11Mohave County Pertussis Outbreak 92 cases (72 confirmed, 20 probable) to date~80% unvaccinatedMost cases in those <5 years old
12Calling All Health Care Workers! Get Vaccinated Against Pertussis! Only 20% of HCW’s in the U.S. have received the adult vaccine for pertussis (Tdap)Only ONE dose of Tdap is needed!Protect yourselfProtect your patients and their familiesProtect infants under <1 year oldAccording to the CDC, Tdap vaccination in adults:Reduces incidence of pertussis in infantsReduces complications in high-risk individuals
13Arizona Partners Against Pertussis (APAP) Goal: Achieve 100% pertussis vaccination rate by April 1, 2013Prize: Certificate of Participation, recognition on the website, and prizes/money
14H. flu type B (Hib) in children <5 years 201220112 confirmed cases- 3 year old: fully immunized- 4 month old: not vaccinated1 confirmed case
16Measles 2012 2011 2 confirmed cases (siblings) 7 year old: PCR positive, not vaccinated5 year old:IgM positive, not vaccinated2 confirmed casesrash, fever, cough, coryza, conjunctivitis
17Mumps 2012 2011 3 confirmed cases (siblings) 9 year old: IgM and PCR positive, not vaccinated12 year old:epi-linked, not vaccinated13 year old:0 cases
18Resources2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare SettingsGuideline for infection control in health care personnel, 1998
19Arizona Vaccines For Children (VFC) Program 2012 Arizona Immunization Program Office (AIPO)Arizona Department of Health ServicesPatty Gast, M.S., Office Chief (602)
20Vaccines Distributed in 2012 The Arizona VFC Program provided 1,596,867 vaccines ($81,119,566) to more than 850 private and public immunization providers statewide in AZVFC vaccine is for children who are on AHCCCS, Native American or uninsured317 vaccine is used in AZ for non-VFC eligible children, such as for insured children who present at County Health Departments
21Vaccine Policy Changes in 2012 Important federal vaccine policies changes were instituted in October 1, 2012, as required by VFC:Federal vaccine may no longer be used for PRIVATELY insured children.Most county health departments are trying to develop a private stock of vaccine and insurance billing programs in order to continue serving privately insured children. County health departments are encountering significant challenges in developing these programs, and we are concerned about where these children can get immunized in the meantime.
22Vaccine Policy Changes Upcoming mid-year 2013 – our federal vaccine can not be used for underinsured children in private provider offices.However, a safety net for these children is being established: county health departments and 24 providers statewide are being deputized with authority from a Federally Qualified Health Center (FQHC) to use VFC vaccine on underinsured children. FQHCs and Rural Health Centers (RHCs) already have this authority.This means that starting in July 2013 (approximately) underinsured children will have to pay out of pocket at their private provider’s office or go to a county, deputized provider, FQHC or RHC to receive free vaccine.For now, in the first half of 2013, all providers should continue using our vaccine on underinsured children.As the Affordable Care Act rolls out in 2014, there will hopefully be fewer and fewer underinsured children.
23Vaccine Policy Changes These policies have affected hospitals’ ability to participate in the Arizona VFC Program, as we previously supplied the Hepatitis B birth dose universally, but now we are not able to do so. Several hospitals have dropped out of the VFC Program, but are offering the birth dose to privately insured children at their own expense.There will always be sufficient vaccine for VFC eligible children.
24Additional UpdatesNew ADHS manual for preventing perinatal hepatitis B virus infections: with chapters specifically aimed at OBs, hospitals, pediatricians, and health departments. It can be found on the ADHS immunization website under AIPO Program Activities—perinatal hepatitis B prevention.March of Dimes sponsoring coalition of 17 health care organizations entitled Arizona Partners Against Pertussis (APAP): Contest to have employers get staff 100% immunized with Tdap. Deadline April 1, 2013. Details on TAPI’s website atAIPO started doing a small pilot project with a rural pharmacy to see if a pharmacy can serve as a VFC vaccine provider in Arizona.FDA has approved Varizig (varicella immune globulin) for prophylaxis in high risk individuals, and has extended use to 10 days (MMWR March 30, 2012).
