sexually transmitted disease (std) surveillance report, 2011 minnesota department of health std...
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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. STDs in Minnesota: Annual ReviewTRANSCRIPT
Sexually Transmitted Disease (STD) Sexually Transmitted Disease (STD) Surveillance Report, 2011Surveillance Report, 2011
Minnesota Department of HealthSTD Surveillance System
www.health.state.mn.us/stdwww.health.state.mn.us/std
Introduction
Under Minnesota law, physicians and laboratories must report all laboratory-confirmed cases of chlamydia, gonorrhea, syphilis, and chancroid to the Minnesota Department of Health (MDH) within one working day.
The MDH does not maintain statistics for other, non-reportable STDs (ex: herpes, HPV/genital warts).
This slide set describes trends in reportable STDs in Minnesota by person, place, and time.
Analyses exclude cases reported from federal and private prisons.
STDs in Minnesota: Annual Review
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.
STDs in Minnesota: Annual Review
Interpreting STD Surveillance Data
Factors that impact the completeness and accuracy of STD data include:
Level of STD screening by healthcare providers Individual test-seeking behavior Sensitivity of diagnostic tests Compliance with case reporting Completeness of 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 above factors.
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Interpreting STD Surveillance Data
The surveillance system only includes cases diagnosed in conjunction with a positive laboratory test. Cases diagnosed solely on symptoms are not counted.
Surveillance data represent cases of infection, not individuals. A person with multiple infections in a given year will be counted more than once.
Caution is warranted when interpreting changes in STD numbers that can seem disproportionately large when the number of cases is small.
Changes in Rate Calculations for 2011
This 2011 data release includes rates calculated using revised population estimates for the calendar years between 2000 and 2010 U.S. Censuses
Previously published rates dating back to 2001 have been updated in this release
Data from the 2010 U.S. Census, released in 2011 reflected substantial growth among populations of color and American Indians in MN. Populations with the greatest increase were Black or African American, Asian/Pacific Islander, and Hispanic/Latino.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
National Context
STDs in Minnesota: Annual Review
Chlamydia—Rates by State, United States and Outlying Areas, 2010National Rate = 422.6 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
Gonorrhea—Rates by State, United States and Outlying Areas, 2010
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
National Rate = 99.6 per 100,000 population
Primary and Secondary Syphilis—Rates by State United States and Outlying Areas, 2010
National Rate = 4.5 per 100,000 population
Source: Centers for Disease Control & Prevention, Division of STD Prevention. 2010 Surveillance Slides.
Overview of STDs in Minnesota
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
STDs in MinnesotaRate per 100,000 by Year of Diagnosis, 2001-2011
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
STDs in Minnesota:Number of Cases Reported in 2011
Total of 19,547 STD cases reported to MDH in 2011:
16,898 Chlamydia cases 2,283 Gonorrhea cases 366 Syphilis cases (all stages) 0 Chancroid cases
CHLAMYDIA
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Rate per 100,000 persons
> 300151 - 30076 - 1500 - 75
2011 Minnesota Chlamydia Rates
by County
City of Minneapolis 848City of St. Paul 795Suburban# 271Greater Minnesota 198
(728 cases missing residence information)
# 7-county metro area, excluding the cities of Minneapolis and St. Paul
St. Louis
Itasca
Cass
LakePolk
Beltrami
Aitkin
Pine
Cook
Koochiching
Otter Tail
Clay
Roseau
Marshall
Becker
Todd
Stearns
Kittson
Swift
Lyon
Pope
Morrison
Wilkin
Renville
Carlton
Martin
Rice
Wright
Norman
FillmoreMowerNobles
Murray
Grant
Sibley
Brown
Rock
Redwood
Douglas
Jackson
Meeker
Goodhue
Winona
Isanti
Faribault
Dakota
Freeborn
Olmsted
Scott
Stevens
Anoka
Nicollet
McLeod
Chippewa
Wabasha
Carver
Pennington
Hubbard
Cro
w W
ing
Lake
of t
he W
oods
Cle
arw
ater
Kan
diyo
hi
Lincoln
Blue Earth
Mill
e La
cs
Houston
Steele
Trav
erse
Dodge
Wadena
Hennepin
Kan
abec
Lac Qui Parle
Benton
Big Stone
Cottonwood
Was
eca
Chisago
Le Sueur
Mahnomen
Yellow Medicine
Pipestone
Red Lake
Sherburne
Watonwan
Washington
Ramsey
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
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.
Chlamydia Infections by Residence at Diagnosis Minnesota, 2011
Total Number of Cases = 16,898
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rates by GenderMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rates by AgeMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Age-Specific Chlamydia Rates by Gender Minnesota, 2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity Minnesota, 2001-2011
* Persons of Hispanic ethnicity can be of any race.
2011 rates compared with Whites:Black = 11x higherAmerican Indian = 4x higherAsian/PI = 2x higherHispanic = 3x higher
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rates by Race/Ethnicity Minnesota, 2001-2011
* Persons of Hispanic ethnicity can be of any race.
