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The State of Health in New Mexico 2018

5. Infectious Disease

The Burden of Infectious Diseases, Including Common Preventable Infections in New Mexico

There are over 75 notifiable infectious diseases or conditions that are reported to NMDOH by law. Several New Mexico notifiable communicable diseases receive attention in the community and in the media, like hantavirus pulmonary syndrome and plague. While those infections can be severe and cause death in the individuals who become infected and sick, they only account for a small number of illnesses in New Mexico each year. Other types of pathogens cause more infections and lead to more healthcare visits, hospitalizations, and severe outcomes including death each year. Influenza and pneumonia top this list. This report will present information regarding some other infectious diseases that are a significant burden to the New Mexico population: sexually transmitted diseases; healthcare-associated infections; and hepatitis C virus infections.

Sexually Transmitted Disease

New Mexico has followed national trends that show significant increases in sexually transmitted disease (STD) including syphilis, gonorrhea and chlamydia. The 2016 national STD surveillance report from the Centers for Disease Control and Prevention (CDC) found that syphilis cases increased 17.6% from 2015 to 2016 nationally, including a 35% increase among women, to rates not seen since 1992. In New Mexico, the increases were even greater. From 2015 to 2016, there was a 61% increase in the rate of primary and secondary syphilis from 5.6 per 100,000 to 9.0 per 100,000 population (Figure 1). The 40% rise in rates of gonorrhea was similarly concerning.

Increases in STD are of concern by themselves, as diseases such as chlamydia and gonorrhea can cause infertility and other medical complications. An additional concern is that rising STD rates often are precursors to an increase in new human immunodeficiency virus (HIV) infections, thus the rising rate of syphilis causes concern about new HIV infections. Of all cases of early syphilis in 2016 in New Mexico, 65.1% were among gay/bisexual men and other men who have sex with men.

While rates of new HIV infections among gay/bisexual men have been relatively stable in New Mexico, rising rates of syphilis may signal that this could change. The NMDOH is responding by offering disease management and partner services for all newly diagnosed cases of HIV and syphilis to ensure timely treatment and referral to medical care. In addition, the department has several new projects to expand use of the newest prevention innovation, pre-exposure prophylaxis, particularly among younger persons, from the racial/ethnic groups with the highest HIV rates.

Healthcare-associated Infections

Healthcare-associated infections (HAIs) - infections patients can get while receiving medical treatment in a healthcare facility - are a major threat to patient safety. Although significant progress has been made in preventing some infection types, there is much more work to be done. On any given day, about one in 25 hospital patients has at least one HAI.

CDC's annual National and State Healthcare-Associated Infections Progress Report describes national and state progress in preventing HAIs. Among New Mexico acute care hospitals, the most recent report found that central line-associated bloodstream infections (CLABSI) were 45% lower compared to the national baseline, hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections) were 58% lower compared to the national baseline, and hospital-onset Clostridium difficile (C. difficile) infections remained 14% higher compared to the national baseline.

While progress has been made in reducing HAIs, antimicrobial resistance has emerged as a new and important threat. Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the infectious organisms have adapted to them, making the drugs less effective. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

Some bacteria known as carbapenem-resistant Enterobacteriaceae, or CRE, have become resistant to most available antibiotics. Infections with these bacteria are very difficult to treat, and can be deadly in up to 50% of patients who become infected. Healthy people do not usually get CRE infections - infections occur most often in patients residing at hospitals, nursing homes, and other healthcare settings (Figure 2). Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are at the highest risk for CRE infections.

The New Mexico Department of Health and the University of New Mexico are collaborating to support and build Antimicrobial Stewardship Programs (ASPs) that can optimize treatment of infections and antibiotic use with the goal of providing every patient with the right antibiotics, at the right time, at the right dose, and for the right duration. The collaboration is designed to preserve the power of antibiotics and improve patient outcomes across New Mexico.

Hepatitis C

Hepatitis C (HCV) is the most common blood borne disease in the United States. In New Mexico, an estimate of 53,000 people, approximately 2.5% of the state's population, have evidence of prior HCV infection. There were total 91 cases of acute hepatitis C cases in New Mexico between 2014 and 2016. Of acute infections 75%-85% will develop to chronic HCV infection and 60%-70% of these people will develop chronic liver disease. Cirrhosis or liver cancer will develop in 1%-5% of patients with chronic liver disease.

In 2016, Valencia, Rio Arriba, Socorro, Colfax, Cibola and Santa Fe counties had the highest rates of HCV infections in the state in the population under 30 years of age. The primary risk factor for HCV infection in New Mexico is injection drug use. In a focused study of the New Mexico population under 30 years of age with acute and chronic HCV, injection drug use was the most common reported risk factor at almost 60% of those interviewed. Injection drug use was even more commonly-reported in patients with acute HCV infection (Figure 3). In 2016, 7,242 New Mexico residents visited an emergency department with the diagnosis of HCV, and of those 1,682 had an overdose as a reason for the emergency department visit. In 2016 there were 5,435 hospitalizations for HCV, and chronic liver disease was the eighth leading cause of death in the state.

