from cases diagnosed through 2004 and reported to the Minnesota Department of Health (MDH) STD Surveillance System. • Data analyses exclude federal and private prisoners.

  3. Introduction • STD Surveillance is the systematic collection of data from cases for the purpose of monitoring the frequency and distribution of STDs in a given population. • STD surveillance data are used to detect problems, prioritize resources, develop and target interventions, and evaluate the effectiveness of interventions.

  4. Interpreting STD Surveillance Data • Factors that impact the completeness and accuracy of the data include: • Level of STD screening and individual test-seeking behavior • Sensitivity of diagnostic tests • Compliance with case reporting • Timeliness of case reporting • Increases and decreases in STD rates can be due to actual changes in disease occurrence and/or changes in one or more of the factors described above. • For example, in 2002 MDH added an active component to the previously passive STD Surveillance System. As a result, compliance with reporting improved and the number of chlamydia and gonorrhea cases reported to MDH increased by at least 7% and 5%, respectively, between 2001 and 2002 as an artifact of reporting.

  5. National Context HIV/AIDS in Minnesota: Annual Review

  6. United States: State-Specific Chlamydia Rates, 2003 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides. STDs in Minnesota: Annual Review

  7. United States: State-Specific Gonorrhea Rates, 2003 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides. STDs in Minnesota: Annual Review

  8. United States: State-Specific P&S Syphilis Rates, 2003 SOURCE:Centers for Disease Control & Prevention, Division of STD Prevention. 2003 Surveillance Slides. STDs in Minnesota: Annual Review

  9. Overview of STDs in Minnesota STDs in Minnesota: Annual Review

  10. STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 1994-2004† * P&S = Primary and Secondary. † While P&S syphilis numbers decreased in 2004, first quarter numbers for 2005 indicate an increase back to 2003 levels.

  11. STDs in Minnesota:Number of Cases Reported in 2004 • Total of 14,703 STD cases reported to MDH in 2004: • 11,601 Chlamydia cases • 2,957 Gonorrhea cases • 145 Syphilis cases (all stages)

  12. CHLAMYDIA STDs in Minnesota: Annual Review

  13. 2004 Minnesota Chlamydia Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Clearwater Polk Cook St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Crow Wing Rate per 100,000 persons Wadena Aitkin Carlton Wilkin Otter Tail 0 - 75 Pine Mille Lacs 76 - 150 Todd Morrison Grant Douglas Kanabec 151 - 300 Traverse Benton > 300 Stevens Pope Big Stone Stearns Isanti Chisago Sherburne City of Minneapolis 886 City of St. Paul 639 Suburban# 168 Greater Minnesota 149 (407 cases missing residence information) Swift Anoka Wright Washington Kandiyohi Meeker Chippewa Hennepin Ramsey Lac qui Parle McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Lyon Goodhue Redwood Le Sueur Nicollet Rice Wabasha Brown # 7-county metro area, excluding the cities of Minneapolis and St. Paul Waseca Pipestone Murray Cottonwood Blue Earth Dodge Olmsted Winona Watonwan Steele Rock Nobles Jackson Martin Houston Faribault Freeborn Mower Fillmore

  14. Chlamydia Infections in Minnesotaby Residence at Diagnosis, 2004 Total Number = 11,601 (407 missing residence information) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  15. Chlamydia Rates by GenderMinnesota, 1994-2004

  16. Chlamydia Rates by AgeMinnesota, 1994-2004

  17. Chlamydia Rates by Race/Ethnicity Minnesota, 1994-2004 * Persons of Hispanic ethnicity can be of any race.

  18. Chlamydia Rates by Race/Ethnicity Excluding BlacksMinnesota, 1994-2004 * Persons of Hispanic ethnicity can be of any race.

