Wisconsin TD ummit 1 November, 1 Madison, W Epidemiology of TDs: What s Happening in Wisconsin? John Pfister, M Microbiologist, Epidemiologist What is epidemiology? The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control of health problems. (Last JM: A Dictionary of Epidemiology, ed. New York, Oxford University Press, 1988.) Objectives of Epidemiology (1) Objectives of Epidemiology () dentify the etiology or the cause of a disease tudy the natural history and progression/prognosis of the disease Determine the extent of the disease found in communities and specific populations, and track changes over time dentify factors that increase a person s risk for the disease 3 Objectives of Epidemiology (3) Epidemiology of exually Transmitted Diseases in Wisconsin Evaluate both existing and new preventive and therapeutic measures and modes of health care delivery Provide the foundation for decisionmaking and public policy development What? Diseases Organisms Where? Communities Geographical Areas Providers Who? pecific Populations Demographics Risk Factors When? Time Periods Trends over Time How? Data ources Measures Laboratory Tests pecimen Types/ites Why? Detection/Control trategies Guidelines/Recommendations Evidence-based 5 1
Reportable TDs in Wisconsin Chlamydia: Chlamydia trachomatis yphilis: Treponema pallidum Gonorrhea: Neisseria gonorrhea Chancroid: Haemophilus ducreyi Pelvic nflammatory Disease (PD) TDs in Wisconsin Data ources Wisconsin Electronic Disease urveillance ystem (WED) Laboratory Databases Wisconsin tate Laboratory of Hygiene (WLH) City of Milwaukee Public Health Laboratories Planned Parenthood Laboratory Research tudy Databases 7 Wisconsin Electronic Disease urveillance ystem (WED) Case Reports Computerized registry of population-based cases reported by laboratories and clinicians Under-reporting, uneven reporting, incomplete data Variation may merely reflect changes in testing and/or reporting practices Wisconsin exually Transmitted Diseases (TDs) tatistics Wisconsin Department of Health ervices, Division of Public Health, TD Program Annual Reports urveillance and tatistical Trends: tatewide profiles, case rates by county, profiles of adolescents and young adults, Milwaukee-specific profiles. Jackie Grayson (Data Manager) & Brandon Kufalk (D/urveillance Coordinator) http://www.dhs.wisconsin.gov/communicable/std/ tatistics/ndex.htm Number of TD Cases Reported in Wisconsin, 13, by Gender 5,, 15, 1, 5, Chlamydia Gonorrhea yphilis Females 1,31,9 1 Males,853,11 1
Number of TD Cases Reported in Wisconsin, 13, by Region Reported Chlamydia Cases by County, Wisconsin, 13 5,, 15, 1, 5, Chlamydia Gonorrhea yphilis Western,5 17 1 outhern 3,75 17 38 outheastern 1,579 3,57 19 Northern 1,1 1 Northeastern 3,9 8 Bayfield Douglas Ashland ron Vilas Burnett Washburn awyer Florence Price Oneida Forest Polk Rusk Barron Marinette Lincoln Langlade Taylor aint Croix Chippewa MenomineeOconto Dunn Marathon hawano Door Pierce Eau Claire Clark Pepin Kewaunee Wood Portage Waupaca Brown Outagamie Buffalo Trempealeau Jackson Manitowoc Waushara Calumet Winnebago Monroe La Crosse JuneauAdamsMarquette Green Lake Fond du Lacheboygan Vernon Columbia auk Dodge Richland Washington Ozaukee Crawford Dane owa JeffersonWaukesha Milwaukee Grant Racine Lafayette Green Rock Walworth Kenosha Total Cases = 3, - 5-135 13-37 375-71 717-3, >3, 19 Reported Gonorrhea Cases by County, Wisconsin, 13 Reported yphilis Cases by County, Wisconsin, 13 Douglas Bayfield Ashland ron Total Cases =,573 Douglas Bayfield Ashland ron Total Cases = 55 Vilas Vilas Burnett Washburn awyer Florence Burnett Washburn awyer Florence Price Oneida Forest Price Oneida Forest Polk Barron Rusk Taylor Lincoln Langlade Marinette Polk Barron Rusk Taylor Lincoln Langlade Marinette aint Croix Chippewa MenomineeOconto Dunn Marathon hawano Door Pierce Eau Claire Clark Pepin Kewaunee Wood Portage Waupaca Brown Outagamie Buffalo Trempealeau