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: cdcinfo@cdc.gov 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