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Control policies for chlamydia among young adults in Europe - IUSTI Europe 2016, ECDC symposium

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The presentation gives an overview on chlamydia among young Europeans and existing control activities in EU/EEA Member States. It refers to the ECDC Guidance on Chlamydia control that was published 2015 and outlines challenges to chlamydia control.

Presentation in the ECDC symposium at IUSTI Europe conference 2016, Budpaest, Hungary.

Published in: Health & Medicine
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Control policies for chlamydia among young adults in Europe - IUSTI Europe 2016, ECDC symposium

  1. 1. Control policies for chlamydia among young adults in Europe Otilia Mardh, ECDC 30th IUSTI-Europe Conference September 15-17, 2016 Budapest ECDC SYMPOSIUM: STI CONTROL AT A EUROPEAN LEVEL FOCUS ON YOUNG PEOPLE
  2. 2. Overview • Chlamydia among young Europeans • Control activities in EU/EEA Member States • ECDC Guidance 2015 • Challenges to chlamydia control
  3. 3. N= 396 128 reported cases (from 26/31 MS) M: F 0.7 Age: 63% of cases among 15-24 year-olds Highest rate (1.1%) among 20-24 year-old women! Chlamydia in EU/EEA, 2014 EU/EEA rate 187/100 000, range 0.0- 549 83% cases DK, NO, SE, UK Age- and gender-specific rates of reported cases per 100 000, 2014 Source: ECDC STI Surveillance report 2015 Notification rates (confirmed cases) per 100 000, 2014 Source: ECDC Surveillance Atlas http://ecdc.europa.eu/en/data-tools/atlas/Pages/atlas.aspx, Rates not calculated- either sentinel surveillance or data not reported
  4. 4. Trends of chlamydia among young women in six* EU/EEA countries, 2006-2014 *countries with national notification rates above the EU/EEA rate in 2014 and consistent reporting Source: The European Surveillance System (TESSy) 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 2006 2007 2008 2009 2010 2011 2012 2013 2014 Casesper100000population 15-19 year-old women Finland Sweden United Kingdom Norway Iceland Denmark EU/EEA rate 1246 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 2006 2007 2008 2009 2010 2011 2012 2013 2014 20-24 year-old-women Finland Sweden United Kingdom Norway Iceland Denmark EU/EEA rate 1405
  5. 5. Trends of chlamydia among young men in six* EU/EEA countries, 2006-2014 300 800 1300 1800 2300 2800 3300 2006 2007 2008 2009 2010 2011 2012 2013 2014 Casesper100000population 15-19 year-old men Finland Norway United Kingdom Sweden Iceland Denmark 300 800 1300 1800 2300 2800 3300 2006 2007 2008 2009 2010 2011 2012 2013 2014 20-24 year-old men Finland Norway United Kingdom Sweden Iceland Denmark *countries with national notification rates above the EU/EEA rate in 2014 and consistent reporting Source: the European Surveillance System (TESSy) EU/EEA rate 367 EU/EEA rate 824
  6. 6. Factors driving chlamydia notification rates? Rates of diagnoses by level of chlamydia control Source: Chlamydia Control in Europe: a survey of Member States (2012) , TESSY for surveillance data Percentage of chlamydia tests analysed using NAAT >90% in 17/28 countries, <50% in 4/28 countries
  7. 7. Chlamydia prevalence estimates among ≤26 years women, high-income countries NOTE: Weights are from random effects analysis . . . . National population, overall Germany Germany Germany Netherlands Netherlands Slovenia USA USA (2007-2008) Subtotal (I-squared = 75.9%, p = 0.000) Sub-national population, overall Denmark Netherlands Sweden United Kingdom United Kingdom Subtotal (I-squared = 81.1%, p = 0.000) National population, sexually experienced France Germany Slovenia United Kingdom Croatia USA Subtotal (I-squared = 0.0%, p = 0.580) Sub-national population, sexually experienced Denmark Denmark Denmark Netherlands Netherlands Norway Spain United Kingdom USA USA Australia New Zealand Subtotal (I-squared = 77.3%, p = 0.000) Country Haar/KIGGS Haar/DEGS Haar/DEGS van Bergen van Bergen Klavs Miller Datta Munk van Valkengoed Jonsson Low Bracebridge Goulet Haar/KIGGS Klavs Fenton Bozicevic Miller Ostergaard Andersen/kit Andersen/postal van den Broek van den Broek Klovstad Franceschi Stephenson Klausner Klausner Hocking Corwin Author 2012 2012 2012 2005 2005 2004 2004 2012 1999 2000 1995 2007 2012 2010 2012 2004 2001 2011 2004 1998 2002 2002 2012 2012 2012 2007 2000 2001 2001 2006 2002 Year 2.11 (1.36, 3.13) 4.50 (1.60, 12.10) 2.00 (0.50, 7.40) 2.60 (1.70, 3.40) 1.90 (1.20, 2.70) 4.10 (2.20, 7.40) 4.74 (3.93, 5.71) 3.80 (2.40, 6.00) 3.05 (2.09, 4.01) 10.70 (7.18, 15.20) 3.82 (2.51, 5.54) 2.70 (1.50, 4.40) 6.20 (4.90, 7.80) 4.40 (3.50, 5.40) 4.92 (3.33, 6.51) 3.60 (1.90, 6.80) 4.44 (2.86, 6.53) 4.70 (2.50, 8.50) 3.00 (1.70, 5.00) 5.30 (2.30, 10.20) 4.70 (3.90, 5.70) 4.32 (3.65, 4.99) 5.00 (3.61, 6.62) 6.50 (4.70, 8.65) 8.00 (5.82, 10.64) 3.90 (2.75, 5.05) 3.95 (3.35, 4.54) 5.80 (4.48, 7.50) 0.60 (0.00, 3.50) 8.00 (2.30, 20.00) 5.00 (2.80, 7.20) 2.30 (0.80, 3.70) 3.70 (1.20, 8.40) 2.30 (0.40, 4.20) 4.24 (3.25, 5.24) in % (95% CI) CT Prevalence 15 18 20 15 20 18 18 14 20 15 19 16 17 18 15 18 18 18 18 16 21 21 16 20 18 15 18 18 22 18 16 min Age 17 19 24 19 24 24 26 25 24 25 25 24 25 24 17 24 24 25 26 19 23 23 19 24 25 24 25 21 25 24 19 max 2.11 (1.36, 3.13) 4.50 (1.60, 12.10) 2.00 (0.50, 7.40) 2.60 (1.70, 3.40) 1.90 (1.20, 2.70) 4.10 (2.20, 7.40) 4.74 (3.93, 5.71) 3.80 (2.40, 6.00) 3.05 (2.09, 4.01) 10.70 (7.18, 15.20) 3.82 (2.51, 5.54) 2.70 (1.50, 4.40) 6.20 (4.90, 7.80) 4.40 (3.50, 5.40) 4.92 (3.33, 6.51) 3.60 (1.90, 6.80) 4.44 (2.86, 6.53) 4.70 (2.50, 8.50) 3.00 (1.70, 5.00) 5.30 (2.30, 10.20) 4.70 (3.90, 5.70) 4.32 (3.65, 4.99) 5.00 (3.61, 6.62) 6.50 (4.70, 8.65) 8.00 (5.82, 10.64) 3.90 (2.75, 5.05) 3.95 (3.35, 4.54) 5.80 (4.48, 7.50) 0.60 (0.00, 3.50) 8.00 (2.30, 20.00) 5.00 (2.80, 7.20) 2.30 (0.80, 3.70) 3.70 (1.20, 8.40) 2.30 (0.40, 4.20) 4.24 (3.25, 5.24) in % (95% CI) CT Prevalence 15 18 20 15 20 18 18 14 20 15 19 16 17 18 15 18 18 18 18 16 21 21 16 20 18 15 18 18 22 18 16 min Age Chlamydia prevalence, % (95% CI) 00 5 10 15 Source: ECDC. Chlamydia control in Europe - literature review; 2014; Redmond S et al. PlosOne; 2014 ≤26 years men
  8. 8. Chlamydia control policies in 28 EU/EEA countries, 2012 No organised chlamydia control activities, (6/28);… Case management (3/28); 10% Case finding* (5/28); 23% Opportunistic testing of selected groups of asymptomatic individuals** (13/28); 43% Organised chlamydia screening programme (1/28). 4% Source: ECDC technical report on Chlamydia control in Europe, a 2012 survey * case management AND partner notification ** includes case management AND partner notification
  9. 9. Population groups targeted for primary prevention activities, EU/EEA Includes data reported from 22 countries: Belgium, Bulgaria, Cyprus, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Portugal, Slovakia, Slovenia, Spain, Sweden, UK Primary prevention strategies for STI/Chlamydia, EU/EEA 2012 Source: ECDC technical report on Chlamydia control in Europe, a 2012 survey Availability of primary prevention strategies No. of countries (N=27) Country has a strategy 12 Other national strategy includes primary prevention activities 3 Not currently, but a strategy in preparation 10 No strategy for primary prevention 2 “A single diagnose of chlamydia increase the risk of all complications. Control programmes must prevent first and repeat infections to improve women’s reproductive health”. Davies et al. Lancet. 2016
  10. 10. Clinical services reporting chlamydia in 2014 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% STI and sexual health clinics* Outpatient clinic** Primary care Other Unknown *STI and sex health clinics includes: family planning, dermatology-venereology, dedicated STI clinic, youth clinics **Outpatient clinics include: hospital emergency departments, gynaecology, Infectious disease, urology Source: the European Surveillance System (TESSy) • Variations across and within countries • Important for case-management guidelines adapted to healthcare provider
  11. 11. ECDC Chlamydia Guidance 2015 Recommendations • A national strategy or plan for STI control • Primary prevention activities • Evidence-based case management guidelines that address criteria for testing, diagnostic method, treatment, partner notification and reporting of cases • Surveillance of diagnosed chlamydia cases • Monitoring and evaluation Widespread testing (<25 y/o) recommended if resources allow and monitoring and evaluation in place Minimum level of prevention and control should include A national strategy or plan for STI control Primary prevention activities Evidence- based case managemen t guidelines Surveillance of diagnosed chlamydia cases Monitoring and evaluation Source: ECDC Chlamydia control in Europe Guidance 2015 See ECDC report. Chlamydia control in Europe - literature review; 2014 for assessment of effectiveness of control strategies
  12. 12. Main challenges to chlamydia control and their effects • Ongoing transmission Asymptomatic infections No lasting immunity No vaccine • Reduced participation • Limited implementation Societal influences e.g. stigma, poorly-resourced populations, availability of public-health funding • Design of control interventions • Clinical and cost-effectiveness measurements (M&E) Gaps in evidence-base e.g. disease burden, risk of progression to complications and attributable fraction Source: ECDC Chlamydia control in Europe Guidance 2015
  13. 13. Thank you! Acknowledgements • Chlamydia Control in Europe project team • ECDC collaborators: EU/EEA STI surveillance network

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