Jackson Manitowoc Waushara Calumet Winnebago Monroe La Crosse Juneau Adams Marquette Green Lake Fond du Lac heboygan Vernon Columbia auk Dodge Richland WashingtonOzaukee Crawford Dane owa Jefferson Waukesha Milwaukee Grant Racine Lafayette Green Rock Walworth Kenosha -5-19 -59-99 1-999 >1 aint Croix Chippewa MenomineeOconto Dunn Marathon hawano Door Pierce Eau Claire Clark Pepin Kewaunee Wood Portage Waupaca Brown Outagamie Buffalo Trempealeau Jackson Manitowoc Waushara Calumet Winnebago Monroe La Crosse Juneau AdamsMarquette Green Lake Fond du Lac heboygan Vernon Columbia auk Dodge Richland WashingtonOzaukee Crawford Dane owa Jefferson WaukeshaMilwaukee Grant Racine Lafayette Green Rock Walworth Kenosha 1-3 -19-9 5-15+ 1 Counts (Cases) versus Rates Counts, also called frequencies, are total number of events (cases) that occur during a defined period of time. Rates are the number of events (cases) that occur during a defined period of time, divided by the average population at risk of that event. (often standardized to per 1, population) Rates are often used instead of counts because they allow comparison of the level of disease in two different populations. Rates* of Reported TD Cases in Wisconsin, 13, by Gender 7 5 3 1 Chlamydia Gonorrhea yphilis Males 5 7 8 Females 577 87 1 Reported Cases per 1, population * Per 1, Population 3
Age-specific Rates* of Reportable TDs**, Wisconsin, 13 3 5,77 mputed TD Case Rates* by Race, Reportable TDs**, Wisconsin, 13 5,, 3,511 13-fold difference Rate* 15 1,997 1,8 Rate* 3,, 1 31 5 5 1 81 11 58 18-5-9 1-1 15-19 - 5-9 3-3 35-39 - 5-9 5+ per 1, population Age group *Cases **Chlamydia, gonorrhea and syphilis 1 1, 857 African American Native American Asian/Pacific slander 355 7 White *mputed rates are calculated by statistically allocating cases reported with unspecified race. **Chlamydia, gonorrhea and syphilis 17 Rates* of Reported TD Cases in Wisconsin, 13, by Region 7 5 3 1 Chlamydia Gonorrhea yphilis Northeastern 3 3 Northern 7 1 outheastern 5 177 8 outhern 3 3 3 Western 9 17 1 Cases per 1, population * Per 1, Population Reported TD Case Rates* by County, Reportable TDs**, Wisconsin, 13 Counties with rates* > Bayfield County Cases Percent Rate Douglas Ashland ron Menominee 3.% 1,378 Vilas Burnett Washburn awyer Florence Milwaukee 1,89.% 1,353 Price Oneida Forest Forest.% 9 Polk Barron Rusk Marinette Lincoln Langlade Kenosha 995 3.5% 5 Taylor aint Croix Chippewa Menominee Oconto Dunn Dane,351 8.% 87 Marathon hawano Door Pierce Eau Claire Clark Pepin Brown 1,19.% 8 Kewaunee Wood PortageWaupaca Buffalo Outagamie Brown TrempealeauJackson Douglas 1.7% 8 Manitowoc Waushara Calumet Winnebago Racine 9 3.% 71 Monroe La Crosse JuneauAdams Marquette Rate* Green Lake Fond du Lacheboygan < Rock 73.% Vernon auk Columbia Dodge -399 Richland Washington Ozaukee Winnebago 5.3% 3 Crawford -599 Dane UBTOTAL,1 7.% 87 owa Jefferson Waukesha Milwaukee Grant -799 Racine Lafayette Green Rock Walworth Kenosha 8+ Other counties 7,938 9.% 7 tate total 8, 1.% 98 *Cases per 1, population **Chlamydia, gonorrhea and syphilis Chlamydia Rates* by tate, 1, CDC Data Primary and econdary yphilis Rates* by tate, 1, Centers for Disease Control and Prevention (CDC) Data L M W (9th) A L MN M W (39th) A MN t a t *Cases per 1, population e t a e *Cases per 1, population 5
t t Nov 1 Gonorrhea Rates* by tate, 1, CDC Data Chlamydia Rates 7-13, by Gender 3 5 15 1 L M A W (3th) MN Cases per 1, 7 5 3 1 5 537 531 187 1 5 581 5 8 Females 7 Males 5 7 8 9 1 11 a e M L A G N A O T A L C A C K H N L M O M T P O N X A K Y *Cases per 1, population N F A D K M N A C V N N L K E Y D M R A D A J V W K N E A C H M C N T A N O D R W W M O M U V N M A V A R E T T H T D Males Females 7 Chlamydia Rates 7-13, by Region Cases per 1, 7 5 3 1 NE W N 7 8 9 1 11 1 13 Northeastern 1 7 31 31 3 Northern 1 1 11 18 18 18 7 outheastern 59 59 1 5 7 35 5 outhern 78 3 8 38 38 3 3 Western 18 1 8 1 7 9 E Gonorrhea Rates 7-13, by Gender Cases per 1, 1 17 1 13 1 11 11 97 1 1 93 83 87 7 Females 8 8 Males 73 7 7 8 9 1 11 1 13 Males Females Gonorrhea Rates 7-13, by Region Cases per 1, 3 5 15 1 E 5 NE W N 7 8 9 1 11 1 13 Northeastern 1 37 7 8 1 3 Northern 11 11 13 1 13 7 1 outheastern 7 199 188 181 179 177 outhern 59 5 8 3 37 3 Western 1 17 1 13 13 17 yphilis Rates 7-13, by Gender yphilis Cases per 1, 1 8 8 Males 8 5 5 5 1 1 1 Females 7 8 9 1 11 1 13 Males Females 5
