pennsylvania department of health std program telephone: 717-787-3981 internet address: email:...
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Pennsylvania Department of Health STD ProgramTelephone: 717-787-3981Internet Address: www.state.pa.us/php/stdEmail: [email protected]
Gonorrhea Overview
Reported GonorrheaReported GonorrheaPennsylvania 1976-2008 (Exclusive of Philadelphia)Pennsylvania 1976-2008 (Exclusive of Philadelphia)
0
2000
4000
6000
8000
10000
12000
14000
Year
Num
ber
of R
epor
ted
Cas
es
TOTALS
2008 Reported Gonorrhea2008 Reported GonorrheaBy Report SourceBy Report Source
Pennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)
43%
57%
Public
Private
N=10,796
Elk
York
Centre
Berks
Butler
Lycoming Pike
Bedford
Clinton
Clearfield
Blair
Indiana
Somerset
Luzerne
Fayette
PerryBucks
Lancaster
Mercer
FranklinChester
Clarion
Schuylkill
Cambria
Monroe
Huntingdon
Greene
Venango
Allegheny
Adams
Washington
Westmoreland
Jefferson
Mifflin
Fulton
Dauphin
Armstrong
Beaver
Sullivan
Juniata
Union Carbon
Lehigh
Columbia
Snyder
Cumberland
Lebanon
Lawrence
Tioga
Erie
PotterBradfordWarren McKean
Crawford Wayne
Forest
Susquehanna
Wyoming
Cameron
Montgomery
Lackawanna
Northumberland Northampton
Delaware
Montour
Philadelphia
Northwest
Southwest
North Central Northeast
South Central Southeast
2008 Gonorrhea Culture Sites andGonorrhea Case Rates* by County, 2008
Rates
No Cases 1 - 25 26 - 50 51 - 75 76 - 125 126 - 333
Health Districts
* Rates are calculated per 100,000 population from the 2000 Census.
Reported Gonorrhea By GenderReported Gonorrhea By GenderPennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)
CY 2000 through 2008CY 2000 through 2008
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Nu
mb
er o
f C
ases
Male
Female
Reported Gonorrhea By AgeReported Gonorrhea By AgePennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)
CY 2007 and 2008CY 2007 and 2008
0
500
1000
1500
2000
2500
3000
Under15
15-19 20-24 25-29 30-34 35-39 40-44 45+
Age
Nu
mb
er o
f C
ases
2007
2008
2008 Reported Gonorrhea By Age2008 Reported Gonorrhea By AgePennsylvania (Exclusive of Philadelphia)Pennsylvania (Exclusive of Philadelphia)
By GenderBy Gender
0
200
400
600
800
1000
1200
1400
Under15
15-19 20-24 25-29 30-34 35-39 40-44 45+
Age
Nu
mb
er o
f C
ases
Male
Female
Reported GonorrheaReported GonorrheaPennsylvania 2008 Pennsylvania 2008
Cases per 100,000 Population Cases per 100,000 Population Select PopulationsSelect Populations
6915
294 315
622 641
0
100
200
300
400
500
600
700
Total White Black Population15-24
Black Male BlackFemale
Year
Num
ber
of R
epor
ted
Cas
es
State
Gonorrhea Positivity Gonorrhea Positivity Pennsylvania 2008 Pennsylvania 2008 Select PopulationsSelect Populations
10.52
2.56
0.45
1.62.08
0.75 0.92
4.66
1.67
6.19
01234567
Population
Per
cent
Pos
itive
STD Prevention ActivitiesSTD Prevention ActivitiesKey Statewide PopulationsKey Statewide Populations
• Individuals age 15 to 24Individuals age 15 to 24• Black MalesBlack Males• Black FemalesBlack Females• Men who have Sex with Men (MSM) in Men who have Sex with Men (MSM) in
selected counties (e.g., Allegheny County)selected counties (e.g., Allegheny County)
ChallengesChallenges
• Budget Cuts Budget Cuts • Reduced Testing OpportunitiesReduced Testing Opportunities• Restrictions on TravelRestrictions on Travel• Loss of Staff (e.g., directly lost ability to map data)Loss of Staff (e.g., directly lost ability to map data)• State Facing a Reduction in ForceState Facing a Reduction in Force• Bunker Mentality Setting-in with Other Departments and Agencies (resulting in Bunker Mentality Setting-in with Other Departments and Agencies (resulting in
less cooperation, reluctance to change, poor morale, etc.)less cooperation, reluctance to change, poor morale, etc.)
