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Chlamydia presentation
- 1. 11/01/2016 Mahwish Aurangzeb MPH (Epidemiology) Florida International University CHLAMYDIA (Silent Epidemic) Infectious Disease Epidemiology
- 2. Disease description Transmission Clinical manifestations Epidemiology: National, State (Florida), Local (Miami-Dade County) Surveillance Diagnosis Treatment Prevention Control Major disparities Presentation Outline Mahwish Aurangzeb, MPH – Florida International University – November, 2016
- 3. Disease Description Caused by Chlamydia Trachomatis Most commonly reported STI / Reportable in all states Highest annual incidence Estimated 2.9 million new infections in the US annually Direct & Indirect annual cost approx. $2.4 billion annually. . Mahwish Aurangzeb, MPH – Florida International University – November, 2016
- 4. Transmission Transmission method : Sexual or Vertical Highly communicable Incubation period is 7-21 days Asymptomatic reservoirs Re-infection is common Risk factors : adolescents, multiple sex partners, history of other STI (co- exists with other STI), OCP, lack of barrier contraception, drug users. .
- 5. Chain of Transmission . Mahwish Aurangzeb, MPH – Florida International University – November, 2016
- 6. Case Definition/Diagnosis Case Definition: a diagnosed case that is laboratory confirmed Preferred : Nucleic acid amplification tests (NAATs) significantly more sensitive, can detect N. Gonorrhea in same sample Acceptable in limited circumstances : Culture (gold standard, variable sensitivity 50-80%, highly specific, approved for use in all anatomical sites, not suitable for widespread screening) Not recommended: non-amplification tests & serology . Mahwish Aurangzeb, MPH – Florida International University – November, 2016
- 7. 7 Clinical Syndromes Caused by C. trachomatis Local Infection Complication Sequelae Urethritis Proctitis Conjunctivitis Epididymitis Reactive arthritis (rare) Cant PEE, cant SEE, Cant climb a tree Infertility (rare) Chronic arthritis (rare) Cervicitis Urethritis Proctitis Conjunctivitis Endometritis Salpingitis Perihepatitis Reactive arthritis (rare) Infertility Ectopic pregnancy Chronic pelvic pain Chronic arthritis (rare) Conjunctivitis Pneumonitis Pharyngitis Rhinitis Chronic lung disease? Rare, can cause blindness Clinical Manifestations Men Women Infants Source:
- 8. Treated effectively : doxycycline, azithromycin, erythromycin, or ofloxacin. 50% patients also have gonorrhea Re- testing advised after treatment. . . Treatment
- 9. . Chlamydia—Rates of Reported Cases by State, U.S & Outlying Areas, 2013 per 100,000 Population NOTE: The total rate of reported cases of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 443.5 per 100,000 population.
- 10. Chlamydia — Rates of Reported Cases by Age and Sex, United States, 2014, per 100,000 Population Content source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, last updated: November 17, 2015.
- 11. Chlamydia — Rates of Reported Cases by Race/Ethnicity, United States, 2010– 2014, per 100,000 Population Content source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control andContent source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Page last updated: November 17, 2015Prevention, Page last updated: November 17, 2015
- 12. * Only includes patients tested for chlamydia.† MSM = men who have sex with men; MSW = men who have sex with women* Only includes patients tested for chlamydia.† MSM = men who have sex with men; MSW = men who have sex with women only.only. Chlamydia — Proportion of STD Clinic Patients* Testing Positive by Age, Sex & Sexual Behavior, STD Surveillance Network (SSuN), 2014, per 100,000 Population
- 13. Incidence rate of Chlamydia calculated according to the reported cases & population in Miami-Dade County, FL and USA, from 2009-2013. Data source (www.floridacharts.com, population www.uscensus.gov (population count may have an error of mean +/-299) Chlamydia - Incidence Rates in The U.S., Florida & Miami-Dade County from 2009 – 2013, per 100,000 Population
- 14. Data source, in person communication, KENNETH KAMPERT, Florida Department of Health Bureau of communicable diseases STD & Viral Hepatitis Sec. Chlamydia –Distribution of Cases by Age Group, Year 2013 in State of Florida per 100,000 Population
