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Chlamydia control in Europe

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					ECDC Guidance
Chlamydia control in Europe
Marita van de Laar, programme coordinator STI/HIV/hepatitis
European Centre for Disease Prevention and Control
London, 30 June 2009
A young EU agency dedicated to the
control of communicable diseases

   ECDC became operational in May 2005
   Located in Stockholm, Sweden
   Director Zsuzanna Jakab
   27 EU Member States & 3 EFTA
   Founding regulation EC/851/2004
Disease Specific Programme
STI, HIV/AIDS and hepatitis

 Coordinate the enhanced surveillance of HIV/AIDS (2008)
  and STI (2009), prepare hepatitis B/C surveillance
 Develop standardised behavioural surveillance and to
  promote second generation surveillance in Europe
 Produce guidance documents on key prevention
  strategies including Chlamydia control, HIV testing,
  migrants, partner notification
 Establish a Monitoring and Evaluation programme to
  review national HIV/STI prevention and control programmes
 Support Member States to monitor the commitments in HIV
  Dublin Declaration and EU Action Plan against HIV
ECDC Guidance
Background and Rationale

Chlamydia is the most prevalent bacterial STI in
 Europe, affecting young people the most
Review of Chlamydia control programmes:
 10/24 countries had no national organisation of Chlamydia
  control
 5 had patient management guidelines and additional 3 had
  active case finding;
 In countries with patient management guidelines, these are
  not always available in the chlamydia testing settings
 In most countries with guidelines, partner notification is part
  of the guideline but implementation is not always clear

Source: Review of Chlamydia control programmes in EU countries. ECDC Technical Report, May 2008
ECDC Guidance
Chlamydia control in Europe

Purpose
 Provide guidance about national Chlamydia control strategy
 Facilitate the development of local evidence-based guidelines
  within the context of national Chlamydia strategies

Target audiences
 National programme managers on sexual health and STI
 Policy makers at EU and national level
 Experts involved in sexual health areas (public health,
  dermato-venerologists, gynaecologists, general practitioners,
  microbiologists, etc.)
ECDC Guidance
Chlamydia control in Europe

Developing a Chlamydia control strategy
 Step-by-step approach
 Ensure that patient management infrastructures and quality
  controls are in place before other community-based
  interventions are introduced
 National Chlamydia control strategy to ensure the
  sustainability of a comprehensive and effective control
ECDC Guidance
Chlamydia control in Europe



       Video on Chlamydia control
ECDC Guidance
Chlamydia control in Europe

Step wise approach
 A: Primary prevention
 health promotion/education, school programmes, condom
  distribution
 B: Case management
 diagnostics, patient and partner management, surveillance
 C: Opportunistic testing
 testing routinely offered to specified sub-populations attending
  clinical services
 D: Screening programme
 organised provision of Chlamydia testing to a defined
  population
ECDC Guidance
Chlamydia control in Europe
Level            Essential activities            Essential policies          Evaluation
A Primary        Sexual health/education,        Health promotion policies   Periodic surveys including
  prevention     awareness campaigns,                                        knowledge and behaviour.
                 promotion of condoms
B Case           Routine surveillance of cases   case reporting policy       Trends in case reports
  management
                 Chlamydia diagnostic services   Guidelines for diagnosis    Quality control of diagnosis
                 Clinical services               Guidelines for patient      Periodic clinical audit
                                                 management
                 Partner notification services   Guidelines for partner      Periodic audit
                                                 notification
C Opportunistic Chlamydia testing routinely      Policy on Chlamydia         Coverage of target group(s)
  testing       offered to sub-populations       testing (who, which
                (asymptomatic people)            settings_)
D Screening     Organised provision of regular   Policy on Chlamydia         Monitoring of coverage,
  programme Chlamydia testing for defined        screening                   positivity, quality
                sub-population(s)                                            Evaluation of trends in
                                                                             complications (PID, ectopic
                                                                             pregnancy, neonatal
                                                                             infections); periodic survey of
                                                                             prevalence
ECDC guidance
Chlamydia control in Europe

The costs and potential benefits of screening will depend on:
 the prevalence in a population or country
 the ability to reach high risk populations
 sexual behaviour
 sensitivity and specificity of testing methods
 uptake of screening in target populations
 uptake of/compliance with treatment

Evaluation efforts includes:
 Enhanced surveillance of Chlamydia
 Repeated surveys on Chlamydia control across Europe
ECDC guidance
Chlamydia control in Europe

Thanks to the Technical Expert Group:

   Helen Ward, United Kingdom (chair)
   Hans Fredlund, Sweden
   Hannelore Gotz, Netherlands
   Véronique Goulet, France
   Angela Robinson, United Kingdom
   Anneli Uusküla, Estonia




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