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Chlamydia Trends: What We Do and Don’t Know

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Presented by Lizzi Torrone, MSPH, PhD, Epidemiologist, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting.

Presented by Lizzi Torrone, MSPH, PhD, Epidemiologist, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting.

Published in: Health & Medicine

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  • 1. Chlamydia Trends:What We Do and Don’t Know Lizzi Torrone Epidemiologist Division of STD Prevention National Chlamydia Coalition January 26, 2012National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of STD Prevention
  • 2. Chlamydia—Rates by Sex, United States, 1990–2010 Rate (per 100,000 population) 750 Women 625 500 375 Total 250 Men 125 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 YearNOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require thereporting of chlamydia cases.
  • 3. Chlamydia—Rates by Age and Sex, United States, 2010Men Rate (per 100,000 population) Women3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700 Age 774.3 15–19 3,378.2 1,187.0 20–24 3,407.9 598.0 25–29 1,236.1 309.0 30–34 530.9 153.2 35–39 220.1 91.3 40–44 94.7 39.3 45–54 32.8 10.9 55–64 9.3 2.8 65+ 2.1 233.7 Total 610.6
  • 4. Chlamydia—Percentage of Reported Cases by Sex and Selected Reporting Sources, United States, 2010 Percentage 40 Private Physician/HMO* 35 STD Clinic Other HD* Clinic 30 Family Planning Clinic 25 Emergency Room 20 15 10 5 0 Men Women*HMO = health maintenance organization; HD = health department.NOTE: These categories represent 72.5% of cases with a known reporting source. Of all cases, 11.6% had amissing or unknown reporting source.
  • 5. What do chlamydia case report data tell us? Chlamydia is the most commonly reported nationally notifiable disease. Chlamydia is most commonly diagnosed among young females. Many females are diagnosed in private healthcare settings.
  • 6. What do chlamydia case report data NOT tell us? The incidence and prevalence of chlamydia.  Duration of infection is unknown  Doesn’t account for changes in • Screening coverage • Test technology used • Empiric treatment • Reporting practices
  • 7. Chlamydia Screening Coverage* Trends (Women Aged 16-20 and 21-24 years, HEDIS)Percentage100 80 Medicaid (21-24 yos) Medicaid (16-20 yos) 60 40 20 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 *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, 2011: http://www.ncqa.org/LinkClick.aspx?fileticket=FpMqqpADPo8%3d&tabid=836
  • 8. What do chlamydia case report data NOT tell us? The incidence and prevalence of chlamydia.  Duration of infection is unknown  Doesn’t account for changes in • Screening coverage • Test technology used • Empiric treatment • Reporting practices
  • 9. Percentage of Nucleic Acid Amplification Tests (NAATs) Used Among Women, Infertility Prevention Project, 2000–2010Percentage 100 80 60 40 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
  • 10. What do chlamydia case report data NOT tell us? The incidence and prevalence of chlamydia.  Duration of infection is unknown  Doesn’t account for changes in • Screening coverage • Test technology used • Empiric treatment • Reporting practices
  • 11. What do we know about trends in Chlamydia? Case reports are increasing, but…  Likely reflects increased screening and use of NAATs
  • 12. After analyzing data at the clinic level to account for unmeasured factors between clinics (e.g., screeningpractices), positivity remained stable from 2004–2008.Limitation: Can’t account for changes within clinics overtime (e,g., demographic shifts in who goes to the clinic)
  • 13. Among both women (19%) and men (8%) aged 16-24 years entering the national job trainingprogram, chlamydia prevalence declined significantly from 2003–2007. Limitation: May not be generalizable andpopulation entering program may change over time
  • 14. epub, Dec 2012In nationally representative surveys from 1999–2008, prevalence decreased 40% among men and women aged 14–39 years and prevalence remained stable among women aged 14–25 years.Limitation: Small sample sizes and low prevalence limit ability to monitor trends in subgroups
  • 15. What do we know about trends in chlamydia? Case reports are increasing, but…  Likely reflects increasing screening and use of NAATs Positivity and prevalence estimates suggest stable or decreasing morbidity, but…  Current national data sources have limitations
  • 16. What don’t we know about trends in chlamydia? What opportunities do we have? Increase screening coverage  Particularly among adolescents  Within the context of a changing healthcare environment Improve chlamydia surveillance  Limitations of current national data sources  Consider different metrics and data sources
  • 17. Acknowledgements Jim Braxton LaZetta Grier Rob Nelson Catherine Satterwhite Hillard Weinstock
  • 18. Thank you! ETorrone@cdc.govFor 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: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of theCenters for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD , and TB Prevention Division of STD Prevention