- 15. Source: in person communication KENNETH KAMPERT, Florida Department of health. Bureau of communicable diseases STD & Viral Hepatitis Sec Chlamydia- Distribution of Cases by Age Group, year 2013 in Miami-Dade County, per 100,000 Population
- 16. Chlamydia Incidence - Rate by Sex in State of Florida & Miami- Dade County from 2008 - 2012 per 100,000 Population 196.5 202.4 213 213.5 234.7 203.2 219.4 232 233.9 235.8 404.2 458.9 471.3 478.7 516.3 546.1 551.3 554.1 560.6 570.9 2008 2009 2010 2011 2012 IncidenceofChlamydia Year Miami-Dade Males Miami-Dade Females Florida MalesFlorida Females Incidence of chlamydia by sex in Miami-Dade and Florida from 2008 to 2012 Data Source: www.floridahealth.gov
- 17. Surveillance (Reportable) . Mahwish Aurangzeb, MPH – Florida International University – November, 2016 Surveillance plays critical role in reducing the burden of disease in society Passive surveillance system Collect: – Cases (case reports) – New infections – Behaviors National surveillance survey Prevalence monitoring (sentinel clinics)
- 18. Surveillance System (data flow) . Figure 1: Chlamydia Surveillance System in the United States (CDC., 2014)
- 19. National Morbidity Surveillance: Reporting of Chlamydia Cases Regional Profiles: One for each 10 HHS (health & human services)regions. (proportion of all chlamydia positives) State Profiles City Profiles No identifiable information Surveillance Methods Source: CDC– Chlamydia statistics and surveillance, Chlamydia surveillance report, 2015.
- 20. State - Florida Florida code 64D-3.002: – Physician: next working day – Lab: next working day Mandated reporters: – Public and private providers – Hospital practitioners – Laboratories Report to county health department (DOH Form # 2136) and CDC (confidential case report form) Youth Risk Behavior Surveillance System (YRBSS) - CDC Surveillance Methods Source: Florida DOH – State and national statistics & notifiable disease reporting & behavioral surveillance, 2012. Florida Department of Health. Florida administrative code. Tallahassee, FL: 2012
- 21. Surveillance Methods (report Florida Health Department) . .
- 22. Report made to CDC
- 23. CDC form Includes - Contact info (name, address phone, DOB, sex, race, ethnicity, ss#) - Demographics - Facility info - Diagnosis Includes: - Patient history - Transmission mode - Test results - Clinical info - Previous testing . Source: U.S. Preventive Services Task Force. Chlamydia and Gonorrhea: Screening recommendation statement [Internet]. 2014 Sep [cited 2016 Oct 30]. CDC form
- 24. Control . .
- 25. Control Measures: National Level Educational programs in schools Technical assistance to laboratories Occupational transmission Surveillance CDC provides leadership in: Awareness campaigns Detection, prevention & control in healthcare settings . Source: U.S. Preventive Services Task Force. Chlamydia and Gonorrhea: Screening recommendation statement [Internet]. 2014 Sep [cited 2016 Oct 30].
- 26. Control Measures: State Level Florida Department of Health offers : Testing Counseling (Posttest counseling part of management. Address safe sex practices that can reduce disease transmission or reinfection). Linkage to care programs Hotlines Prevention Interventions for high risk negative persons Community needs assessments Surveillance and data management Community planning & media campaigns Source: Florida DOH – STD prevention, 2015.
- 27. Control Measures: Local Level Miami-Dade County: Prevention Health education/risk reduction Counseling & testing Surveillance Patient care services Local and state campaignsSource: Miami-Dade County – STD services, 2012.
- 28. Risk of Reinfection (Article #1) . Mahwish Aurangzeb, MPH – Florida International University – November, 2016 Annual redetection rate = 18.5 per 100 PY (95%CI) (2015)
- 29. Barriers in reporting (Article #2) . . Awareness in medical and clinical staff regarding value of chlamydia screening tests and address this in general practice. (2016)
- 30. Data Limitations • Case report data are influenced by screening coverage • Case report and positivity data are from different diagnostic tests (direct fluorescent antibody, EIA, DNA probe assay, NAAT) with different sensitivity and specificity. • Screened population prevalence; is not true prevalence, may include those women tested two or more times during a year. . . Source: U.S. Preventive Services Task Force. Chlamydia and Gonorrhea: Screening recommendation statement [Internet]. 2014 Sep [cited 2016 Oct 30].
