National STD Conference Jim Kent M.S. Outbreak of LGV in Michigan 2015-2016 Poster Session WP - These slides include the same basic information as in the poster If you have questions about the data in these slides please contact Jim Kent at KentJ3@michigan.gov
Outbreak of LGV in Michigan 2015-2016 Population Health Administration Division of HIV and STD Services, STD Section And Bureau of Epidemiology and Population Health
What is LGV? Genital ulcer disease Caused by L1, L2 and L3 serovars of Chlamydia trachomatis Tests positive on CT NAAT Endemic among heterosexuals in tropical Africa, Asia, and Caribbean.
What is LGV? Nationally notifiable until 1993 Still notifiable in Michigan Last reported MI case was in 2008 Outbreaks among MSM in Netherlands (2004) and UK (2012)
LGV Reporting in U.S., 1944-94 3,000 2,500 2,000 1,500 1,000 500 0 1944 1945 1946 xx 1956 1957 1958 xx 1968 1969 1970 xx 1980 1981 1982 xx 1991 1992 1993 1994
Symptoms Primary symptoms may include a lesion or pimple around the penis or vagina; these may resolve spontaneously Lymphadenopathy often occurs as a secondary symptom Rectal symptoms including proctitis may occur
Treatment CDC recommends treating a presumptive diagnosis of LGV with 7 days of doxycycline A confirmed diagnosis, or presumptive diagnosis among a high-risk individual (e.g., HIV+ MSM) requires 21 days of doxycycline
Lymphogranuloma venereum (LGV) in Michigan 2015 1 case reported August 17 3 cases reported September 22 The first 4 reports were all from one site, all were males, HIV-infected, all were MSM Report outbreak to CDC Activate Emergency Response Plan First conference call Sept 29 First Health Alert Network message Sept 29 A
Collaboration Team (1) Wayne State University HIV Clinic Debbie Richmond Lawrence Crane Jonathan Cohn MDHHS Epidemiology Katie Macomber Jevon McFadden Amy Bohner MDHHS Lab Jim Rudrick Marty Soehnlen Kelly Jones
Collaboration Team (2) MDHHS STD Section Karen Krzanowski Sandra Johnson Tay Starr Shawn Odom Karen Lightheart Patricia Villegas Alana Thomas Katrina Perkins Cathy Hollis Dan Lowery
Collaboration Team (3) Detroit STD Clinic Chris Finch Joe Enos CDC Laboratory Allan Pillay Chen Cheng Ellen Kersh John Papp CDC STD / Epidemiology Alex devoux Laurie Anderson Kyle Bernstein Elizabeth Torrone
MI Case Definition Clinical diagnosis Confirmed: Positive for L1, L2, or L3 markers by molecular testing at CDC Probable Chlamydia positive and sex partner of LGV case Or Chlamydia positive and symptomatic Suspect Symptomatic and sex partner of LGV case
Diagnosis Clinical symptoms are non-specific Lesions Lymphadenopathy Proctitis Chlamydia trachomatis from an affected site Antibody profiles are non-specific, difficult to interpret CDC Molecular techniques are for research only
LGV Incidence by Definition 8 6 4 2 0 June 2015 July 2015 Aug 2015 Sept 2015 Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Apr 2016 Confirmed Probable Suspect May 2016
Clinical Presentation and Diagnosis 31 presented with symptoms Some during routine HIV follow up 6 with penile or genital ulcer or lesion 9 with lymphadenopathy 26 with rectal symptoms 6 were referred as partners of other cases 2 were partners of LGV and had symptoms 3 identified through clinical review of sx
Diagnosing facility All 42 cases were diagnosed at clinics that see a high volume of HIV patients: 26 at a major adult HIV clinic 4 at a related HIV clinic for young adults 7 at the Detroit STD clinic 1 case each at 5 clinics in or near Detroit that serve HIV clients
LGV Epidemiology (n=42) 100% are men who have sex with men 100% are HIV infected 6 new HIV infections diagnosed among this population 93% of cases are African American 74% of cases are residents of the City of Detroit
LGV cases by county As of May 31 2016 (n= 42) 31 Detroit 4 Wayne Co. 3 Oakland Co. 2 Macomb Co. 1 Ingham Co. 1 Saginaw Co.
LGV in Michigan June 2015- June 2016, N= 35
LGV Cases by Age Group (n= 42) 14 Male 12 10 8 6 4 2 0 0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 +
LGV Cases by years since HIV diagnosis 8 7 6 5 4 3 2 1 0
LGV Cases by HIV viral load (n= 42) 25 20 15 10 5 0
LGV Cases by CD4 percent (n= 42) 14 12 10 8 6 4 2 0 0-9% 10-14% 15-19% 20-29% 30-39% 40-49%
LGV Cases by CD4 count (n= 42) 16 14 12 10 8 6 4 2 0 0-99 100-199 200-299 300-399 400-499 500-999 1000+
Partner Services 12 / 42 cases were named as partners of other LGV cases 29 additional partners named Multiple anonymous partners named
What next? Continue surveillance Remind clinicians of the ongoing outbreak Simplify reporting and submission of laboratory samples LGV may be endemic among MSM in southeast Michigan