Contributing Factors

Risk and Resiliency Factors
Using antibiotics only when necessary and minimizing the use of invasive medical devices where possible can reduce the risk of developing an HAI or antibiotic resistant infection.

Those in the U.S. at highest risk of contracting HCV are current or past injection drug users, people who come into contact with contaminated blood, children born to mothers infected with HCV, and people who have sex with an HCV-infected person.
Health Disparities
In New Mexico, gay/bisexual men, other men who have sex with men, and transgender persons with male sexual partners account for most cases of both HIV and syphilis in New Mexico.

HAIs tend to occur in older populations who spend more time as hospital inpatients.

Rural and Hispanic populations of New Mexico are disproportionally affected by HCV infections.

Assets and Resources

NMDOH funds HIV testing services that target populations at greatest risk, ensuring that testing is available at over 50 locations. More than 10,000 confidential tests are delivered annually. The Centers for Disease Control and Prevention (CDC) has identified evidence-based HIV prevention strategies for populations at greatest risk. New Mexico has a syringe exchange program to foster safe injection practices. The U.S. Food and Drug Administration recently approved medications that, if taken appropriately, can cure most patients with HCV infection in 8 - 12 weeks.

New Mexico has a syringe exchange program to foster safe injection practices.

NMDOH has Disease Prevention Teams (DPT) in each region of the state that conduct HIV and STD partner services and disease investigation. This work identifies persons who are risk of STD and helps assure that they obtain treatment quickly to minimize harm to them, and to avoid the further spread of disease.

HAIs are tracked through the National Healthcare Safety Network (NHSN). NHSN provides the data needed to identify problem areas, and measure progress of prevention efforts.

Summary

Pneumonia and influenza are the infectious diseases that provide the greatest burden to New Mexico. Sexually transmitted diseases, healthcare-associated infections and hepatitis C cause a large number of infections each year. Fortunately, these infections are curable and can be prevented. Improvements in primary prevention of sexually transmitted diseases and hepatitis C infections is achievable with educational campaigns advocating healthy behaviors and healthcare-associated infections can be minimized with evidence-based infection control practices. The NMDOH will continue its mission of improving the health status of all New Mexicans by working to prevent these infectious diseases.
References

Figure 1. Rates of Primary and Secondary Syphilis, New Mexico and U.S., 2000 - 2016 Rates of Primary and Secondary Syphilis, New Mexico and U.S., 2000 - 2016 Sources: NMDOH PRISM, CDC NCHHSTP, UNM GPS Program Figure 2. Percentage of Reported Cases for Two Carbapenem-resistant Bacteria by Pathogen and Facility Type, New Mexico, 2015-2017 Percentage of Reported Cases for Two Carbapenem-resistant Bacteria by Facility Type, New Mexico, 2015-2017 Source: CDC AR Patient Safety Atlas Figure 3. Percentage of Cases that Reported Each Risk Factor, Acute Hepatitis C Cases in Persons Less Than Age 30 Years, New Mexico, 2014-2016 New Hepatitis C Cases Diagnosed in last 5 years, New Mexico, 2012-2016 Total 91 Cases of Acute Hepatitis C in New Mexico between 2014 and 2016.
Source: NMDOH NM-EDSS

What is Being Done?

  • New Mexico law requires notification of NMDOH for over 75 infectious diseases and conditions and performs routine case investigation for any reports with potential to endanger the public's health and safety.
  • NMDOH offers confidential testing for HIV and all sexually-transmitted diseases which includes risk reduction counseling and behavioral interventions to encourage individual risk reduction.
  • NMDOH offers disease management and partner services in all newly diagnosed cases of HIV and syphilis.
  • New Mexico has expanded its laboratory capacity to detect antibiotic resistance as well as its surveillance and response infrastructure to promote HAI prevention practices, respond to outbreaks, and monitor emerging HAI pathogens.
  • New Mexico has a robust syringe exchange program to promote safe injecting practices and to reduce HCV transmission.

What Needs to be Done?

  • With the advent of curative medications for hepatitis C infections New Mexico needs to focus efforts to assure that infected patients are linked to healthcare for treatment.
  • New biomedical strategies are available to prevent new HIV infections, most notably Pre-Exposure Prophylaxis (PrEP). Additional resources are needed to increase awareness of and utilization of PrEP by those at greatest risk.
How Antibiotic Resistance Happens
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Tue, 18 June 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT