Chlamydia trachomatis in Tasmania 2001–2007: rising notification trends

Objectives: To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub‐groups, from 1 January 2001 to 31 December 2007. Methods: An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider. Results: In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15–24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15–24 years and males 15–19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only. Conclusions: This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health‐seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs.     

Chlamydia sentinel surveillance in Aboriginal Community Controlled Health Services finds higher testing and positivity rates among younger people

Objective: To measure chlamydia testing and positivity rates among 16–39 year olds attending Aboriginal Community Controlled Health Services (ACCHSs). Methods: Retrospective non‐identifiable computerised records containing consultation and chlamydia testing data were collected for patients (16–39 years) attending eight ACCHSs during 2008–09 in urban, regional and remote settings for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) system. Annual chlamydia testing and positivity rates were estimated. Results: Over two years, 13,809 patients aged 16–39 years (57.8% female, 82.3% Aboriginal or Torres Strait Islander) attended. The annual overall chlamydia testing rate was 13.0% (2008) and 16.0% (2009). Testing rates were higher among females (p<0.001) and among patients aged 16–29 than 30–39 years (males: p=0.01; females: p<0.001). Chlamydia positivity was 8.5% overall; similar in females (8.7%) and males (7.8%) (p=0.46); highest among 16–19 years (females: 17.4%; males: 13.0%), declining to 1.5% among females 35–39 years (p<0.001) and 4.8% among males 30–34 years (p<0.001). Conclusions: Chlamydia testing at these ACCHSs approached recommended levels among some patient groups, however, it should increase. High positivity among younger people highlights they should be targeted. Implications: Young people should be targeted for sexual health interventions. ACCHSs are well placed to provide enhanced sexual health services if appropriately resourced.     

A new national Chlamydia Sentinel Surveillance System in Australia: evaluation of the first stage of implementation

The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) was established with funding from the Department of Health and Ageing to trial the monitoring of the uptake and outcome of chlamydia testing in Australia. ACCESS involved 6 separate networks; 5 clinical networks involving sexual health services, family planning clinics, general practices, antenatal clinics, Aboriginal community controlled health services, and 1 laboratory network. The program ran from May 2007 to September 2010. An evaluation of ACCESS was undertaken in early 2010, 2 years after the program was funded. At the time of the evaluation, 76 of the 91 participating sites were contributing data. The jurisdictional distribution of the 76 sites generally matched the jurisdictional distribution of the Australian population. In 2008, the chlamydia testing rates in persons aged 16-29 years attending the 26 general practices was 4.2% in males and 7.0% in females. At the 25 sexual health services, the chlamydia testing rates in heterosexuals aged less than 25 years in 2008 was 77% in males and 74% in females. Between 2004 and 2008, the chlamydia positivity rate increased significantly in heterosexual females aged less than 25 years attending the sexual health services, from 11.5% to 14.1% (P < 0.01). Data completeness was above 85% for all core variables except Aboriginal and/or Torres Strait Islander status and country of birth, which ranged from 68%-100%, and 74%-100%, respectively, per network. There were delays in establishment of the system due to recruitment of 91 sites, multiple ethics applications and establishment of automated extraction programs in 10 different database systems, to transform clinic records into a common, pre-defined surveillance format. ACCESS has considerable potential as a mechanism toward supporting a better understanding of long-term trends in chlamydia notifications and to support policy and program delivery.     

Two years of enhanced surveillance of sexually-transmitted chlamydia in South East Queensland

The National Sexually Transmissible Infections Strategy 2005-2008, released in 2005, lists exploring and addressing barriers to enhanced data collection for chlamydia surveillance among the actions required for chlamydia control and prevention. This study describes a method of enhanced surveillance of sexually transmitted chlamydia notifications undertaken in South East Queensland, and the epidemiology and management of chlamydia over the study period. The service providers of a random sample of chlamydia notifications meeting preset inclusion criteria were faxed an information package and questionnaire. Telephone follow-up was initiated for non-responders. The first year of data were compared to the second year of data. The overall response rate was 93.2 per cent. Males were more likely than females to be tested because of symptoms in the first year of the study, but not the second. Females were 5.2 times (95% CI 2.43, 10.91) more likely to be screened on the suggestion of the service provider than males. The positivity rate among those tested for sexually transmitted chlamydia increased across the study period. An information package and questionnaire faxed to notifying clinicians is a simple and effective means of conducting enhanced surveillance of sexually transmitted chlamydia. An increase in the screening of males may be contributing to the increasing rate of notifications. An increasing positivity rate among all those tested for chlamydia may be due to more prevalent disease, or more focused testing of high risk groups.     

