Catherine Satterwhite, MSPH, MPH Epidemiologist National Chlamydia Coalition October 29, 2010 CDC Epidemiology Update Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention
May 30, 2015
Catherine Satterwhite, MSPH, MPHEpidemiologist
National Chlamydia CoalitionOctober 29, 2010
CDC Epidemiology Update
Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention
Outline
May 2010: CDC’s Public Health Grand Rounds
Chlamydia Trends Chlamydia Prevention Strategies: Results
from a Modeling Collaboration Chlamydia Immunology Consultation and JID
Supplement 2010 Treatment Guidelines
CHLAMYDIA PREVENTION: CHALLENGES AND STRATEGIES FOR REDUCING DISEASE BURDEN
Public Health Grand Rounds
Number of External Viewers
Chlamydia Public Health Grand Rounds Viewership
Number of Downloads/Page Views
Chlamydia Public Health Grand Rounds Viewership: Downloads and Page Views
Archives
http://www.cdc.gov/about/grand-rounds/archives/2010/05-May.htm
http://www.youtube.com/watch?v=iGgsfppw6Ds
CHLAMYDIA TRENDSHow are we doing?
Pre
vale
nce,
%
Chlamydia Prevalence in Sexually Active Females Aged 14-24 in the United States
NHANES, National Health and Nutrition Examination Survey, 1999-2008
Sexual activity =“yes” response to “Have you ever had sex?” Sex = vaginal, anal, or oral sex
Chlamydia Case Rates: United States, 1989–2008
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services; November 2009
Datta et al. Presented at4 8th Annual ICAAC/IDSA 46th Annual Meeting, Washington, D.C., 10/25-28/2008.*Ages 14-39 years
0
1
2
3
4
5
1999-2000 2001-2002 2003-2004 2005-2006
Pre
vale
nc
e (
%)
2-Year Interval
Women
Men
11
National Health and Nutrition Examination Survey (NHANES): Chlamydia Prevalence
by Sex*, 1999-2006
Chlamydia Prevalence is Not Increasing NHANES (stable/decreasing) IPP (stable)
Chlamydia positivity rates have not changed from 2004 to 2008 • OR: 1.00 (0.99, 1.00)
National Job Training Program (decreasing) Among both women (19%) and men (8%), chlamydia
prevalence declined significantly from 2003-2007 • CT case rates increased by 22.7% from 2003-2007
EFFECTS OF SCREENING AND PARTNER NOTIFICATION ON CHLAMYDIA PREVALENCE IN THE U.S.: A MODELING STUDY
Mirjam Kretzschmar, Catherine Satterwhite, Jami Leichliter, Stuart Berman
Use Modeling to Analyze Effects of Prevention Strategies on Chlamydia
Prevalence
Impact of increasing chlamydia screening coverage
Impact of increasing partner notification/treatment
Individual-based stochastic model Describes formation and dissolution of heterosexual
partnerships, sexual networks
Effect of Prevention Strategies on Chlamydia Prevalence After 20 Years of
Screening
Three different strategies each resulted in a 22.5% prevalence reduction Increasing screening of sexually active women ≤25 years
from 20% to 65% (25% partner notification/treatment) Increasing partner notification/treatment from 25% to 55%
(20% screening coverage) Increasing screening coverage from 20% to 35% and
partner notification/treatment from 25% to 40% Combined approach may be more effective
Best use of resources: Partner services? Adding male screening had marginal impact, but
would require substantial additional resources
CHLAMYDIA IMMUNOLOGY CONSULTATION FINDINGS
JID Supplement ,15 June 2010 (Volume 201, Suppl 2):
* JID 2010;201 (Suppl 2): S134
% of untreated chlamydia progressing to PID (high-risk populations) in 2 week interval between testing and treatment: 2-5%
% of untreated chlamydia progressing to PID (1 year, POPI trial): 10%
% of PID progressing to infertility: up to 18% Not specifically chlamydia-associated PID
* JID 2010;201 (Suppl 2): S156
Two large RCTs: ~50% reduction in PID (Scholes, Ostergaard) Major methodological limitations
Army (Clark): no benefit POPI: no benefit
Study underpowered: Results suggest possible benefit
16/26 (62%) of women with PID were CT positive at PID diagnosis CT may be a major contributor to clinically-diagnosed
PID 10/16 women who were CT positive at PID
diagnosis were CT negative at enrollment (when screening would have hypothetically occurred) 6/16 cases of PID might have been prevented (38%) by
screening* BMJ 2010 340:c1642.
* JID 2010;201 (Suppl 2): S190
2010 STD TREATMENT GUIDELINES
Up and coming (preliminary language only—final language pending):
Chlamydia Screening Among Young Women: Changes from 2006
Age cut-off remains the same: <26 years No change to risk factors
New sex partner, multiple sex partners Addresses USPSTF age change (<25 years)
USPSTF found epidemiology of chlamydial infection in the U.S. has not changed
Added language: Among women, the primary focus of chlamydia screening efforts should be to detect chlamydia and prevent complications, whereas targeted chlamydia screening in men should only be considered when resources permit and do not hinder chlamydia screening efforts in women.
Chlamydia Screening Among Men
2010 Insufficient evidence to recommend routine chlamydia
screening in young men because of several factors (feasibility, efficacy, cost)
Screening of young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, STD clinics).
Changes from 2006: Expansion to allow for venue-based male screening
Chlamydia Retesting in Women and Men
2010 Chlamydia-infected women and men should be retested
approximately 3 months after treatment If retesting at 3 months is not possible, clinicians should
retest whenever persons next present for medical care in the 12 months following initial treatment.
Changed from 2006: Strengthened language, added men
Screening Among Pregnant Women: Chlamydia
2010: All pregnant women should be routinely screened for chlamydia during the first prenatal visit. Retest during 3rd trimester: Women aged ≤25 years and
those at increased risk If diagnosed with chlamydia in 1st trimester, retest within
3-6 months (preferably 3rd trimester) Changes from 2006: Strengthened and
clarified retesting language
Chlamydia Screening Coverage* Trends (Women Aged 15-24, HEDIS)
*Among women enrolled in commercial or Medicaid plans who had a visit where they were determined to be sexually activeThe State of Healthcare Quality, 2010:
http://www.ncqa.org/portals/0/state%20of%20health%20care/2010/SOHC%202010%20-%20Full2.pdf
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thanks!
National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention
Division of STD Prevention