CDC Epidemiology Update


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Presented by Catherine L. Satterwhite, MSPH, MPH, Epidemiologist, Division of STD Prevention, CDC at the 2010 National Chlamydia Coalition meeting

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CDC Epidemiology Update

  1. 1. 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
  2. 2. 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
  4. 4. Number of External Viewers Chlamydia Public Health Grand Rounds Viewership
  5. 5. Number of Downloads/Page Views Chlamydia Public Health Grand Rounds Viewership: Downloads and Page Views
  6. 6. Archives  
  7. 7. CHLAMYDIA TRENDS How are we doing?
  8. 8. Prevalence,% 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
  9. 9. 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
  10. 10. 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 Prevalence(%) 2-Year Interval Women Men 11 National Health and Nutrition Examination Survey (NHANES): Chlamydia Prevalence by Sex*, 1999-2006
  11. 11. 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
  12. 12. EFFECTS OF SCREENING AND PARTNER NOTIFICATION ON CHLAMYDIA PREVALENCE IN THE U.S.: A MODELING STUDY Mirjam Kretzschmar, Catherine Satterwhite, Jami Leichliter, Stuart Berman
  13. 13. 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
  14. 14. 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
  15. 15. CHLAMYDIA IMMUNOLOGY CONSULTATION FINDINGS JID Supplement ,15 June 2010 (Volume 201, Suppl 2):
  16. 16. * 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
  17. 17. * 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
  18. 18.  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.
  19. 19. * JID 2010;201 (Suppl 2): S190
  20. 20. 2010 STD TREATMENT GUIDELINES Up and coming (preliminary language only—final language pending):
  21. 21. 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.
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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 active The State of Healthcare Quality, 2010:
  26. 26. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: Web: 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
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