Evaluating the impact of health reforms in the Netherlands: Assessing the impact of an alcohol ban on sexually transmitted infections in national surveillance data

BackgroundOn 1 January 2014, the minimum age to buy alcohol increased (16–18 years), accompanied by a public awareness campaign (NIX18). Decreases in alcohol consumption are associated with less risky sexual behaviour. This study analyzed the association between the health reforms andChlamydia trachomatis infections (chlamydia) among young heterosexual people.MethodsChlamydia positivity rates, age, and gender from all STI-clinic attendees between 16 and 19 years old in the Netherlands of 2010 to 2016 were obtained. Interrupted time-series assessed immediate and gradual trends in chlamydia rates.ResultsAmong the control group (18–19 year olds) chlamydia rates increased 0.5% each post-ban month (95% Confidence Interval [CI] 1.002–1.008, p = .001). Among 16–17 year olds there was no monthly increase post-ban (Rate Ratio 1.000, 95% CI 0.993–1.007, p = .948). In terms of confounders, only controlling for partner notification dissolved these time trends.ConclusionsWe found that chlamydia rates after the alcohol ban differed between 16–17 year olds and 18–19 year olds. This demonstrates that the health reforms might have affected this secondary outcome, but obtaining certainty using national surveillance data is difficult. Specific studies should be designed, as now changes in chlamydia over time could be explained by STI-clinic policy changes, by changes on an individual level including reduced alcohol consumption or most likely by the combination of these factors.     

Indirect estimation of Chlamydia screening coverage using public health surveillance data

Although routine screening of all sexually active adolescent females for Chlamydia trachomatis infection is recommended at least annually in the United States, no national or state-specific population-based estimates of chlamydia screening coverage are known to exist. Conclusions regarding screening coverage have often been based on surveys of health care provider or facility screening practices, but such surveys do not consider persons who do not seek care at these facilities or who seek care at more than one facility. The authors developed a method to estimate the proportion of sexually active females aged 15-19 years screened for chlamydia in 45 states and the District of Columbia by using national data on chlamydia positivity, estimates of sexual activity from the National Survey of Family Growth, and chlamydial infections reported to the Centers for Disease Control and Prevention. Because of uncertainty regarding these values and related assumptions, credibility intervals were calculated by using a Monte Carlo model. When this model was used, the median state-specific proportion of sexually active females aged 15-19 years screened in 2000 was 60% (90% credibility interval: 55, 66). These results and this method should be evaluated for their utility in guiding implementation of national and state chlamydia control programs.     

Trends in health status and chronic disease risk factors over 10–14 years in a remote Australian community: a matched pair study

Objective: To determine trends in health status over a 10‐year interval in a high‐risk remote Australian Aboriginal community. Methods: Two health surveys were performed, one between 1992 and 1997 and the other between 2004 and 2006, on people aged five years or older. Outcomes were compared across age‐matched and sex‐matched pairs. Results: There were 1,209 matched pairs. In the second survey, birthweights tended to be higher, and there were significant increases in heights of adolescents and young adults, and high density lipoprotein cholesterol (HDL‐C) levels generally. Young adult males were lighter, had lower measurements for waist circumference and blood pressure and less frequently had overt‐albuminuria, while elevated blood pressure was less common in older males. However, females ≥15 years had higher measurements for waist circumference, waist to hip ratio (WHR), body mass index (BMI) and diastolic blood pressure and a higher proportion of diabetes, notably in those aged older than 45 years. Males aged 15–24 years were less likely to be smokers while women aged less than 45 years were more often current drinkers. Conclusions: Results indicative of better nutrition among youth, better health of young adult males, stable or lower levels of albuminuria and improved HDL levels are all encouraging. The waist circumference increase in females might reflect better food access. An increase in diabetes in older subjects probably reflects recent enhanced survival of middle‐aged and older people with – and at risk for – diabetes.     