GONORRHEA
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
2011 Minnesota Gonorrhea Rates
by County
Rate per 100,000 persons
City of Minneapolis 211City of St. Paul 132Suburban# 30Greater Minnesota 14
(91 cases missing residence information)
# 7-county metro area, excluding the cities of Minneapolis and St. Paul
St. Louis
Itasca
Cass
LakePolk
Beltrami
Aitkin
Pine
Cook
Koochiching
Otter Tail
Clay
Roseau
Marshall
Becker
Todd
Stearns
Kittson
Swift
Lyon
Pope
Morrison
Wilkin
Renville
Carlton
Martin
Rice
Wright
Norman
FillmoreMowerNobles
Murray
Grant
Sibley
Brown
Rock
Redwood
Douglas
Jackson
Meeker
Goodhue
Winona
Isanti
Faribault
Dakota
Freeborn
Olmsted
Scott
Stevens
Anoka
Nicollet
McLeod
Chippewa
Wabasha
Carver
Pennington
Hubbard
Crow Wing
Lake
of t
he W
oods
Cle
arw
ater
Kandiyohi
Lincoln
Blue Earth
Mill
e La
cs
Houston
Steele
Trav
erse
Dodge
Wadena
Hennepin
Kan
abec
Lac qui Parle
Benton
Big Stone
CottonwoodWaseca
Chisago
Le Sueur
Mahnomen
Yellow Medicine
Pipestone
Red Lake
Sherburne
Watonwan
Was
hing
ton
Ramsey
> 10030 - 10011 - 290 - 10
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
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.
Gonorrhea Infections in Minnesotaby Residence at Diagnosis, 2011
Total Number of Cases= 2,283
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rates by GenderMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rates by AgeMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Age-Specific Gonorrhea Rates by GenderMinnesota, 2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Minnesota, 2001-2011
* Persons of Hispanic ethnicity can be of any race.
2011 rates compared with Whites:Black = 26x higherAmerican Indian = 6x higherAsian/PI = 0x higherHispanic = 2x higher
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rates by Race/Ethnicity Minnesota, 2001-2011
* Persons of Hispanic ethnicity can be of any race.
SYPHILIS
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Syphilis Rates by Stage of Diagnosis Minnesota, 2001-2011
* P&S = Primary and Secondary
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
2011 Minnesota Primary & Secondary
Syphilis Rates by County
Rate per 100,000 persons
> 1.0
0.21 – 1.00 – 0.2
# 7-county metro area, excluding the cities of Minneapolis and St. Paul
St. Louis
Itasca
Cass
LakePolk
Beltrami
Aitkin
Pine
Cook
Koochiching
Otter Tail
Clay
Roseau
Marshall
Becker
Todd
Stearns
Kittson
Swift
Lyon
Pope
Morrison
Wilkin
Renville
Carlton
Martin
Rice
Wright
Norman
FillmoreMowerNobles
Murray
Grant
Sibley
Brown
Rock
Redwood
Douglas
Jackson
Meeker
Goodhue
Winona
Isanti
Faribault
Dakota
Freeborn
Olmsted
Scott
Stevens
Anoka
Nicollet
McLeod
Chippewa
Wabasha
Carver
Pennington
Hubbard
Crow Wing
Lake
of t
he W
oods
Cle
arw
ater
Kandiyohi
Lincoln
Blue Earth
Mill
e La
cs
Houston
Steele
Trav
erse
Dodge
Wadena
Hennepin
Kanabec
Lac qui Parle
Benton
Big Stone
CottonwoodWaseca
Chi
sago
Le Sueur
Mahnomen
Yellow Medicine
Pipestone
Red Lake
Sherburne
Watonwan
Was
hing
ton
Ramsey
City of Minneapolis 15.2 (58 cases)City of St. Paul 4.9 (14 cases)Suburban# 2.4 (52 cases)Greater Minnesota 0.5 (13 cases)
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
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.
Primary & Secondary Syphilis Infections in Minnesota by Residence at Diagnosis, 2011
Total Number of Cases = 139
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by GenderMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by AgeMinnesota, 2001-2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Age-Specific Primary & Secondary Syphilis Rates by Gender, Minnesota, 2011
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
*Includes persons reported with more than one race
Primary & Secondary Syphilis Cases by RaceMinnesota, 2011
Total Number of Cases = 139
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Primary & Secondary Syphilis Rates by Race/EthnicityMinnesota, 2001-2011
* Persons of Hispanic ethnicity can be of any race.
CHLAMYDIA AND GONORRHEA AMONGADOLESCENTS & YOUNG ADULTS
(15-19 year olds) (20-24 year olds)
STDs in Minnesota: Annual Review
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Cases in 2011 (n = 16,898)
MN Population in 2010 (n = 5,303,925)
Chlamydia Disproportionately Impacts Youth
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Disproportionately Impacts Youth
MN Population in 2010 (n = 5,303,925)
Gonorrhea Cases in 2011 (n = 2,283)
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Characteristics of Adolescents & Young Adults† Diagnosed With Chlamydia or Gonorrhea in 2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.* Total includes 5 cases diagnosed in transgendered persons
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
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.