  19. GONORRHEA STDs in Minnesota: Annual Review

  20. 2004 Minnesota Gonorrhea Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Clearwater Polk Cook St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Crow Wing Wadena Aitkin Carlton Wilkin Rate per 100,000 persons Otter Tail 0 -19 Pine Mille Lacs Todd 20 - 100 Morrison Grant Douglas Kanabec > 100 Benton Traverse Stevens Pope Stearns Isanti Big Stone Chisago Sherburne City of Minneapolis 276 City of St. Paul 190 Suburban# 40 Greater Minnesota 21 (96 missing residence information) Swift Anoka Wright Washington Kandiyohi Meeker Chippewa Ramsey Lac qui Parle Hennepin McLeod Carver Yellow Medicine Renville Dakota Scott Sibley Lincoln Lyon Goodhue Redwood Le Sueur Nicollet Rice Wabasha Brown # 7-county metro area, excluding the cities of Minneapolis and St. Paul Pipestone Waseca Murray Cottonwood Blue Earth Steele Dodge Olmsted Winona Watonwan Rock Nobles Jackson Martin Houston Faribault Freeborn Mower Fillmore

  21. Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2004 Total Number = 2,957 (96 missing residence information) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  22. Gonorrhea Rates by GenderMinnesota, 1994-2004

  23. Gonorrhea Rates by AgeMinnesota, 1994-2004

  24. Gonorrhea Rates by Race/Ethnicity Minnesota, 1994-2004 * Persons of Hispanic ethnicity can be of any race.

  25. Gonorrhea Rates by Race/Ethnicity Excluding BlacksMinnesota, 1994-2004 * Persons of Hispanic ethnicity can be of any race.

  26. PRIMARY & SECONDARY SYPHILIS STDs in Minnesota: Annual Review

  27. 2004 Minnesota P&S Syphilis Rates by County Kittson Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Red Lake Clearwater Polk Cook St. Louis Lake Itasca Norman Mahnomen Hubbard Becker Cass Clay Crow Wing Wadena Aitkin Carlton Wilkin Otter Tail Rate per 100,000 persons Mille Lacs Pine Todd 0 – 0.2 Morrison Grant Douglas Kanabec 0.21 – 1.0 Traverse Benton > 1.0 Stevens Pope Big Stone Stearns Isanti Chisago Sherburne City of Minneapolis 4.2 City of St. Paul 1.0 Suburban# 0.4 Greater Minnesota 0.0 Swift Anoka Washington Wright Kandiyohi Meeker Ramsey Chippewa Lac qui Parle Hennepin McLeod Carver Yellow Medicine Renville Dakota Scott Sibley # 7-county metro area, excluding the cities of Minneapolis and St. Paul Lincoln Lyon Goodhue Redwood Le Sueur Nicollet Rice Wabasha Brown Pipestone Blue Earth Steele Murray Cottonwood Dodge Olmsted Winona Watonwan Waseca Rock Nobles Jackson Martin Houston Faribault Freeborn Mower Fillmore

  28. Primary &Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2004 Total Number = 27 Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  29. Primary & Secondary Syphilis Rates† by AgeMinnesota, 1994-2004 † While P&S syphilis numbers decreased in 2004, first quarter numbers for 2005 indicate an increase back to 2003 levels.

  30. Primary &Secondary Syphilis Rates by GenderMinnesota, 1994-2004

  31. Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 1994-2004 * Persons of Hispanic ethnicity can be of any race.

  32. Primary & Secondary Syphilis Rates by Race/Ethnicity Minnesota, 1997-2004 * Persons of Hispanic ethnicity can be of any race.

  33. ADOLESCENTS & YOUNG ADULTS 15-19 year olds 20-24 year olds STDs in Minnesota: Annual Review

  34. Chlamydia disproportionately impacts adolescents & young adults Chlamydia Cases in 2004 (n = 11,601) MN Population in 2000 (n = 4,919,479)

  35. Gonorrhea disproportionately impacts adolescents & young adults Gonorrhea Cases in 2004 (n = 2,957) MN Population in 2000 (n = 4,919,479)

  36. Characteristics of adolescents & young adults diagnosed with chlamydia or gonorrhea in 2004(n=9,089)

  37. Characteristics of adolescents & young adults diagnosed with chlamydia or gonorrhea in 2004 (Continued) Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (excluding Minneapolis), Ramsey (excluding St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties outside the seven-county metro area.