• Political ChangesPolitical Changes• Loss of Health Commissioner in Chester CityLoss of Health Commissioner in Chester City• Other County/Municipal cut backs have resulted in a fracturing of Other County/Municipal cut backs have resulted in a fracturing of
existing existing long-term relationslong-term relations..• State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT State Consolidation of Contracts (e.g., Proposed 193% increase in GC/CT
test Price)test Price)
• Unrealistic Expectations Placed on Field StaffUnrealistic Expectations Placed on Field Staff• Is it reasonable for one DIS to cover 12 counties?Is it reasonable for one DIS to cover 12 counties?
• 29 Early Syphilis Cases29 Early Syphilis Cases• 3,241 Chlamydia Cases3,241 Chlamydia Cases• 573 Gonorrhea Cases573 Gonorrhea Cases• 1 Congenital Syphilis1 Congenital Syphilis
PA’s Approach to High PA’s Approach to High Morbidity Areas in the StateMorbidity Areas in the State
Targeted Intervention Based on Data• Morbidity Data• Prevalence Data• Mapping of Data• Strategic allocation of resources
Use a multitude of data sources to make “case” to local and district jurisdictions
Involvement of a large number of stakeholders
Frequent Follow-up of Partners Face-to-face meetings very critical
Targeted Communication Health Alerts Press Releases
STD Prevention ActivitiesSTD Prevention ActivitiesA success story?A success story?
““Know your enemy and know yourself and you can fight a Know your enemy and know yourself and you can fight a hundred battles without disaster.”hundred battles without disaster.”
With the gonorrhea increase in Delaware County it was critical With the gonorrhea increase in Delaware County it was critical to determine:to determine:
• Was the increase real?Was the increase real?• Where were the increases occurring? Where were the increases occurring? • What populations were being impacted?What populations were being impacted?• Who were the partners that need to be engaged?Who were the partners that need to be engaged?
Reported GonorrheaReported GonorrheaDelaware County 2000-2008 Delaware County 2000-2008
0
200
400
600
800
1,000
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Num
ber
of R
epor
ted
Cas
es
TOTALS
®v
®v
Delaware
Ri
Vet e
ra
Avenue of the
States
Springbrooke
Edg
em
ont
CROZER-CHESTER MEDICAL CENTER
2007 Gonorrhea Cases by Census TractDelaware County - All Ages
0 0.5 10.25
Miles
2007 Gonorrhea Cases by Census Tract
1 - 5
6 - 10
11 - 15
16 - 25
26 - 65
GC Increase in Delaware CountyGC Increase in Delaware County
Location Disease
2007DiseaseCounts
Estimated 2006 Population
Case Rate Per 100,000 Population
Chester City Gonorrhea 460 36,801 1249.97
Delaware Gonorrhea 921 555,996 165.65
State Gonorrhea 12,712 12,440,621 102.18
Philadelphia Gonorrhea 5,246 1,448,394 362.19
Location Disease
2006DiseaseCounts
Estimated 2006 Population
Case Rate Per 100,000 Population
Chester City Gonorrhea 247 36,801 671.18
Delaware Gonorrhea 513 555,996 92.27
State Gonorrhea 11,466 12,440,621 92.17
Philadelphia Gonorrhea 5,218 1,448,394 360.26
Key STD Prevention ActivitiesKey STD Prevention Activitiesin Delaware Countyin Delaware County
• Expanded Testing Services in ChesterExpanded Testing Services in Chester• Community Health FairsCommunity Health Fairs• After School ScreeningAfter School Screening• Expanded Clinical ServicesExpanded Clinical Services• School-based ScreeningSchool-based Screening
Collaboration with Family Planning and Hospital System to open a Collaboration with Family Planning and Hospital System to open a School-based Health Resource Center that screens students for School-based Health Resource Center that screens students for
GC/CTGC/CT
• Heavy Media ExposureHeavy Media Exposure• Health AlertsHealth Alerts• Sustained Press Releases (at least 6)Sustained Press Releases (at least 6)• Positive local newspaper coveragePositive local newspaper coverage
• Community-Based MeetingsCommunity-Based Meetings• Youth Violence Youth Violence • Key stakeholder MeetingsKey stakeholder Meetings
• Enhanced Disease Intervention InterviewsEnhanced Disease Intervention Interviews
• Aggressive Partner TherapyAggressive Partner Therapy