Characteristics of Adolescents & Young Adults† Diagnosed With Chlamydia or Gonorrhea in 2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rates Among Adolescents & Young Adults† by Gender in Minnesota, 2001-2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia — Positivity Rates by Age and Gender MIPP† Clinics, 2002-2011
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Cases Among Adolescents and Young Adults†
by Gender and Race, Minnesota, 2011
Males (n = 2,998) Females (n = 8,876)
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia Rate Among Adolescents and Young Adults† by Race, Minnesota, 2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Chlamydia — Positivity Rates Among 15-24 Year-olds by Race MIPP† Clinics, 2002-2011
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rates Among Adolescents & Young Adults† by Gender in Minnesota, 2001-2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea — Positivity Rates by Age and Gender MIPP† Clinics, 2002-2011
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Cases Among Adolescents and Young Adults†
by Gender and Race, 2011
Males (n = 476) Females (n = 914)
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea Rate Among Adolescents and Young Adults† by Race, Minnesota, 2011
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.Rate=Cases per 100,000 persons based on 2000 U.S. Census counts.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gonorrhea — Positivity Rates Among 15-24 Year-olds by Race MIPP† Clinics, 2002-2011
† The Minnesota Infertility Prevention Project (MIPP) is a project funded by the CDC to provide STD testing and treatment to uninsured men and women ages 15-24. Participating clinics include STD, family planning, adolescent, and community clinics.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Summary of Chlamydia and Gonorrhea Among Adolescents and Young Adults†, Minnesota, 2011
Adolescents and young adults accounted for 69% of chlamydia and 65% of gonorrhea cases diagnosed in Minnesota.
74% of chlamydia or gonorrhea cases diagnosed among adolescents and young adults were females.
Whites and Blacks accounted for 43% and 31% of chlamydia or gonorrhea cases, respectively.
32% of gonorrhea or chlamydia cases were in the Cities of Minneapolis and Saint Paul.
† Adolescents defined as 15-19 year-olds; Young Adults defined as 20-24 year-olds.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review STDs in Minnesota: Annual Review
Topic of Interest:Early Syphilis Among
Men Who Have Sex With Men in Minnesota
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Number of Early Syphilis† Cases by GenderMinnesota, 2001-2011
MSM=Men who have sex with men. Figure does not include cases diagnosed in transgendered persons (1 each in 2004, 2005, 2007, and 2009).† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Early Syphilis† Cases by Stage at Diagnosis Minnesota, 2001-2011
† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Early Syphilis† by Gender and Sexual Behavior Minnesota, 2001-2011
MSM=Men who have sex with men† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Early Syphilis† Cases Among MSM by Age Minnesota, 2011 (n=218)
MSM=Men who have sex with men† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Mean Age = 35.8 yearsRange: 15 to 64 years
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Early Syphilis† (ES) Cases Co-infected with HIV, 2006-2011
MSM=Men who have sex with men† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Gay and bisexual men account for 88% of cases among men.
71% of cases among MSM are White, but a disproportionate number of cases (15%) are African American.
52% in the City of Minneapolis and 30% live in the suburbs
57% of cases are also infected with HIV.
Among cases interviewed by the MDH Partner Services Program: Commonly reported risk factors were meeting partners on the internet,
anonymous sex, and no condom use.
Characteristics of Early Syphilis† Cases Among MSM, Minnesota, 2011
MSM=Men who have sex with men† Early Syphilis includes primary, secondary, and early latent stages of syphilis.
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
What’s Being Done in Minnesota? The MDH Partner Services Program continues to follow up on early
syphilis cases and their sex partners.
In 2004 the MDH implemented the Syphilis Elimination Effort (SEE). SEE activities include:
Developed a clinician toolkit for syphilis testing and treatment; Created a new outbreak response plan; and Increased awareness among gay/bisexual men through advertising in
magazines, bars, and websites. SEP website: www.health.state.mn.us/sep - includes several archived provider
presentations and links to current awareness campaign materials
Physicians are encouraged to screen men who have sex with men at least annually and to ask about sex partners.
STDs in Minnesota: Annual Review
SURVEILLANCE SUMMARY
Data Source: Minnesota STD Surveillance System STDs in Minnesota: Annual Review
Summary of STD Trends in Minnesota From 2001-2011, the chlamydia rate increased by 90%. Gonorrhea increased for the
first time since 2007. Rates of reported syphilis increased slightly in 2011 compared to 2010.
Minnesota has seen a resurgence of syphilis over the past decade, with men who have sex with men being especially impacted.
Persons of color continue to be disproportionately affected by STDs. STD rates are highest in the cities of Minneapolis and Saint Paul. However, chlamydia
and gonorrhea cases in the Twin Cities suburbs and Greater Minnesota account for 64% of the reported cases in 2011.
Adolescents and young adults (15-24 years) have the highest rates of chlamydia and gonorrhea, making up 69% of new infections in 2011.
Between 2010 and 2011, the chlamydia rate increased by 9% and the gonorrhea rate increased by 5%. Primary/secondary syphilis cases decreased by 8%. Men who have sex with men comprised 88% of all male cases in 2011; cases among women remain low.