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      Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study

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          Abstract

          Background

          A population-based study of Chlamydia trachomatis (CT) infections is essential in designing a specific control program; however, no large investigation of CT infections among the general population in mainland China has been conducted since 2000. We aimed to determine the prevalence, risk factors, and associated medical costs of CT among residents, 18–49 years of age, in Shandong, China.

          Methods

          From May to August 2016, a multistage probability sampling survey involving 8074 individuals was distributed. Data were collected via face-to-face interviews, followed by self-administered questionnaire surveys. First-void urines were collected and tested for CT and Neisseria gonorrhoeae (NG) using nucleic acid amplification.

          Results

          The weighted prevalence of CT infection was 2.3% (95% confidence interval [CI], 1.5–3.2) in females and 2.7% (1.6–3.8) in males. Women, 30–34 years of age, had the highest prevalence of CT infections (3.5%, 2.6–4.4), while the highest prevalence of CT infections in males was in those 18–24 years of age (4.3%, 0.0–8.8). Neisseria gonorrhoeae infection had a prevalence of 0.1% (0.0–0.3) in women and 0.03% (0.0–0.1) in men. Risk factors for CT infections among females included being unmarried, divorced, or widowed (odds ratio [OR], 95% CI 3.57, 1.54–8.24) and having two or more lifetime sex partners (3.72, 1.14–12.16). Among males, first intercourse before 20 years of age (1.83, 1.10–3.02) and having two or more lifetime sex partners (1.85, 1.14–3.02) were associated with CT infections. The estimated lifetime cost of CT infections in patients 18–49 years of age in Shandong was 273 million (range, 172–374 million) China Renminbi in 2016.

          Conclusions

          This study demonstrated a high burden of CT infections among females < 35 years of age and males < 25 years of age in Shandong. Thus, a CT infection control program should focus on this population, as well as others with identified risk factors.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-018-3432-y) contains supplementary material, which is available to authorized users.

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          Sexually transmitted infections: challenges ahead.

          Magnus Unemo, Catriona S. Bradshaw, Jane Hocking … (2017)
          WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
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            Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study

            Shigui Yang, Jie Wu, Cheng Ding … (2017)
            Summary Background The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies. Methods Incidence and mortality data for 45 notifiable infectious diseases were extracted from a WChinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression. Findings Between January, 2004, and December, 2013, 54 984 661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100 000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100 000), hepatitis B (81·57 per 100 000), and tuberculosis (80·33 per 100 000). 132 681 deaths were reported among the 54 984 661 cases (average yearly mortality 1·01 deaths per 100 000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100 000 in 2004 to 483·63 per 100 000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009–13 (2·3%) was significantly lower than in 2004–08 (6·2%). Interpretation Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence—including hand, foot, and mouth disease, hepatitis B, and tuberculosis—and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis). Funding Chinese Ministry of Science and Technology, National Natural Science Foundation (China).
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              Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident.

              Katherine Hendricks, Dana Meaney-Delman, Julie T Guarnizo … (2015)
              In 2014, CDC published updated guidelines for the prevention and treatment of anthrax (Hendricks KA, Wright ME, Shadomy SV, et al. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20[2]. Available at http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm). These guidelines provided recommended best practices for the diagnosis and treatment of persons with naturally occurring or bioterrorism-related anthrax in conventional medical settings. An aerosolized release of Bacillus anthracis spores over densely populated areas could become a mass-casualty incident. To prepare for this possibility, the U.S. government has stockpiled equipment and therapeutics (known as medical countermeasures [MCMs]) for anthrax prevention and treatment. However, previously developed, publicly available clinical recommendations have not addressed the use of MCMs or clinical management during an anthrax mass-casualty incident, when the number of patients is likely to exceed the ability of the health care infrastructure to provide conventional standards of care and supplies of MCMs might be inadequate to meet the demand required. To address this gap, in 2013, CDC conducted a series of systematic reviews of the scientific literature on anthrax to identify evidence that could help clinicians and public health authorities set guidelines for intravenous antimicrobial and antitoxin use, diagnosis of anthrax meningitis, and management of common anthrax-specific complications in the setting of a mass-casualty incident. Evidence from these reviews was presented to professionals with expertise in anthrax, critical care, and disaster medicine during a series of workgroup meetings that were held from August 2013 through March 2014. In March 2014, a meeting was held at which 102 subject matter experts discussed the evidence and adapted the existing best practices guidance to a clinical use framework for the judicious, efficient, and rational use of stockpiled MCMs for the treatment of anthrax during a mass-casualty incident, which is described in this report. This report addresses elements of hospital-based acute care, specifically antitoxins and intravenous antimicrobial use, and the diagnosis and management of common anthrax-specific complications during a mass-casualty incident. The recommendations in this report should be implemented only after predefined triggers have been met for shifting from conventional to contingency or crisis standards of care, such as when the magnitude of cases might lead to impending shortages of intravenous antimicrobials, antitoxins, critical care resources (e.g., chest tubes and chest drainage systems), or diagnostic capability. This guidance does not address primary triage decisions, anthrax postexposure prophylaxis, hospital bed or workforce surge capacity, or the logistics of dispensing MCMs. Clinicians, hospital administrators, state and local health officials, and planners can use these recommendations to assist in the development of crisis protocols that will ensure national preparedness for an anthrax mass-casualty incident.
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                Author and article information