25Additional UpdatesWaiting for MMWR to publish provisional recommendations from ACIP vote on:Tdap for every pregnant woman during every pregnancyMeasles recommendation changes, including MMR down to 6 months old for international travel and 2 doses of MMR for > 12 months old for international travelADHS study showed risk factors for having 1st hepatitis B vaccine >14 days versus 1st in 3 days.Babies born to mothers with private insurance were twice as likely to miss the HBV vaccine birth doseBabies born to mothers with complications during labor or delivery were more than twice as likely to miss the HBV vaccine birth dose than when the mother experienced no complications
26Additional Updates All influenza vaccines this season are trivalent. Looking to the future. New influenza vaccines will likely be available next seasonLive attenuated quadrivalent vaccines: both intranasal and injection. (H1N1, H3N2, and 2 Bs)First influenza vaccine grown with cell culture technology (dog kidney cells). No risk for egg allergic patients.
27Please contact Karman Tam for more information: email@example.com Thank you!Please contact Karman Tam for more information:(602)
28Coccidioidomycosis in Arizona Clarisse Tsang, MPHActing Program ManagerInfectious Disease EpidemiologyAPIC: January 25, 2013
29Impact of Cocci on Arizonans 60% of all reported US cases are in Arizona2nd most commonly reported infectious diseaseSymptoms last for a median of 4 monthsIn 2007, $83 million was spent on cocci for hospital visits
30Surveillance: Cocci Case Definition Council for State and Territorial Epidemiologists (CSTE)Updated in 2007Clinical case definitionLab criteria*Arizona Department of Health Services (ADHS)Since 1997No clinical symptoms required*Lab criteria for diagnosis includes either detection of IgM by immunodiffusion (ID), enzyme immunoassay (EIA), latex agglutination, or tube precipitin OR IgG by ID, EIA, or complement fixation (CF) OR cultural, histopathologic, or molecular evidence of Cocci species
31Rates of Reported Cocci Cases, Arizona, 1990-2012 Change in EIA ReportingLab Reportable
32Reported Cocci Cases, Age and Gender YearAge (median, mean)Gender (% female)p-value (Gender)2007 vs X subgroup200752, 5145%n/a200851, 5048%200947, 4755%201048, 4758%2011*(2/14-12/31)p <EIA alone46, 4662%other positive results52, 5043%p = 0.07*2011 Numbers are provisional and have not been finalizedn/a = have not analyzed yet
33Reported Cocci Cases by Age, 2007-2011 Reported cases per 100,000
422012-2013 Season Early flu season around the country First case confirmed on October 30th, 2012 with activity intensifying in the last few weeksVaccine is a good match to all three circulating strainsan A/California/7/2009 (H1N1)pdm09-like virusan A/Victoria/361/2011 (H3N2)-like virusa B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses)
46Percentage of Visits for Influenza-like illness at sentinel outpatient providers, 2012-2013
47School surveillanceApprox. 300 schools around the state participate in an automated surveillance program that pulls data from the school nurses’ databaseAnalyzed weekly for influenza-like illness visits to school nurses’ officeSeeing a small increase in activity nowSome counties have additional school surveillance:Maricopa: Has web-based system to collect information from participating schools on student absences due to ILI, respiratory diseases, GI diseases and other reasons. Plans to expand system.
48Pediatric Flu-Associated Mortality One case this season:Yavapai County child 5 years oldPCR confirmed influenza A (H3) and RSVUnderlying conditionsNot vaccinated
49Antiviral resistance (national) Oseltamivir: Resistant Viruses, Number (%)Zanamivir: Resistant Viruses, Number (%)Influenza A (H3N2)None (671* tested)Influenza BNone (263 tested)2009 Influenza A (H1N1)None (85* tested)None (55 tested)*Includes specimens tested in national surveillance and additional specimens tested at public health laboratories in four states (AZ, MD, NY, and PA) who share testing results with CDC.Neuraminidase inhibitors continue to show very little resistance (e.g., Tamiflu).Adamantanes are not useful as high levels of resistance persist among 2009 influenza A (H1N1) and A (H3N2) viruses.
50Antiviral TreatmentClinical trials and observational data show that early antiviral treatment may do the following:shorten the duration of fever and illness symptomsreduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, respiratory failure) and deathshorten the duration of hospitalization
51CDC Recommendations for Influenza Antiviral Medications for the 2012-2013 Season Clinical benefit is greatest when antiviral treatment is administered early – ideally within 48 hours of symptom onsetHowever, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness and in hospitalized patients when started after 48 hours of illness onset
52CDC Recommendations (cont’d) Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza whois hospitalized;has severe, complicated, or progressive illness; oris at higher risk for influenza complications. This list includes:
53children younger than 2 years;[ii]adults aged 65 years and older; persons with immunosuppression, including that caused by medications or by HIV infection;women who are pregnant or postpartum (within 2 weeks after delivery);persons aged younger than 19 years who are receiving long-term aspirin therapy;American Indians/Alaska Natives;persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40);
54residents of nursing homes and other chronic-care facilities. persons with the following conditions:chronic pulmonary (including asthma)cardiovascular (except hypertension alone)renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus)neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
55Additional Updates All influenza vaccines this season are trivalent. Looking to the future. New influenza vaccines will likely be available next seasonLive attenuated quadrivalent vaccines: both intranasal and injection. (H1N1, H3N2, and 2 Bs)First influenza vaccine grown with cell culture technology (dog kidney cells). No risk for egg allergic patients.
58Healthcare Associated Infections Program: Selected 2012 Investigations January 25th, 2013APIC Grand Canyon“State of the State”Health Services Advisory GroupJason Matthew Lempp, MPHCDC/CSTE Applied Epidemiology FellowHealthcare Associated Infections EpidemiologistArizona Department of Health Services (ADHS)Office of Infectious Disease ServicesJason Matthew Lempp, MPHCDC/CSTE Applied Epidemiology FellowOutbreak Capacity EpidemiologistOffice of Infectious Disease ServicesArizona Department of Health Services
59ADHS & Healthcare Associated Infection (HAI) Program 1Facilitate State HAI Advisory CommitteeProvide infection prevention technical assistanceEducation on best practicesCounties & facilitiesAssist outbreak and exposure investigationsMonitor AZ public HAI data & reportable disease surveillanceBuild partnerships and capacity to prevent HAIs2
60Arizona HAI Advisory Committee 2008 AZ Legislature – Infection Prevention and Control Advisory Committee (IPCAC)Expanded to HAI Advisory Committee (2010)Infection preventionists, Nurses, Doctors, Pharmacists, Epidemiologists, Medical industry reps, YOU?Quarterly Meetings: March 18th, 2013State HAI Coordinator – Vinita Oberoi– (602)
61Training & EducationPreventionSurveillanceHAIsDialysisAntimicrobial StewardshipLong Term Care
632012 HAI Investigations~80 “outbreak” investigations initiated in HCFs ~75% GI related (typically Norovirus) Primarily handled by county health depts ~10% Lice & Mite related (scabies) ~10% Vaccine Preventable or Respiratory Influenza, Pertussis – Disease Specific Epis These are some of the “Others”… HAI “exposure investigations” ≠ “outbreaks”
64MRSA – Pain Management Clinic Severe methicillin-resistant Staphylococcus aureus (MRSA) case led to concern of HAI by treating MD4 MRSA cases investigated at hospital, similar onsets3 received recent procedure at same outpatient clinicsites of infection align with pain treatment injection sitesCounty and ADHS found infection control breachesSingle-dose vial of contrast media (radiologic imaging reagent) vial associated with cases seen at clinic
