Lab Matters Spring 2020 - Page 19

FROM THE BENCH Monitor Trends The Wisconsin-Milwaukee SURRG Program engages cross sector collaborations across multiple agencies to maintain the infrastructure needed to implement, maintain and monitor ARGC trends. In Wisconsin, these agencies include five SURRG clinics (one STD clinic and four non-STD community partner clinics) in the city of Milwaukee, MHDL, regional reference AR Lab Network and CDC laboratories, DSTDP SURRG Program staff, MHD laboratorians, clinicians, data analysts, field investigation disease intervention specialists, WI DPH STD Program staff, and technical assistance and epidemiologic consultation from the Health Care Education and Training agency (HCET) whose offices are located in Wisconsin and Indiana. Local data management and analytic activities support quality assurance monitoring, reporting on project performance measures, inform programmatic improvements, and describe social networks to enhance understanding of the transmission dynamics of antibiotic resistant GC in Milwaukee. Clinical, epidemiologic data and laboratory results are evaluated and analyzed locally. Selected SURRG data elements from Milwaukee, WI are transmitted to CDC as one of the 8 SURRG project sites contributing data nationally, to contribute to nationwide susceptibility and resistance patterns and trends.. These robust collaborations have enabled swift use of laboratory and clinical data to improve methods of culture collection and the use of population-specific selective criteria for culture collection to increase detection and recovery rates of gonorrhea isolates for AST. These criteria have expanded local capacity in Milwaukee for prompt detection and response to resistant gonorrhea identified through increased culturing of genital and extragenital sites of sexual activity among men, men who report sex with men (MSM) and symptomatic female patients who are at risk of resistant gonorrhea infection. During calendar year 2019, twenty percent of patients cultured for gonorrhea in SURRG clinics were identified as having an Alert isolate, defined as a GC positive specimen with reducedantimicrobial susceptibility to at least one of the antibiotics recommended for dual treatment of gonorrhea (126 patients with one or more Alert isolates of 620 GC culture positive patients identified in SURRG clinics). Of these patients with Alert isolates, 77% returned for test of cure and partner services in 2019. The majority of non-susceptible isolates (98%) identified in 2019 had reduced susceptibility to azithromycin. To date, no known treatment failures have occurred in Wisconsin. Next Steps Maintain capacity: Protocols will be maintained to ensure identification of antibiotic resistant gonorrhea by conducting AST using Etest on at least 15 percent of total reported GC cases in the jurisdiction per year. • Provide resources to other jurisdictions: The MHD Public Health Laboratory will serve as a GC-AST testing site and resource for the state of Wisconsin to integrate GC-culture, AST and test of cure as routine surveillance and intervention practices. • Provide flexible sample collection options: Implementation of self-collect swabs for both genital and extra-genital GC-AST surveillance will increase identification of ARGC in higher risk populations. • Implement advanced molecular diagnostic surveillance: Development of culture-independent GC-AST molecular testing will enhance field investigations for timely identification of social networks to mitigate the spread of GC and ARGC threats locally. • Inform clinical and public health partners: Dissemination of these findings will inform effective clinical and public health practices and interventions to prevent and control transmission of GC and ARGC. n References 1. CDC. Combating the Threat of Antibiotic-Resistant Gonorrhea. Available from https://www.cdc.gov/std/ gonorrhea/arg/carb.htm. 2. CDC. Funding Opportunity Description for ELC SURRG Project 2021 Acknowledgments STAFF: Julie Plevak, program assistant, MDHL Rachel Mukai, epidemiologist, Clinical Services, MHD Keenan Health Center STD Clinic Otilio Oyervides, field operations manager, MHD Keenan Health Center STD Clinic Darlene Harper, senior technical advisor, CDC Brandon Kufalk, disease intervention specialist, WI DPH STD Control Section Anthony Wade, director, STD Control Section, WI DPH Chris Steward, WEDSS program administrator, WI DPH PARTNERS: Jeremy Roseberry, HIV/STD project manager, HCET Deb Bonilla, VP of Patient Services, Planned Parenthood of Wisconsin Dr. Andy Petroll medical director, Froedtert Hospital & the Medical College of Wisconsin Inclusion Health Clinic, Brady Street Clinic BESTD Ruthie Weatherly, Manager, Brady Street Clinic BESTD Dr. Paul Hunter, associate professor, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health Dr. Jessica Dalby, assistant professor, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health CDC’s Division of STD Prevention SURRG Program Staff CDC ELC Grant # CK19-1904 3. WI-Milwaukee SURRG Program Performance Measures 2017-2019 4. CDC. Abstract submitted for 2020 STD Conference. Extragenital Cultures from Women and Men with Opposite-Sex and Same-Sex Sexual Exposure Are Important for Antibiotic-Resistant Gonorrhea (ARGC) Surveillance. J. Pfister 1 , L. Amsterdam 1 , D. Shrestha 1 , C. Steward 1 , M. Khubbar 2 , R. Gomez 2 , J. Weiner 2 , T. Dasu 2 , J. Dalby 3 , H. Hermus 4 , J. Katrichis 4 , S. Bhattacharyya. 2 1 Wisconsin Department of Health Services, 2 City of Milwaukee Health Department Laboratory, 3 University of Wisconsin School of Medicine and Public Health, 4 City of Milwaukee Health Department PublicHealthLabs @APHL APHL.org Spring 2020 LAB MATTERS 17