WASHINGTON STATE COMMUNICABLE DISEASES OF PUBLIC HEALTH SIGNIFICANCE FOR THE CIVIL SURGEON SCOTT LINDQUIST MD MPH WASHINGTON STATE DEPARTMENT OF HEALTH STATE EPIDEMIOLOGIST FOR COMMUNICABLE DISEASES FOREIGN-BORN POPULATION OF THE U.S., 1900 Source: https://www.gilderlehrman.org/content/map-foreign-born-population-united-states-1900 2 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 1
FOREIGN-BORN POPULATION OF THE U.S., 2012-2016 Source: http://www.pewhispanic.org/2018/09/14/facts-on-u-s-immigrants-county-maps/ 3 PROPORTION OF FOREIGN-BORN RESIDENTS, US & WA, 1900-2010 25.0% 22% 20.0% 15.0% 10.0% 13.6% 13% 12.9% 5.0% 0.0% 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 US Foreign Born % WA Foreign Born % Source: US Census 4 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 2
REGION OF BIRTH AMONG FOREIGN-BORN RESIDENTS OF WA, 2016 REGION OF BIRTH, FOREIGN-BORN RESIDENTS OF WA, 2016 TOP 5 COUNTRIES/REGIONS (N=1,020,359) 1. Mexico 14% 2. China* 35% 3. Philippines* 4. India* 5. Eastern Europe 43% (excludes Russia & Poland) 2% 6% *WHO High Burden Country for TB, 2016 Europe Asia Africa Oceania Americas Source: Census: ACS, 2016 5 30,000 25,000 20,000 15,000 10,000 5,000 NEW LAWFUL PERMANENT RESIDENTS WA 2008 2017 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 6 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 3
NEW NATURALIZED CITIZENS IN WA, 2016-2018 Source: USCIS 7 CHALLENGES TO SOLVE: 10-YEAR INFECTIOUS DISEASE TRENDS IN WASHINGTON STATE, ANNUAL NEW CASE COUNTS, 2008-2017 8 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 4
HIV: MAJOR INITIATIVES / ACCOMPLISHMENTS END AIDS WASHINGTON PRE-EXPOSURE PROPHYLAXIS DRUG ASSISTANCE PROGRAM (PREP DAP) STANDARDS FOR HEALTH CARE FOR LGBTQ PERSONS (BREE) HIV DRUGS ON HCA S PREFERRED DRUG LIST WORK TO MODERNIZE STATE LAWS HOUSING FUNDING INTEGRATION (HRSA AND HUD) HEALTH DISPARITIES DATA TO DRIVE HEALTH DISPARITY WORK HIV STIGMA COORDINATOR COMMUNITY ENGAGEMENT COORDINATORS (HIV+/50+ & HIV-) HEALTH CARE PEER NAVIGATOR SYSTEM 9 WASHINGTON STATE HIV CARE CONTINUUM, 2016 10 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 5
TB RATES U.S. AND WA TB RATES BY ORIGIN WA Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 6
Proportional TB Burden by Origin WA TB Burden by Race/Ethnicity and Origin WA; 2015-2017 AIAN - American Indian or Alaskan Native; NHPI - Native Hawaiian or Other Pacific Islander. Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 7
TB Burden by Country of Origin WA, Non-U.S. Born; 2015-2017 Arrival to TB Diagnosis WA, Non-U.S. Born; 2015-2017 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 8
HEPATITIS C HEPATITIS C IS THE MOST COMMON BLOODBORNE INFECTION IN THE UNITED STATES. IN THE US, IT KILLS MORE PEOPLE EVERY YEAR THAN ALL OTHER 59 REPORTABLE INFECTIOUS DISEASES COMBINED. HOSPITALIZATION COSTS RELATED TO HEPATITIS C IN WASHINGTON WERE $114 MILLION FROM 2010 THROUGH 2014. 17 100 90 80 70 60 50 40 30 20 10 0 22 Acute HCV cases in Washington State, by year of report (2008 2017) 333% increase statewide 2009 2016 ~75% of those for whom risk factors were collected report injection drug use 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 95 73 18 Source: WA DOH Hepatitis Surveillance Records Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 9
10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 6466 Chronic HCV cases in Washington State, by year of report (2008 2017) 4,438 8,839 Risk/exposure data for chronic cases is sparse (~80% missing), but when present, injection drug use is often reported 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 19 Source: WA DOH Hepatitis Surveillance Records HCV BY YEAR OF BIRTH THE TALE OF 2 EPIDEMICS 1945 1965 birth cohort second wave, ages 37 and younger in 2014 20 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 10
FIVE-YEAR RATE OF CHRONIC HEPATITIS C INFECTIONS PER 100,000 PERSONS AMONG NON-INCARCERATED RESIDENTS WASHINGTON STATE, 2010-2014 SOURCE: WA DOH HEPATITIS SURVEILLANCE RECORDS 21 Washington State Communicable Diseases of Public Health Significance for the Civil Surgeon 11