65Infection Control Issues Dilution of reagents:not manufacturer’srecommendations2) “Single-dose” vials used for more than one patientSolution: Pharmaceutical Compounding –Sterile preparation by licensedpharmacy or reagent laboratory3) Insufficient PPE (respirators) during spinal injectionsSalineContrast Media Reagent
66Quick 2x2 Statistical Tests *Patient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7Patient 8Patient 9Patient 10Patient 11Patient 12Patient 13Patient 14Patient 15Patient 16Patient 17Patient 18Patient 19Patient 20Patient 21Patient 22Patient 23Patient 24Patient 25Patient 26Patient 27Patient 28Quick 2x2 Statistical Tests*Morning28 Patients seen at clinic on same DOS as 3 cases*10 Patients received contrast media injections (*)**“Morning” versus “Afternoon” Contrast separation**AfternoonCulture Confirmed MRSAAfter-noonContrast( + )( - )Yes314No242528Culture Confirmed MRSAAnyContrast( + )( - )Yes3710No182528Patient 15*Patient 21Fisher exact: *Fisher exact: 0.073*Patient 26*
67OUTCOMES Investigations National picture: Single-dose vials & HAI education campaignsMedication shortage of appropriate doses/concentrations
68Hepatitis B – Dialysis Ward Hepatitis B virus (HBV) infected, dialysis patientout of state visitor to AZ, no medical recordsAdmitted at hospital, received 9 sessions of dialysisInitial unknown HBV status = received testingUpon blood borne pathogen (BBP) lab results, HBV+ not communicated – no dedicated machine/HCW13 dialysis patients used shared dialysis machine
69Infection Control Issues Unknown BBP status should (ideally) receive lab results prior to receipt of hemodialysisUnknown hepatitis status requiring dialysis should have dedicated station, machine and HCWIncreased terminal cleaning for unknown & HBV+BBP results not communicated to nursing staff!?
70OutcomesCollaborationADHS Infection Control Technical Assistance Visit: Division of Licensing Services Surveyors with Office of Infectious Disease Services Epidemiologists Improved practices with facility No resultant seroconversionsEpidemiologyCountiesFacilitiesLicensing
71Hepatitis C – Multi-State Investigation National investigation of hepatitis C virus (HCV) infected traveling HCW, alleged drug diverter8 states affected, with 17 facilities (AZ = 2)Thousands of patients since 2005 notifiedOver 30 patients with linked genotypes (NH, KS)
72Infection Control Issues Protocols/systems to monitor narcoticsAutomated dispensing cabinetsLimited access to non-essential staffOther issues brought to light:Employee screening?Background checks?National registry for HCWs?
73Outcomes No evidence to support that HCV transmission Results of HCV testing of two Arizona facilities for patients with exposure to injectable narcotics and cardiac cathiterization lab or other high-risk unitsFacilityFacility PatientCountsTestedNegative (%);Positive (%)ExcludedDeceased; Prior +Contacted**PhoneConfirm LetterLTFALLTotal288111 (38.5)110 (38.2)1 (0.3)*18 (6.2)12 (4.2)5 (2.1)54 (18.8)10 (3.5)44 (15.3)105 (36.4)*Positive patient not same genotype as HCW – not linked to NH cluster** 132 patients calls made by ADHS and LHD – many disconnected #’sNo evidence to support that HCV transmissionoccurred due to traveling HCW exposureNational investigation is still ongoing
74Blood Borne Pathogen Exposure & Laryngoscope Processing LHD contacted ADHS about a outpatient clinic identified by “parent” HCF of gap in infection controlLaryngoscopes are semicritical items, requiring “high-level” disinfection – this scope was reportedly cleaned with alcohol but did not routinely receive this level of cleaning.Procedural gap 2008 – 2012+500 patients exposed
75High Level Disinfection High-level disinfection: complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores.The FDA definition: a sterilant used for a shorter contact time to achieve a 6-log10 kill of an appropriate Mycobacterium species. Cleaning followed by high-level disinfection should eliminate enough pathogens to prevent transmission of infection.