  38. Chlamydia Rates for Adolescents & Young Adultsby Gender in Minnesota, 1994-2004

  39. Gonorrhea Rates for Adolescents & Young Adultsby Gender in Minnesota, 1994-2004

  40. EMERGING TRENDS: • Drug Resistant Gonorrhea • Syphilis among MSM • Chlamydia Rate Double since 1996 STDs in Minnesota: Annual Review

  41. Increasing Prevalence of Drug-Resistant Gonorrhea in Minnesota STDs in Minnesota: Annual Review

  42. Background Information • CDC-recommended antibiotic treatments for gonorrhea: • Ceftriaxone • Single dose therapy, administered by injection • Relatively expensive • Cefixime • Single dose therapy, administered orally • Production discontinued in 2002; No longer available • Ciprofloxacin, Ofloxacin, Levofloxacin (Quinolones) • Single dose therapy, administered orally • Spread of quinolone-resistant N. gonorrhoeae (QRNG) threatens the efficacy of fluoroquinolones as the frontline treatment for gonorrhea

  43. Prevalence of Quinolone-Resistant N. Gonorrhoeae (QRNG) 1990s QRNG prevalent in Asia, >40% in some countries Hawaii discontinues use of fluoroquinolones following increase in QRNG prevalence from 1.4% in 1997 to 9.5% in 1999 2000 2001 California discontinues use of fluoroquinolones after reaching QRNG prevalence of 5% in 2001 2002 CDC recommends non-quinolone therapy for infections acquired in HI, CA, and other areas with high QRNG prevalence 2003 Increases in QRNG reported in other U.S. states (e.g., MI, MA) 2004 Prevalence of QRNG in MN five times higher than in 2002

  44. Prevalence of QRNG in Minnesota,1999 - 2004

  45. Prevalence of QRNG Among Male GISP† Participants by Mode of Transmission in Minnesota, 2002 - 2004 † The Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system established by the CDC to monitor antimicrobial resistance in Gonorrhea among males. The Red Door Clinic in Minneapolis is one of the participating clinics. The data shown has been collected through this project.

  46. Characteristics of the 2004 QNRG cases(n = 28) • 71% 0f the cases were White • 32% of cases (9) were among men under 30 years of age, the average age for cases was 32.5 years • 22 of the 28 cases (79%) were among gay/bisexual males • Eighteen percent of cases among gay/bisexual males were also HIV+ • A majority of cases reported having multiple sex partners in the previous 60 days • Two of the cases reported travel and sexual activity in areas with high QNRG prevalence (Philippines and Hawaii)

  47. What’s Being Done in Minnesota? • MDH has expanded the current QRNG surveillance system to include women and Room 111 in St. Paul • MDH will use the data to guide future treatment recommendations • Healthcare providers are encouraged to obtain travel histories of patients and to be alert for treatment failures. Gonorrhea infections acquired in areas with high QRNG prevalence and among MSM should receive non-quinolone therapy • Clinicians and laboratories are asked to report suspected treatment failures and resistant gonococcal isolates to MDH • MDH Partner Services Program follows up on cases and sex partners

  48. Syphilis among Gay/Bisexual Men in Minnesota STDs in Minnesota: Annual Review

  49. Early Syphilis Cases by Stage at Diagnosis Minnesota, 1994-2004

  50. Early Syphilis* among Gay/Bisexual Men Minnesota, 2001-2004 • 48 early syphilis cases diagnosed in 2004, compared with: • 92 cases in 2003 • 82 cases in 2002 • 49 cases in 2001 • 34 cases among gay/bisexual men in 2004, compared with: • 71gay/bisexual men in 2003 • 56 gay/bisexual men in 2002 • 5 gay/bisexual men in 2001 • Characteristics of the 2004 gay/bisexual male cases (n=34): • 80% White • 71% live in Hennepin County • Average age = 37 • 32% HIV+ * Early Syphilis includes primary, secondary, and early latent stages of syphilis.