Intersecting Infections of Public Health Significance Page i Intersecting Infections of Public Health Significance The Epidemiology of HIV, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis in King County 2008 Intersecting Infections of Public Health Significance was supported by a cooperative agreement from the Centers for Disease Control and Prevention Published December 2009 Alternate formats of this report are available upon request Intersecting Infections of Public Health Significance Page ii David Fleming, MD, Director Jeffrey Duchin, MD, Director, Communicable Disease Epidemiology & Immunization Program Matthew Golden, MD, MPH, Director, STD Program Masa Narita, MD, Director, TB Program Robert Wood, MD, Director, HIV/AIDS Program Prepared by: Hanne Thiede, DVM, MPH Elizabeth Barash, MPH Jim Kent, MS Jane Koehler, DVM, MPH Other contributors: Amy Bennett, MPH Richard Burt, PhD Susan Buskin, PhD, MPH Christina Thibault, MPH Roxanne Pieper Kerani, PhD Eyal Oren, MS Shelly McKeirnan, RN, MPH Amy Laurent, MSPH Cover design and formatting by Tanya Hunnell The report is available at www.kingcounty.gov/health/hiv For additional copies of this report contact: HIV/AIDS Epidemiology Program Public Health – Seattle & King County 400 Yesler Way, 3rd Floor Seattle, WA 98104 206-296-4645 Intersecting Infections of Public Health Significance Page iii Table of Contents INDEX OF TABLES AND FIGURES ········································································ vi EXECUTIVE SUMMARY ······················································································ 1 I. INTRODUCTION ··························································································· 2 II. DESCRIPTION OF KING COUNTY···································································· 5 III. HUMAN IMMUNODEFICIENCY VIRUS (HIV) ···················································· 7 Background ····································································································· 7 Surveillance systems and reporting requirements ······················································· 7 Clinical aspects ································································································· 7 Transmission···································································································· 8 Prevention······································································································· 8 HIV in King County ···························································································· 9 Findings from case surveillance······································································· 9 Findings from other projects and research studies················································ 14 HIV/AIDS key findings ························································································ 20 IV. HEPATITIS B AND C····················································································· 21 Hepatitis B································································································· 21 Background ····································································································· 21 Surveillance systems and reporting requirements ······················································· 21 Clinical aspects ································································································· 21 Transmission···································································································· 21 Prevention······································································································· 22 Hepatitis B in King County ··················································································· 22 Findings from case surveillance······································································· 22 Findings from other projects and research studies················································ 23 Hepatitis B key findings······················································································· 24 Hepatitis C································································································· 25 Background ····································································································· 25 Surveillance systems and reporting requirements ······················································· 25 Clinical aspects ································································································· 25 Transmission···································································································· 25 Prevention······································································································· 25 Hepatitis C in King County ··················································································· 26 Findings from case surveillance······································································· 26 Findings from other projects and research studies················································ 27 Hepatitis C key findings······················································································· 28 V. SEXUALLY TRANSMITTED DISEASES—GONORRHEA, CHLAMYDIA, SYPHILIS ········· 29 Background ····································································································· 29 Surveillance systems and reporting requirements ······················································· 29 Transmission···································································································· 29 Chlamydia ································································································· 30 Clinical aspects ································································································· 30 Chlamydia in King County ···················································································· 30 Findings from case surveillance······································································· 30 Intersecting Infections of Public Health Significance Page iv V. SEXUALLY TRANSMITTED DISEASES (continued) Gonorrhea··································································································· 31 Clinical Aspects ·································································································· 31 Gonorrhea in King County ····················································································· 31 Findings from case surveillance ······································································· 31 Syphilis······································································································· 34 Clinical Aspects ·································································································· 34 Syphilis in King County ························································································· 34 Findings from case surveillance ······································································· 34 STDs in men who have sex with men (MSM) ····················································· 34 Findings from case surveillance ······································································· 34 Findings from other STD projects and research studies·········································· 35 STD key findings ································································································ 36 VI. TUBERCULOSIS··························································································· 37 Background······································································································· 37 Surveillance systems and reporting requirements························································· 37 Clinical aspects··································································································· 37 Transmission ····································································································· 37 Prevention ········································································································ 37 Tuberculosis in King County··················································································· 37 Findings from case surveillance ······································································· 37 Findings from other projects and research studies················································ 41 Tuberculosis key findings ······················································································ 41 VII. CO-INFECTIONS ························································································ 42 Introduction ······································································································ 42 HIV/hepatitis C ··························································································· 42 Background······································································································· 42 Transmission ····································································································· 42 HIV/HCV co-infection in King County ········································································ 42 Findings from case surveillance ······································································· 42 HIV/HCV co-infection key findings ···········································································