Chlamydia Screening and Positivity in Juvenile Detention Centers,United States, 2009–2011

An estimated 2.9 million new chlamydia infections occur in the United States each year. Among women, chlamydia can lead to serious adverse outcomes, including pelvic inflammatory disease and infertility. Chlamydia prevalence is highest among females aged 15–19 years. Despite long-standing recommendations directed at young, sexually active females, screening remains sub-optimal. Juvenile detention centers (JDCs) are uniquely situated to screen and treat high-risk adolescents. From 2009–2011, performance measure data on chlamydia screening coverage (proportion of eligible females screened) and positivity (proportion of females tested who were positive) were available from 126 geographically-dispersed JDCs in the United States. These facilities reported screening 55.2% of females entering the facilities (149,923), with a facility-specific median of 66.4% (range: 0–100%). Almost half (44.4%) of facilities had screening coverage levels of 75–100%. This screening resulted in the detection of 12,305 chlamydial infections, for an overall positivity of 14.7% (facility-specific median = 14.9%, range: 0–36.9%). In linear regression analysis, chlamydia positivity was inversely associated with screening coverage: as coverage increased, positivity decreased. The burden of chlamydia in JDCs is substantial; facilities should continue to deliver recommended chlamydia screening and treatment to females and identify mechanisms to increase coverage.     

Evaluation of tuberculin skin testing in tuberculosis contacts in Victoria,Australia, 2005–2013

Aim: To review the programmatic use of the tuberculin skin test (TST) following tuberculosis (TB) exposure in Victoria, Australia.Methods: A retrospective review of data collected for public health surveillance was performed to identify contact demographic factors, including bacille Calmette-Guérin (BCG) status and age and outcomes of TST.Results: Contact tracing was performed for 15 094 people, of whom 13 427 (89.0%) had a TST performed. The TST was positive in 31.4% (95%CI 30.6–32.2) of all contacts, and 48.8% of contacts born outside of Australia. Amongst contacts who were TST-negative at baseline, the conversion rate following exposure was 14.8%. Conversion was most common in those aged 45–54 years, with <12% positivity in both the youngest (<5 years) and oldest (⩾65 years) age groups. Active TB developed in 1.1% of all contacts. Contacts aged <5 years had the highest risk of developing active TB following exposure (3.8%), while low risk was seen in those aged ⩾65 years (0.3%).Conclusion: Overall, contact tracing and TST in this setting appear to yield a high proportion of people at risk for the development of active TB. The yield of testing in some groups, particularly those aged ⩾65 years, was low, and investigation of alternative strategies should be considered.     

The pattern of notification and testing for genital Chlamydia trachomatis infection in Victoria, 1998-2000: an ecological analysis

OBJECTIVE: This ecological study analyses routinely collected chlamydia notification and testing data to investigate any patterns. METHODS: Age and sex-specific chlamydia notification and testing rates for Victoria were calculated for the period 1998 to 2000. RESULTS: Chlamydia notification and testing rates rose between 1998 and 2000. Notification rates were higher among women aged 15 to 24 years than men of the same age (p < 0.01) and higher among 25 to 44-year-olds living in metropolitan rather than rural/regional Victoria (p < 0.01). Testing rates were higher for women than men (p < 0.01) and higher in metropolitan rather than rural/regional areas (p < 0.01) in all groups except women aged 15-24 years. CONCLUSIONS: These increasing rates highlight that chlamydia infection represents a substantial public health problem. IMPLICATIONS: Although these data provide useful information showing these rates vary with age and sex, formal epidemiological prevalence and risk factor studies are required.     

Prevalence and correlates of Chlamydia infection in Canadian street youth.

PURPOSE: To determine the prevalence and correlates of Chlamydia trachomatis in Canadian street youth. METHODS: A cross-sectional study of street youth between the ages of 15-24 years was conducted over a 9-month period in seven large urban centers across Canada. Youth were recruited through "drop-in" centers, outreach work, and mobile vans in each city. Information was collected through a nurse-administered questionnaire. Youth were asked to provide urine to test for chlamydia trachomatis by polymerase chain reaction. Separate logistic regression models were run for males and females controlling for age. RESULTS: The prevalence rate of chlamydia was 8.6% in 1355 youth (95% CI = (7.1%, 10.1%)). Higher prevalence rates were found in females than in males (10.9% vs. 7.3%, respectively) and in Aboriginal youth than in non-Aboriginal youth (13.7% vs. 6.6%, respectively). Four variables were associated with increased risk of chlamydia infection in females: Aboriginal status; self-perceived risk; having no permanent home; and having been in foster care. One predictor of chlamydia for males was having had a social worker. CONCLUSIONS: A high prevalence of chlamydia was found in this vulnerable population in comparison to other Canadian youth. Having been in foster care and having had a social worker were found to have a strong association with chlamydia.     

