1. 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.

2. Outline... 2007 Surveillance Report and Chlamydia Supplement NHANES Behavioral Risk Data

3. 2007 Surveillance Report and Chlamydia Supplement

4. 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

5. Rate (per 100,000 population) Men Women Total 0 120 240 360 480 600 198890929496982000020406 Chlamydia — Rates by Sex: United States, 1988–2007 543.6 190.0 Total cases reported in 2007: 1,108,374 CT screening demonstration project (Region X) Program expansion All 50 reportNotifiable

6. Chlamydia — Rates by Race/Ethnicity: United States, 1998–2007 1398.7 162.3

7. Chlamydia — Age- and Sex-specific Rates: United States, 2007

8. Chlamydia — Cases by Reporting Source and Sex: United States, 1998–2007

9. IPP Data

10. Reported Chlamydia Test* Volume: Infertility Prevention Program, 2001 - 2006 *Positive and negative test results only.

11. 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 0 20 40 60 80 100 0304050607 Region II Percent 0 20 40 60 80 100 0304050607 Region III Percent 0 20 40 60 80 100 0304050607 Region IV Percent 0 20 40 60 80 100 0304050607 Region V Percent 0 20 40 60 80 100 0304050607 Region VI Percent 0 20 40 60 80 100 0304050607 Region VII Percent 0 20 40 60 80 100 0304050607 Region VIII Percent 0 20 40 60 80 100 0304050607 Region IX Percent 0 20 40 60 80 100 0304050607 Region X Percent 0 20 40 60 80 100 0304050607

12. 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 3.5 NH 3.8 MA 4.5 RI 5.7 CT 6.8 NJ 7.7 DE 6.4 MD 5.7 DC 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 6.4 5.0 8.1 6.1 7.2 6.1 13.8 7.2 5.7 6.9 8.3 4.8 7.8 8.0 6.9 4.7 5.3 11.3 6.5 13.8 12.8 7.5 7.1 2.9 8.2 6.1

13. 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 VII IX I II X III VI V VIII

14. Median state-specific positivity rate 0 2 4 6 8 10 19979899200001020304050607 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)

15. 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

16. 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

19. 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

20. Regional Behavioral Risk Data Who collects What? How is it Used?

21. Behavioral Risk FactorRegions Condom at last sexI and X Consistent Condom Use- 12 monthsI Douching last 30 daysIX New Sex Partner 60 or 90 daysAll but II, III, V Number of Sex Partners last 30 daysIX No SexI Multiple Sex Partners NS, 60 or 90All but II, III, V Exposed to ChlamydiaIX Risk HistoryII Symptomatic Sex PartnerVI and X Monogomous Sex PartnerVI Partner with other PartnersIX and X

22. 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

23. Questions?