76Why BBP Testing?Last DOS 7/12 – most bacterial infections would present by now, leaving primary BBPs – Hepatitis B, Hepatitis C, and HIVOver 200 patients have been tested to date. A small number of patients (< 1%) have been identified with HCV antibody positive results – indicating past or current HCV infection.Investigation ongoing to identify presence or absence of HCV prior to DOS
77HCV ~3.25% of birth cohort 1945-1965 are anti-HCV (+) = 2.74 million ~75% of which have chronic HCV infection = 2.0 million
78Contaminated MPA x 2 National Recall: New England Compounding Center Contaminated methylprednisolone (MPA) –None distributed or “used” in AZPatients receiving injections in other states (n = 4)2 “cases”; 2 “non-cases” with similar SxRegional Recall: Nevada compounding center“Contaminated” methyprednisolone – AZ MDs contacted0 infections; NV investigation = lab contaminant?
79Thank YouHAI Advisory Committee and Subcommittee Members Counties helping our prevention and education campaigns Counties and facilities who worked with us on these investigations (you know who you are!) CDC – Division of Healthcare Quality Promotion Division of Viral Hepatitis ADHS – Office of Infectious Disease Services
80Questions? Jason Matthew Lempp Jason.Lempp@AZDHS.gov (602) 364-0780 MRSAJason Matthew Lempp(602)
812012 Arizona Vector/Zoonotic Diseases Update Selam Tecle, MPHVBZD EpidemiologistOffice of Infectious Disease ServicesArizona Department of Health Services
822012 Brucellosis Cases 6 cases reported Demographics 5 Maricopa County, 1 Pinal CountyDemographics4 female, 2 maleAge range: 30 – 69 years; mean: 51 years4 cases reported consumption of unpasteurized cheese produced out of the countryOne case had past exposure to livestock in GuatemalaNo local high risk exposures reported
832012 Hantavirus Cases Demographics 1 case (fatal) reported Apache County residentDemographicsMale62 years oldReported exposure to mouse droppings at different locations all within the countyImportant to remind residents to take precautions when cleaning rodent infested areas
842012 Lyme Disease Cases13 cases of Lyme Disease were reported in Arizona by following counties:2 Cochise1 Coconino2 Maricopa1 Mohave1 Navajo3 Pima3 YavapaiAll cases had travel history to one of the following endemic areas:MinnesotaNew YorkCaliforniaMaineRhode IslandMassachusettsPennsylvaniaGermanyCanada*Lyme Disease is not endemic to Arizona. Evidence of the vector (Ixodes pacificus) has only been found in Mohave County at the top of the Hualapai Mountains.
852012 Q Fever Update 4 cases reported Demographics 2 Maricopa County2 Pima CountyDemographicsAll maleAge range: 32-70; median age: 34No local high risk exposures reported
872012 Rabies Update Exposure to Lab Confirmed Rabid Animals: 7 Humans25 Domestic Animals0 Human cases0 Domestic animal cases
88Rocky Mountain Spotted Fever Update 43 cases (3 deaths) reported in 2012287 suspect cases still under investigationStatewide planCDC best practices for prevention and spreadIn-service training at hospitalsEnsure continuity of care for transfer cases from tribal health facilities
892012 West Nile Virus Update132 human cases (7 deaths) reported in ArizonaLa Paz, Maricopa, Mohave, Pima, Pinal, Yuma82 (62%) reported were neuroinvasive5,387 cases reported nationally (243 deaths)189 positive mosquito poolsApache, La Paz, Maricopa, Pima, Pinal, Yavapai, Yuma
104Our Challenges Goals: Capture all cases PFGE all specimens Interview all individualsBIG Challenges:Non-culture methodsStaffingComplex Food Supply Chain
105Foodborne Disease Epidemiologist THANK YOU!Evan Henke, PhD, MPHFoodborne Disease EpidemiologistArizona case definitions and exclusion rules
106Arizona Department of Health Services STD Control Program 2013 APIC State of the StateJanuary 25, 2013
107STD Reporting Requirements Reportable sexually transmitted diseases to local health department/ADHS (within 5 working days):Chlamydia (genital)GonorrheaSyphilisHerpes genitalisChancroidUpdated Administrative Rules for Provider Reporting (R )New Communicable Disease Reports
108Program Responsibilities Monitor, control, and prevent sexually transmitted diseases through education of those at risk.Detect asymptomatic and symptomatic infected individuals.Diagnosis and treat those who are infected.Evaluate, treat and counsel sex partners of persons who have a sexually transmitted disease.
109Program Targets Adolescents and Young Adults Men Who have Sex With Men Multi-Drug Resistant GonorrheaCongenital Syphilis
114Awareness of recommendation to screen women under 26. Women more likely to pursue care.Infertility Prevention ProjectAlthough undiagnosed, the effective use of expedited therapy for partners will prevent additional transmission
115CDC RecommendationCDC recommends annual screening of chlamydia for all sexually active females 25 and under and for women older than 25 with risk factors such as a new sex partner or multiple partners.
125In 2011, increased by 4% nationally. 40% increase in 201128% increase in 2012Overall 80% increase since 2010Arizona ranked 32nd nationally by rate during 2011 (nat’l rate: )Maricopa 15th by case in 2011
133Treatment of Suspected Resistance The Centers for Disease Control and Prevention (CDC) and the Arizona STD Control Program recommend the following in cases of suspected cephalosporin treatmentIf the patient has not already been treated with ceftriaxone 250 mg, then treat with ceftriaxone 250 mg IM x 1 AND azithromycin 1 gram orally in a single dose.Perform a test of cure with culture and antibiotic susceptibility testing (before re-treating).Inform your local health department.For clinical consultation call the STD Program's Medical Epidemiologist at (602)In patients who have already been treated with the recommended ceftriaxone regimen whose symptoms do not resolve after treatment, please call (602) for clinical consultation.Emphasize that patients should abstain from oral, vaginal, or anal sex until one week after the patient and all of his/her partners are treated.
136Thanks!To the incredible staff in the ADHS STD Control Program.QUESTIONS?
137Arizona HIV/AIDS Data January 2013 Rick DeStephensHIV Epidemiology
138HIV/AIDS Events Per Year Arizona, 1981-2011 Whats important in this slide are the blue and green lines… HIV and deaths. This shows what an HIV epi curve looks like or epidemic stages. Incidence being new cases red and blue lines peaked REPORTING.Because at the beginning of the epidemic in the 80s and 90s people weren’t getting diagnosed and reported diagnosis’ until it was possibly too late and there were already sick.
139Arizona 5-Year Emergent HIV/AIDS Case Rate Trend Emergenct cases- are incident cases which are based upon the sum of new HIV cases, and new AIDS cases not diagnosed as HIV infections in any prior calendar year.Rates are Frequency with which an event occurs in a defined population.These annualized 5-year rates may be regarded as the average annual rate across the 5 years in the reporting timeframe.The State of Arizona is has experienced significant population growth over the last decade. Most of that growth is taking place in the Phoenix Metropolitan area. Recent trends show the 5-year HIV/AIDS emergence case rate has been declining. Steady decline throughout the 90s, leveling off from the period and beginning to decline lightly again starting with the time period. The rate of emergent HIV infection in AZ was per 100,000 per year during the time period. According to the most recent estimates of CDC, the 2010 estimated HIV/AIDS diagnosis rate for AZ was under the national rate.
140Arizona Prevalent HIV, AIDS Cases December 2004 – June 2012Important slide to look at.prevalence rates continue to rise in Arizona. Prevalence of reported HIV infection is cases per 100,000 persons (up from in 2010). Currently, there are about 15,000 persons living with HIV/AIDS in Arizona, a rise of nearly 30% in 5 years. The increase in prevalence rates appears to be due to the efficacy of multi-drug treatments for HIV infection, which have sharply reduced HIV-related death. Additionally, Arizona’s increased population growth may be contributing to an increase in prevalence; 23% of prevalent cases were diagnosed in another state, while only 11% of cases present in Arizona five years ago have left the state.In June 2009, the number of persons living with AIDS in Arizona surpassed the number of persons with HIV infection who have not been diagnosed with AIDS. Because the burden of HIV-related disease is greater among persons with AIDS, treatment, utilization, and continuity of care will become increasingly critical issues.
141Arizona Emergent HIV/AIDS Rate by County 2006-2010 State Emergence Rate = 10.96Correctional Dx:*68% of Pinal County**36% of Graham County
142Arizona Emergent HIV/AIDS Cases, by County 2006-2010 Correctional Dx:*68% of Pinal County**36% of Graham County
143Arizona Emergent HIV/AIDS by Gender: 1999-2011 Rate per 100,000As we already know higher rates in males. 86% of total cases in AZ are males, for both prevalenace and incidence/emergent cases.
144Arizona 5-Year New HIV/AIDS Rate by Race/Ethnicity, 1990-2011 Rates of HIV/AIDS prevalence and emergence differ sharply between African Americans and other race/ethnicity groups. African Americans are the only race/ethnicity group in Arizona that experiences such a severe disparity of HIV/AIDS impact. Currently, the emergent HIV/AIDS rate among African Americans in Arizona is nearly three times that of the state average. The disparity observed in Arizona among African Americans is also seen elsewhere in the country. The CDC estimates that, in 2009, blacks were 14% of the total population in states with established confidential HIV reporting, and 44% of new HIV diagnoses.*Non-Hispanic, A/PI/H=Asian/Pacific Islander/Native Hawaiian, AI/AN=American Indian/Alaska Native
146Risk -- New HIV/AIDS DXMen who have sex with men (MSM) account for the largest proportion of emergent HIV/AIDS cases in Arizona. The proprtion of emergent cases that are MSM-related hover right around 60%. This proportion had been rising over time, but has declined in recent years. The downward trend in rates among MSM has been mirrored by a similar upward trend among persons with no reported risk. It had reached a high of 26% in In recent years, increased efforts to ascertain risk has decreased NRR to 13%.
147Transmission Category, Estimates of New HIV Infection, United States and Arizona, 2006 In Arizona, we show what is ACTUALLY being reported. we have a no reported risk/other category.The United States estimate does not include an NRR category. We don’t know exactly what they do but They assign a value based on an algorithm that looks at proportions in order to assign each NRR/other person to a particular category.
148Female United States and Arizona Estimates of New HIV Infections, By Transmission Category The United States estimate does not include an NRR category.US statistics found atIDU = Injection Drug User NRR =No Risk Reported
158Risk Factors for TB Cases, Arizona, 2011 % of Cases in AZ% of Cases in USForeign-born17066.661.8Correctional Facility Cases6424.64.2HIV Positive104.37.7Contact of Infectious TB Case, <2 years155.9Diabetes Mellitus3112.2Excess Alcohol3413.312.4Non-injecting Drug Use259.87.6Injecting Drug Use83.11.5Homeless5.8Long-term Care Facility2.3
160% of TB Cases with HIV Co-infection & % of HIV Results Known, Arizona, 2007 - 2011
161Primary Resistance to Anti-TB Drugs, Arizona, 2007 – 2011
162Interferon-Gamma Release Assays Two IGRAs available and FDA approvedQuantiFERON-TB Gold In-Tube test (QFT-GIT)T-SPOT.TB (T-Spot)Each of the tests measure different aspects of the immune responseResults might not be interchangeableDifferent tests can yield different results
163General Recommendations for Use of IGRAs Used as aids in diagnosing infection with M. tuberculosisShould not be used for testing those at low risk for both infection and progressionSame recommendation for TSTIGRA lab testing availability should be determined prior to testing
164Test SelectionAn IGRA may be used in place of (but not in addition to) a TST in all situation in which CDC recommends a TSTEven in special circumstances, either test is considered acceptable medical and public health practice
165Either TST or IGRA Contacts to an active case Periodic screenings for occupation exposuresHealthcare workersTwo-step testing not needed with IGRAIGRAs do not have booster effectIGRAs may produce more conversions
166New LTBI Treatment 3HP Once weekly dose for 12 weeks Combination of Isoniazid & RifapentineOnce weekly dose for 12 weeksMust be given by DOTHealthy patients ≥ 12 years of age
167TB Program Contacts Cara Christ, MD TB Control Officer/Medical DirectorCarla Chee, MHSOffice ChiefEric Hawkins, MSProgram ManagerLarissa AndersonSpecial Projects EpidemiologistCherie Fulk, RN, MPHTB Nurse CoordinatorMary GullionProgram Project Specialist