Neighborhoods and Infectious Disease Risk: Acquisition of Chlamydia during the Transition to Young Adulthood

Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults’ acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults’ acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1–3 (1994–2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents’ interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.     

Relative risk of suicide following exposure to recent stressors,Victoria, Australia

Objective : This study aimed to identify stressors over‐represented in the 12 months prior to death among 553 Victorian adults who died by suicide. Methods : Age‐ and sex‐specific suicide rates and relative risks of suicide were calculated using numerator data on suicides occurring in 2013 by people with a given exposure sourced from the Victorian Suicide Register and denominator data on the total Victorian population with that exposure sourced from the 2014 Australian Bureau of Statistics General Social Survey. Results : Mental illness was associated with increased suicide risk among people of all age groups and both sexes. Alcohol and/or other drug problems were associated with increased risk for males and females of all ages, with the exceptions of the oldest males and females, and the youngest females. Trouble with the police was associated with increased risk among all but the oldest males, whereas among females it was associated with elevated risk in those aged 25–44 years and 65+ years. Conclusions and Implications for public health : Males experiencing mental illness and alcohol and other drug problems should be a particular priority for suicide prevention initiatives but people exposed to other stressors such as contact with the police and divorce/relationship separation also warrant attention.     

Nowhere near the point of diminishing returns: correlations between chlamydia testing and notification rates in New South Wales

OBJECTIVE: To examine the relationship between chlamydia testing and chlamydia detection rates in New South Wales, Australia, from 1999 to 2001. METHODS: Correlations between population-based chlamydia testing and notification rates--stratified by age group, area of residence, and year--were determined by linear regression. RESULTS: Strong positive correlations between chlamydia testing and notification rates were observed for both women (r = 0.91, p < 0.001) and men (r = 0.94, p < 0.001). Between 1999 and 2001, the chlamydia test positivity rate increased from 4.3% to 7.3% for women (p < 0.0001) and from 7.8% to 10.5% for men (p < 0.0001). CONCLUSIONS AND IMPLICATIONS: This study suggests that Australia could benefit from a major chlamydia screening program.     

Access to chlamydia testing needed for high‐risk groups: patterns of testing and detection in an urban area of New Zealand

Objective : To describe population rates of chlamydia testing and detection by sociodemographic characteristics, and to determine whether testing is reaching those groups most at risk of infection. Methods : Laboratory data for urogenital chlamydia tests in an urban region of New Zealand were collated for the period 1999 to 2005. Census data were used to estimate rates of testing and diagnosis (per 100,000 population). Regression analyses summarised patterns in testing and diagnosis by age, sex, ethnicity and socioeconomic deprivation (controlling for potential confounding factors). Results : Rates of chlamydia testing and detection differed significantly by age, sex, ethnicity and deprivation. Females had lower rates of chlamydia diagnoses than males (OR 0.4, 95% CI 0.39–0.42) but were tested five times more often. When tested, rates of chlamydia detection were significantly higher among Pacific (OR 2.33, 95% CI 2.16–2.5), and Māori (OR 2.01, 95% CI 1.87–2.17) than among European (reference group), and among individuals living in areas of greater socioeconomic deprivation (OR 1.66, 95% CI 1.55–1.77). Chlamydia diagnoses were significantly higher in the under 25 year old age group, with the highest odds of a positive result among the 15–19 year age group (OR 9.06, 95% CI 8.23–9.98). Conclusion : This analysis identified higher‐risk groups who appeared to be underserved by testing relative to their higher rates of infection (including Māori, Pacific, 15–19 year olds and individuals living in areas of high socioeconomic deprivation). Implications : Appropriate chlamydia control programs with testing targeted towards higher‐risk groups are urgently needed in NZ.     