- 31. Underlying factors affecting STD disparities include Amount of STDs already in the community Silent carrier of the disease Access to/acceptance of care Poverty, unemployment, drugs (Risky behavior) Stigma, denial/ not using condoms Discrimination, homophobia STD complacency Source: Courtesy of Florida DOH – Epidemiology of ST Infection Trends in Florida Reported through 2011, slide 25Epidemiology of ST Infection Trends in Florida Reported through 2011, slide 25
- 32. Conclusion Chlamydia continues to be a most commonly reported infection in the U.S. and particularly in FL and Miami-Dade Surveillance & public awareness plays important role in control and prevention Disparities continue to increase Source: Epidemiology of ST Infection in the United States: Implications for Linkage to care. Moore, Clinical Infectious Diseases, 2011.
- 33. QUESTIONS? . .
- 34. . Mahwish Aurangzeb, MPH – Florida International University – November, 2016 1. U.S Census Bureau. Census data. Available from http://www.census.gov. Accessed October 15, 2015. 2. Centers for Disease Control and Prevention. Available from http://wonder.cdc.gov/std-v2013.html. Accessed October 15, 2015. 3. FLORIDA DEPARTMENT OF HEALTH Division of Public Health Statistics & Performance Management. Available from http://www.floridahealth.gov/diseases-and- conditions/sexually-transmitted-diseases/std-statistics/index.html. Accessed October 15, 2015 4. In person communication KENNETH KAMPERT, Florida Department of health. Bureau of communicable diseases STD & Viral Hepatitis Sec. on October 20, 2015 5. Ready-To-Use STD Curriculum for Clinical Educators - Chlamydia. Retrieved from https://www2a.cdc.gov/stdtraining/ready-to-use/chlamydia.htm 6. http://www.cdc.gov/std/chlamydia/default.htm 7. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002321/ 8. http://www.std-gov.org/stds/chlamydia.htm 9. http://www.cdc.gov/std/ept/ References
Editor's Notes
- Good evening everyone, the topic od my presentation today is most commonly reported STI in US , chlamydia also known as silent epidemic
- Here is the outline of my presentation, we ll discuss description , transmisson , prevention , contol , diagnosis, epidemiology of the disease
- So WHAT IS CHLAMYDIA, like I said it is the most reported STI in USA, WITH HIGEST ANNUAL INCIDENCE, ESTIMATED 2.9 MILLION NEW CASES ARE REPORTED ANNUALY IN USA, AND DIRECT N INDIRECT HEALTH CARE COST LINK TO THE DISEASE IS 2.4 BILLION 1. It’s a real good reason to wear condoms. 2. It’s contagious. Treatment doesn’t prevent you from reacquiring it. 3. If both partners aren’t treated, then neither is treated. 4. It causes serious damage to females. PID 5. STDs hang out together. 6. It is easily prevented and treated. aged 14-24) and is especially prevalent among young women. Co-infection of chlamydia and gonorrhea is common. Chlamydia can infect the genitals, rectum, throat and eyes. Nucleic Acid Amplification (NAA), via either urine or swab, is considered the best option in testing for chlamydia. Rate highest in women n young adults 15-24
- Prevention by breaking the chain, wearing condoms and monogamy
- Uncomplicated chlamydia infection can be treated effectively with antibiotics Uncomplicated chlamydia infection can be treated effectively with antibiotics such as doxycycline, azithromycin, erythromycin, or ofloxacin. ”such as doxycycline, azithromycin, erythromycin, or ofloxacin. ” “Up to 50 percent of patients with chlamydia also have gonorrhea, so an antibiotic against gonorrhea is given along with an antibiotic for chlamydia, unless laboratory tests have declared the patient free of gonorrhea
- Majority (>50%) asymptomatic Symptoms/signs if present: mucopurulent, mucoid or clear urethral discharge, dysuria Incubation period unknown (probably 7–21 days in symptomatic infection) Cervicitis Majority are asymptomatic Local signs of infection, when present, include Mucopurulent endocervical discharge Edematous cervix with erythema and friability Urethritis Usually asymptomatic Signs/symptoms, when present, include dysuria, frequency, “sterile” pyuria Pelvic Inflammatory Disease (PID) Endometritis Salpingitis Tubo-ovarian abcess Peritonitis Perihepatitis (Fitz-Hugh-Curtis Syndrome) Reactive arthritis
- Age is a risk factor for chlamydial and gonococcal infections, with the highest infection rates occurring in women aged 20 to 24 y. Other risk factors include new or multiple sex partners, a sex partner with concurrent partners, or a sex partner with a sexually transmitted infection (STI); inconsistent condom use among persons who are not in mutually monogamous relationships; previous or concurrent STI; and exchanging sex for money or drugs.
