Chlamydial Infections in the U.S. Steven J Shapiro CCID/NCSHHSTP/DSTDP/PTB Region I Infertility...
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Transcript of Chlamydial Infections in the U.S. Steven J Shapiro CCID/NCSHHSTP/DSTDP/PTB Region I Infertility...
Chlamydial Infections in the U.S.
Steven J Shapiro
CCID/NCSHHSTP/DSTDP/PTB
Region I Infertility Prevention Project Wells Beach, Maine
June 2, 2009
Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Outline...
2007 Surveillance Report and Chlamydia Supplement
NHANES Behavioral Risk Data
2007 Surveillance Report and Chlamydia Supplement
Interpretation Challenges
Increases in lab test sensitivity Underdetection, underreporting
2000 estimate: 2.8 million cases 2000 case reports: 709,452
Different screening rates Application of screening criteria varies
CDC: Screen all sexually-active women <26 years annually
Rate (per 100,000 population)
MenWomenTotal
0
120
240
360
480
600
1988 90 92 94 96 98 2000 02 04 06
Chlamydia — Rates by Sex: United States, 1988–2007
543.6
190.0
Total cases reported in 2007: 1,108,374
CT screening demonstrationproject (Region X)
Program expansion
All 50 reportNotifiable
Rate (per 100,000 population)
American Indian/AK NativeAsian/Pacific IslanderBlackHispanicWhite
0
340
680
1020
1360
1700
1998 99 2000 01 02 03 04 05 06 07
Chlamydia — Rates by Race/Ethnicity: United States, 1998–2007
1398.7
162.3
Men Rate (per 100,000 population) Women
Age3250 2600 1950 1300 650 0 0 650 1300 1950 2600 3250
11.8 123.010-14615.0 3004.715-19
932.9 2948.820-24518.6 1184.525-29
246.8 460.530-34129.9 188.135-3971.4 76.540-4432.3 28.545-5410.1 8.055-642.7 1.865+
190.4 544.8Total
Chlamydia — Age- and Sex-specific Rates: United States, 2007
Chlamydia — Cases by Reporting Source and Sex: United States, 1998–2007
Cases (in thousands)
non-STD Clinic Malenon-STD Clinic FemaleSTD Clinic MaleSTD Clinic Female
0
150
300
450
600
750
1998 99 2000 01 02 03 04 05 06 07
IPP Data
Reported Chlamydia Test* Volume: Infertility Prevention Program, 2001 - 2006
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
2001 2002 2003 2004 2005 2006 2007
*Positive and negative test results only.
Chlamydia — Trends in nucleic acid amplification test (NAAT) usage among 15- to 24-year-old women tested in family planning clinics
by HHS region, 2003–2007
SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention
Region I
Percent
020406080
100
03 04 05 06 07Region II
Percent
020406080
100
03 04 05 06 07Region III
Percent
020406080
100
03 04 05 06 07Region IV
Percent
020406080
100
03 04 05 06 07
Region V
Percent
020406080
100
03 04 05 06 07Region VI
Percent
020406080
100
03 04 05 06 07Region VII
Percent
020406080
100
03 04 05 06 07Region VIII
Percent
020406080
100
03 04 05 06 07
Region IX
Percent
020406080
100
03 04 05 06 07Region X
Percent
020406080
100
03 04 05 06 07
Chlamydia — Positivity among 15- to 24-year-old women tested in family planning clinics by state:
United States and outlying areas, 2007
*Data not available in 2007.Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15-24 years screened during 2007.
SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention
Positivity (%)
Puerto Rico 7.7
Virgin Is. 16.8
See*
<5.0
5.0-9.9
>=10.0
(n= 1)
(n= 6)
(n= 39)
(n= 7)
VT 3.5NH 3.8MA 4.5RI 5.7CT 6.8NJ 7.7DE 6.4MD 5.7DC
12.7
5.2
8.3 8.2
6.2 6.9
8.3
12.3
8.4
5.4
7.2 8.0
5.8
6.45.0
8.1
6.1
7.2
6.1
13.8
7.2
5.7
6.96.9
8.3
4.8
7.8
8.0
8.0
6.9
4.7
5.3
11.3
6.5
6.5
13.8
12.87.5
7.1
2.9
8.26.1
Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family planning
clinics by HHS region, 2003–2007
SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention
Region I
Region II
Region III
Region IV
Region V
Region VIRegion VII
Region VIII
Region IX
Region X
4.7
03
4.6
04
4.7
05
4.7
06
4.8
07
7.4
03
7.1
04
5.7
05
5.6
06
5.9
07
5.6
03
6.0
04
5.8
05
5.4
06
5.5
07
6.2
03
8.4
04
8.8
05
9.0
06
9.6
07
7.3
03
7.5
04
7.7
05
7.6
06
7.6
07
7.3
03
7.4
04
7.4
05
7.9
06
8.8
07
5.5
03
5.8
04
5.8
05
6.5
06
6.5
07
5.9
03
6.3
04
6.3
05
7.2
06
7.3
07
6.5
03
6.7
04
6.4
05
6.8
06
7.3
07
5.8
03
5.9
04
5.6
05
5.7
06
5.8
07
IV
VIIIX
IIIX
III
VI
VVIII
Median state-specific positivity rate
0
2
4
6
8
10
1997 98 99 2000 01 02 03 04 05 06 07
Chlamydia — Median State-specific Positivity Among 15-24 Year-old Women Tested in Family
Planning Clinics, 1997–2007
Note: As of 1997, all 10 Health and Human Services (HHS) regions, representing all 50 states, the District of Columbia, and outlying areas, reported chlamydia positivity data.
SOURCE: Regional Infertility Prevention Projects; Office of Population Affairs; Local and State STD Control Programs; Centers for Disease Control and Prevention
6.9%↓
(2.9-16.8)5.1%
↓
(2.0-11.2)
Trends in Chlamydia Population Prevalence in the US, 1999-2006
Results from the National Health and Nutrition Examination Survey (NHANES)
Datta, S. Deblina; Sternberg M, Satterwhite CL, Johnson R, Papp J, McQuillan G, Berman S, Weinstock H
Introduction
First analysis of national CT trend data from 1999-2006 using population based data collected from participants aged 14-39 years of the National Health and Nutrition Examination Survey (NHANES), a representative sample of the U.S civilian, non-institutionalized population
Figure 1. Chlamydia trachomatis Prevalence Estimates and 95% CI in 2 Year Intervals, NHANES 1999-2006
0
1
2
3
1999-2000 (n=3145) 2001-2002 (n=3487) 2003-2004 (n=3211) 2005-2006 (n=3375)
Years Sampled
Pre
vale
nce
(%)
p value for overall homogeneity=0.05
1999-2002 (n=6632) 2003-2006 (n=6586)Prevalence (95%CI) Prevalence (95%CI) p-value
Total 2.2 (1.8-2.8) 1.7 (1.3-2.2) 0.11
Gender Male 2.0 (1.6-2.5) 1.4 (1.0-2.0) 0.08 Female 2.5 (1.8-3.4) 2.0(1.5-2.8) 0.37
Age Group (years) 14-19 3.4 (2.8-4.2) 2.3 (1.6-3.3) 0.04 20-29 2.5 (1.9-3.4) 2.2 (1.4-3.3) 0.55 30-39 1.3 (0.7-2.4) 0.9 (0.6-1.3) 0.36
Racial/Ethnic Group Non-Hispanic White 1.5 (1.0-2.4) 1.0 (0.7-1.5) 0.17 Non-Hispanic Black 6.3 (5.4-7.5) 5.2 (3.6-7.3) 0.26 Mexican-Americans 3.1 (2.3-4.2) 1.7 (1.0-2.9) 0.03
Table 1. Chlamydia Prevalence Estimates and Chi-squre Test by 4-Year Intervals in NHANES, 1999-2006
Summary
Decreases observed in overall CT prevalence during this time period but not at a statistically significant level
Statistically significant decreasing trends observed in some subgroups
14-19 year olds experienced decreasing trend in CT; this is a group that has previously been identified as the age group with highest CT prevalence; it is also a group targeted for routine CT screening
Mexican-Americans experienced decreasing trend in CT Non-Hispanic Blacks had highest prevalence of any
racial/ethnic group over this period and did not experience statistically significant declines
Regional Behavioral Risk Data
Who collects What?
How is it Used?
Behavioral Risk Factor Regions
Condom at last sex I and X
Consistent Condom Use- 12 months I
Douching last 30 days IX
New Sex Partner 60 or 90 days All but II, III, V
Number of Sex Partners last 30 days IX
No Sex I
Multiple Sex Partners NS, 60 or 90 All but II, III, V
Exposed to Chlamydia IX
Risk History II
Symptomatic Sex Partner VI and X
Monogomous Sex Partner VI
Partner with other Partners IX and X
Uses of Behavioral Risk Data
Limited regional uses Region IX
establish screening criteria and notable risk factors
Region X Informed development of the
selective screening criteria No other regional uses; if used at
individual state level
Questions?