Mesothelioma in South Africa, 1976-84: incidence and case characteristics

Malignant mesothelioma is a rare tumour known to be associated with prior exposure to asbestos. Previous studies have described the occupational and clinical features of cases of mesothelioma in the Republic of South Africa (RSA) but none has set out to determine incidence of this disease. To estimate incidence, a case register was compiled for 1976-84 by contacting all medical practitioners and institutions likely to have seen cases of mesothelioma in this period; demographic, diagnostic and exposure details were sought. Cases were accepted if they provided evidence of histological diagnosis of mesothelioma. Fifty-two per cent of 1347 cases identified were in whites, 31% in blacks, 16% in coloureds and 1% in Asians. Seventy-three per cent of cases occurred in males. The majority of whites were aged 51-70 years, while the majority in other race groups were aged 41-60 years. The ratio of only pleural to only peritoneal mesothelioma was 11:1, although there were marked differences by race. Eighty-five per cent of males with exposure information available had prior exposure to asbestos, mostly occupational. A similar proportion of women had contact with asbestos but mostly through other types of exposure. Standardized incidence rates per million population aged 15 years and over were calculated for sex-race subgroups and were highest in white males (32.9 per million per year, 95% Cl 22.7-46.4), coloured males (24.8 per million per year, 95% Cl 16.2-36.9) and coloured females (13.9 per million per year, 95% Cl 7.7-23.5). These incidence rates are amongst the highest ever reported for a national population. Age-specific standardized incidence rates were highest in white males (over 100 per million per year in men over 55 years). Reasons for the differing rates by population group are likely to include differential access to health services. More rigorous control of asbestos exposure in the RSA is recommended.     

Testing and screening for chlamydia in general practice: a cross‐sectional analysis

Objectives: Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. Methods: A cross‐sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP‐term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor‐initiated screening. Results: Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15–25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor‐initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor‐initiated. Conclusions: GP registrars screen for chlamydia disproportionately in younger females and new patients. Implications: Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.     

中国人群2002年吸烟和被动吸烟的现状调查

目的描述2002年中国人群吸烟、戒烟和被动吸烟的流行水平及在不同教育水平、职业和地区的分布特点，判断烟草流行的变化趋势。方法在145个疾病监测点中通过多阶段分层随机抽样，使用调查表人户调查，完成调查16407人，其中有16056人合格记录用于分析。采用总吸烟率、现在吸烟率、吸烟者日平均吸烟量、吸烟花费、戒烟率等指标，根据2002年普查人口进行加权计算。结果男性吸烟率为66．0％，女性吸烟率为3．08％，与1996年结果比较，人群吸烟率下降1．8％，15～24岁人群吸烟率上升，15岁以上吸烟者达到3．5亿人，较1996年增加3000万人。男性吸烟者水平大致相等，女性吸烟的地区差别更明显，东北、华北等地女性吸烟率依然很高。戒烟率增加，从1996年的9．42％上升到现在的11．5％，意味着增加了1000万戒烟者，但不打算戒烟者依然占了绝大多数，达到74％。人均吸烟量基本不变，为14．8支／日，吸烟者平均每日花费2．73元，但不同人群差异很大，最高和最低者相差15倍。被动吸烟暴露并没有大的改善，1996年和2002年两次调查结果几乎相等，人群中被动吸烟暴露水平分别为53％和52％。人们对烟草危害健康的知识增加，但西部地区人们的知识贫乏。60％以上的人支持公共场所禁止吸烟，45％支持禁止烟草广告，但地区差异依然很大。结论中国男性烟草使用的流行水平已经达到高峰，目前处在平台期，还没有明显的下降趋势。有关吸烟有害健康知识的传播还远远不够，特别西部地区人群对控烟措施的理解和支持率均不高，中国人群在短时间内烟草流行率不会明显下降，烟草导致的疾病负担在未来30—50年内将成为现实。     

北京市2010—2019年15~24岁人群生殖道沙眼衣原体感染流行状况

  目的  了解2010—2019年北京市15~24岁人群生殖道沙眼衣原体感染流行情况, 为制定防治策略提供科学依据。  方法  通过中国疾病预防控制信息系统收集2010—2019年北京市15~24岁人群生殖道沙眼衣原体感染报告数据, 应用描述流行病学方法进行分析。  结果  2010—2019年北京市15~24岁人群生殖道沙眼衣原体感染报告病例数累计为1 871例, 其中女性1 287例(68.79%); 报告率由3.16/10万增加到25.15/10万, 年均增长25.92%, 年增长趋势有统计学意义(χ2=836.86, P < 0.01)。人群报告率均呈增长趋势, 除2010和2012年外, 女性报告率均高于男性。2010—2019年各年龄组报告率均呈增长趋势, 增幅最大的为15~19岁人群。  结论  北京市15~24岁人群生殖道沙眼衣原体感染报告率呈增长趋势, 要关注青少年的性与生殖健康教育、重视生殖道沙眼衣原体的流行, 提高监测水平。