                Contributors
                Pengcheng Huai:
                ORCID: http://orcid.org/0000-0002-9658-018X
                huaipengcheng@163.com
                Furong Li: lfr2008@foxmail.com
                Zhen Li: lizhen19871012@163.com
                Lele Sun: 438065194@qq.com
                Xi’an Fu: f19830827@126.com
                Qing Pan: 349385789@qq.com
                Gongqi Yu: yugongitje@163.com
                Zemin Chai: 359342307@qq.com
                Tongsheng Chu: tongshengchu@163.com
                Zihao Mi: mizihao2015@126.com
                Fangfang Bao: baofangfang2008@163.com
                Honglei Wang: hongleiwang86@163.com
                Bingni Zhou: 383118538@qq.com
                Chuan Wang: wangchuan86@126.com
                Yonghu Sun: suohandong@126.com
                Guiye Niu: miss2001flyn@126.com
                Yuan Zhang: zhangyuanbj@sina.cn
                Fanghui Fu: 1259934806@qq.com
                Xiaoqiao Lang: 289308838@qq.com
                Xiaoling Wang: 472634899@qq.com
                Hui Zhao: zhaohui7867@qq.com
                Daina Liu: 1558179042@qq.com
                Hong Liu: hongyue2519@hotmail.com
                Dianchang Liu: dianchangliu@163.com
                Jian Liu: liujian751123@163.com
                Aiqiang Xu: aqxuepi@163.com
                Furen Zhang: +86531-87298801 , zhangfuren@hotmail.com
                Journal
                Journal ID (nlm-ta): BMC Infect Dis
                Journal ID (iso-abbrev): BMC Infect. Dis
                Title: BMC Infectious Diseases
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2334
                Publication date (Electronic): 26 October 2018
                Publication date PMC-release: 26 October 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 534
                Affiliations
                [1 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, Shandong Provincial Hospital for Skin Disease, , Shandong University, ; Jinan, China
                [2 ]GRID grid.410587.f, Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, ; 27397 Jingshi Road, Jinan, 250022 China
                [3 ]ISNI 0000 0004 1761 1174, GRID grid.27255.37, Department of Epidemiology, School of Public Health, , Shandong University, ; Jinan, China
                [4 ]Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
                [5 ]ISNI 0000 0000 8803 2373, GRID grid.198530.6, Shandong Center for Disease Control and Prevention, ; Jinan, China
                Author information
                http://orcid.org/0000-0002-9658-018X
                Article
                Publisher ID: 3432
                DOI: 10.1186/s12879-018-3432-y
                PMC ID: 6204023
                PubMed ID: 30367605
                SO-VID: 1d3bff96-c84a-4954-b776-ebc999be2eee
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 23 June 2018
                Date accepted : 3 October 2018
                Funding
                Funded by: The National Key Research and Development Program of China
                Award ID: 2016YFE0201500
                Award Recipient :
                Funded by: The Innovation Project of Shandong Academy of Medical Sciences
                Funded by: The Syphilis and Other Sexually Transmitted Diseases Control Research in Shandong
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: chlamydia trachomatis,neisseria gonorrhea,prevalence,risk factor,medical cost,general population,china
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: chlamydia trachomatis, neisseria gonorrhea, prevalence, risk factor, medical cost, general population, china

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