- Which just prove the point that population at risk is young people betwee the age 15-25 The graph above compares the incidence rate according to the reported cases of Chlamydia in Miami Dade county, state of Florida & US over 5 years period(2009-13). There was a steady rise of disease incidence in USA from 2009 -2010 when the rate reached 422.8 from 403.9, followed by a sharp rise in rates reaching maximum of 453.2 per 100,000 population in 2011 which remained same the following year, the trend shows gradual decrease next year. However Florida trend shows a steady rise in incidence of disease over the period & has reached to 413 from 387.8. Miami Dade County data depicts a steady rise in reported cases till 2011 with a sharp rise till 2012 and this trend continued to rise in next year. This could mean there was increased awareness of screening hence there was a rise in reported cases causing a rise in incidence rate of chlamydia. In short there is rise in reported cases of Chlamydia all over US, including state of FL & Miami-Dade County after 2010 and there are still large population that has the disease.
- American indian and alaskan natives this difference is not because of color of heritage but social conditions are responsible for this difference shows that there are higher rates of STDs among some racial or ethnic minority groups compared to whites.2.3 It is important to understand that these higher rates are not caused by color or heritage, but by social conditions that are more likely to affect minorities. Factors such as poverty, large gaps between the rich and the poor, few jobs, and low education levels can make it more difficult for people to stay sexually healthy.4People who cannot afford basic needs may have trouble accessing quality sexual health services.5Many racial/ethnic minorities may distrust the health care system, fearing discrimination from doctors and other health care providers.6 This could create negative feelings around getting tested and treated for STDs.In communities with higher STD rates, sexually active people may be more likely to get an STD because they have greater odds of selecting a partner who is infected.7,8
- Incidence by Ethnicity: National, State and Local Data
- INFERENCE: The graph above compares the incidence rate according to the reported cases of Chlamydia in Miami Dade county, state of Florida & US over 5 years period(2009-13). There was a steady rise of disease incidence in USA from 2009 -2010 when the rate reached 422.8 from 403.9, followed by a sharp rise in rates reaching maximum of 453.2 per 100,000 population in 2011 which remained same the following year, the trend shows gradual decrease next year. However Florida trend shows a steady rise in incidence of disease over the period & has reached to 413 from 387.8. Miami Dade County data depicts a steady rise in reported cases till 2011 with a sharp rise till 2012 and this trend continued to rise in next year. This could mean there was increased awareness of screening hence there was a rise in reported cases causing a rise in incidence rate of chlamydia. In short there is rise in reported cases of Chlamydia all over US, including state of FL & Miami-Dade County after 2010 and there are still large population that has the disease.
- The pie chart shows that Chlamydia is prevalent in all age groups in State of Florida. The 1% prevalence of disease in children makes the likelihood of acquiring the disease by infected mother rather than sexual contact. It then shows increase in percent to a 26% in the age group 15-19 this could be due to the fact that children/young adults are experimenting with sex, making most of newly found freedom with less knowledge of prevention. High prevalence is seen till the age 20-29 which is considered as reproductive/sexually active age group. Then as adults mature & attain awareness by the age 30-34 they start practicing safe sex the percentage of disease has decrease due to sexual choices & education to 8%.By 30-54 there is further reduction in percentage to 2-3% depicting people are probably married or settled down with single partner. 65+ population has little or no disease the reason other than awareness is loss in sexual appetite.