yphilis Rates 7-13, by Region Cases per 1, 1 8 W 7 8 9 1 11 1 13 Northeastern 1 1 1 1 1 Northern 1 1 1 outheastern 7 7 9 8 outhern 1 3 3 3 Western 1 1 1 1 1 N NE E Wisconsin Research tudies Over the past 3 years, clients seen in specific settings (family planning clinics, TD clinics, correctional facilities, adolescent health clinics, university health clinics, etc.) have periodically been evaluated to: Determine the true prevalence of chlamydia and gonorrhea infections in those populations through universal testing Determine factors that indicate increased risk for infection Determine and evaluate cost-effective selective screening criteria and strategies Evaluate clinical service delivery procedures and protocols Evaluate laboratory testing methodologies Universal Testing tudy of Chlamydia nfections Among Women Attending PPW Clinics, 1 Cumulative elective creening Criteria Patients Meeting Criteria Chlamydia Positive ensitivity (% of All Positives) # % # % 1 TD Contact 18 3.% 1 18.8% 9.8% Criterion 1 + ymptoms of TD,31 35.% 38 1.3% 5.8% 3 Criteria + Partner Risk 3,58 55.% 318 8.9% 75.9% Criteria 3 + History of TD 3,973 1.1% 338 8.5% 8.7% 5 Criteria + Age <19 Milwaukee Only,.% 351 8.% 83.8% Criteria 5 + Age <19 Cities >35,,55 7.% 37 8.1% 87.% Population 7 Criteria + Age <19 All Clinics,19 71.% 38 8.% 87.8% 8 Criteria 7 + Age <3 Milwaukee Only (Age<19 Elsewhere),81 7.8% 38 7.9% 91.% 9 Criteria 8 + Age <3 Cities >35, Population 5,93 81.% 393 7.% 93.8% 1 Criteria 9 + Age <3 All Clinics 5,38 8.8% 393 7.3% 93.8% 11 Universal creening,5 1% 19.% 1% pecimens Tested for Chlamydia, WLH & MHDL, 13, by Provider Type (n=7,11) CORR 5,1 UNV 8, TD 1,8 ADOL 1,5 OTHER 3,537 Non PPW FP 11,1 PPW, 3,7 pecimens Tested for Gonorrhea, WLH & MHDL, 13, by Provider Type (n=51,73) CORR 5,1 ADOL 1,5 OTHER 3,537 Chlamydia Positivity, 13, by Gender and Provider Type 5.%.% UNV 8, PPW, 3, 15.% 1.% 5.% TD 1,8 Non PPW FP 11,1.% CORR UNV MTD ADOL FP PPW OTH Females 3.% 3.5% 8.% 15.% 8.% 9.% 3.9% Males.% 5.8% 1.% 8.% 1.5%.1% 5.5%
Gonorrhea Positivity, 13, by Gender and Provider Type ite of pecimen Collection, Male Clients of Milwaukee TD Clinics, 13 (n=,739) 1.% 9.% 8.% 7.%.% 5.%.% 3.%.% 1.%.% CORR UNV TD ADOL FP PPW OTH Females.3%.% 5.5% 8.9% 1.1%.%.% Males.3% 1.5%.% 1.1%.8%.8% 1.8% NAOPHARYNX 1,99 (3%) RECTUM, 7 (%) URNE,,3 (%) Chlamydia and Gonorrhea Positivity among Males Attending Milwaukee TD Clinics, 13, by pecimen ite.% The Future of Public Health nstitute of Medicine (OM), National Academy of ciences Washington, DC: National Academy Press; 1988. 1.%.% Chlamydia Gonorrhea Nasopharynx 1.8% 5.3% Rectal 1.5% 11.5% Urine 13.% 7.% The core functions of public health agencies at all levels of government are assessment, policy development, and assurance To fulfill the assessment function every public health agency should regularly and systematically collect, assemble, analyze, and make available information on the health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Public Health urveillance Public Health urveillance The ongoing systematic collection, analysis, interpretation, and dissemination of health data Public health agencies use surveillance data to describe and monitor health events in their jurisdictions, set priorities, and to assist in the planning, implementation, and evaluation of public health interventions and programs. 7
Data, nformation, Knowledge, and Wisdom.urval Castro, Anthony Mills. http://www.systems-thinking.org/dikw/dikw.htm 8