1. Washington State’s SSuN Project: Overview and Population Sampling Schema Principal Collaborators Meeting Atlanta, GA December 2009

2. WA SSuN Overview Clinic Surveillance Trich Susceptibility Testing
Patients seen at Harborview STD Clinic in Seattle
Trich Susceptibility Testing
King County Public Health Laboratory
Population Surveillance
GC patients
39 Counties
Random sample
Data Quality Assurance

3. Clinic & Trich Surveillance Summary
Clinic Surveillance
Harborview STD Clinic (Seattle)
Data collected for 6,634 patient visits (1/ /2009)
Core, Standard, Lab and Dx data transmitted
Trich Resistance Surveillance
Women seen at Harborview STD Clinic (Seattle)
Started 5/2009
Submitted 48 specimens as of 11/15
47 survived and were assayed
6.4% demonstrated in vitro resistance (MLC 50+)

4. What’s Happening with GC in WA?
Gonorrhea Incidence Rate by Census Tract, Washington State, 2008
Gonorrhea Cases and Crude Incidence Rate, Washington State

5. Sampling Schema for Population-based Surveillance Activities
There are two random samples
1. Fixed sample
0.22 sample fraction (22% of all cases) in 25 counties
0.15 sample fraction in King County
2. Variable Sample
sample fraction for some jurisdictions
Can be changed to reflect staff capacity
All GC cases diagnosed are eligible for sampling
Sample assigned at the time the case is initially entered into the surveillance system

6. Sampling Schema
Imports System.Web.Caching
Public Class Randomizer
Public Shared Function GetRandomObj As System.Random
Dim ha As HttpApplication = HttpContext.Current.ApplicationInstance
Dim cash As Cache = HttpContext.Current.Cache
If ( IsNothing( cash("RandomizerObj") ) ) Then
dim randomObj as New System.Random()
cash.Insert( "RandomizerObj", randomObj, nothing, Cache.NoAbsoluteExpiration, TimeSpan.FromMinutes(20) )
End If
return ctype(cash.Item("RandomizerObj"), System.Random)
End Function
End Class
Random number generator returns an integer between 0 and 100
The random sample ‘cascades’
If Fixed Sample = No
Then eligible for Variable Sample
Effective sample fraction is increased for jurisdictions with a Variable Sample set at > 0

7. Sample Fractions

8. PHIMS-STD Data Management System Screenshots

9. Assigning the SSuN Sample

10. Overview

11. Brief Progress Report Population-based Surveillance
1,912 eligible GC cases diagnosed through 9/09
516 (27%) randomly selected
350/516 (68%) completed interview
Completed interviews comprise 18.3% of all cases diagnosed
Test data transferred and reviewed
Quality assurance processes in place to assess missing data and provide interviewer feedback

12. Challenges Staff/Interviewer capacity at the local level
Diversion of staff resources to H1N1
Interviewer turnover & training
Finding and organizing metadata for analysis
Permanent $ resources to support data/surveillance system
Pressure to change existing data systems to conform with SSuN formats (e.g., exposure period of 2 vs. 3 months)
Changing standards of care, new protocols, etc.
Data collection methods (CASI in clinic, etc.)

13. Questions? Acknowledgements & Contacts: Mark Stenger, MA
IDRH Assessment Unit,
Washington State Department of Health
Roxanne Pieper Kerani, PhD
Public Health – Seattle & King Co.
STD Program/Harborview Medical Center ,
Matthew Golden MD, MPH
Director, PHSKC STD Control Program
Associate Professor of Medicine, UW Center for AIDS & STD
Harborview Medical Center ,