- INFERENCE: The percentage of chlamydia in the above pie chart shows highest prevalence of the disease among reproductive/sexually active age group 15-46, the distribution of the disease is 33% in age group 15-19% which portrays young adults are practicing unsafe sex this percentage has increased to 46% by the age group 20-24. Percentage shown declining trend in more mature age group 4-10% among 30-39 which shows awareness & practice of save sex. This decline continues in following age groups to as low as 1% by the age 64 & zero percent in population above 65 endorses the link of disease to sexual activity. Florida trends follow the same pattern.
- This graph depicts the 5year trend of incidence rate of Chlamydia among both genders in Miami Dade County and State of Florida. The disease is more prevalent in females in Miami Dade County &in State of Florida as compare to men over this entire period of time. The disease incidence is gradually increasing in both men and women in Miami-Dade County, especially in women there is sharp increase in incidence rate from 2011-2012 whereas the rise in male incidence is steady. Looking at state of Florida, males are following the same pattern as male population of Miami Dade County however we can see a steady rise in disease rate in women after year 2011 from 554.1 per 100,000 population to 570.9 towards the end of year 2012. This increase in number can show either there is more spread of disease or increase in awareness of women.
- 2 slides on control measures. Control/treatment at community level not hospital level. Cost/budgets. Reference a peer review article. http://www.cdc.gov/hiv/strategy/index.htm http://www.cdc.gov/hiv/aboutDHAP.htm National HIV/AIDS Strategy (NHAS): July, 2010 Goals by 2015: Reduce new infections by 25% Increase linkage to care by 20% Improve health outcomes Reduce disparities Enhanced Comprehensive HIV Prevention Planning (ECHPP) Project 3 year funding to implement NHAS Implemented in 12 cities with highest number of people living with AIDS (Miami) Actively coordinates federally funded programs CDC provides leadership in: National awareness campaigns (Act Against AIDS) Detection, prevention and control of HIV in healthcare settings Educational programs in schools Technical assistance to laboratories Occupational transmission Surveillance
- The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. The USPSTF recommends screening for chlamydia in sexually active women age 24 years and younger and in older women who are at increased risk for infection. Florida Department of Health: Testing (2011: # 420,587) Counseling Linkage to care programs Hotlines Prevention (2010 FL budget: $39.2 million) Interventions for high risk negative persons and American Indian populations Housing programs for PLWA Community needs assessments Surveillance and data management Community planning & media campaigns (We Make the Change) Miami-Dade County: Prevention Health education/risk reduction Counseling & testing Surveillance Patient care services (Ryan White Part B, AIDS drug assistance program) Local and state campaigns (ex: Test Miami, Business Responds to AIDS, Faith Based Initiatives, Africa-American Testing Initiatives, The Turning Point
- Miami-Dade County: Prevention Health education/risk reduction Counseling & testing Surveillance Patient care services (Ryan White Part B, AIDS drug assistance program) Local and state campaigns (ex: Test Miami, Business Responds to AIDS, Faith Based Initiatives, Africa-American Testing Initiatives, The Turning Point)
- The purpose of the study was to investigate the frequency and risk factors for incident and redetected Chlamydia trachomatis infection in sexually active, young, multi-ethnic women in the community. The annual incidence & predictors of chlamydia infection and reinfections was found in sexually active women on basis of their sexual activities (sexual intercourse at early age & new partner in 12 month time); smoking & concurrent bacterial vaginosis or high risk human papillomavirus. 954 participants with returned repeat samples were slightly older, and less likely to be of black ethnicity or to have had chlamydia or bacterial vaginosis at baseline. Among 907 women who were negative for chlamydia at baseline incident chlamydia infection was 4.6%, while taking into account the total follow-up time, the estimated annual incidence rate was 3.4 per 100 person-years (95% CI 2.5 to 4.6 per 100 person-years). Predictors of incident chlamydia infection were age <20 years RR 4.0, a new sexual partner during 12 months follow-up RR 4.4, smoking RR 2.2, baseline bacterial vaginosis RR 2.0 and baseline high risk carcinogenic human papillomavirus RR 2.2. None of these predictors were significantly associated in chlamydia redetection. The annual redetection rate was 18.5 per 100 person-years (95% CI 9.9 to 30.0 per 100 person-years)
- Find peer reviewed article
- If a person has been diagnosed and treated for chlamydia, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis)