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Aspects of Chlamydia trachomatis transmission dynamics.

机译：沙眼衣原体传播动力学方面。

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摘要

The Centers for Disease Control and Prevention (CDC) estimates between 3-4 million Chlamydia trachomatis genital infections occur each year, making it the most commonly reported sexually transmitted disease (STD) in the United States. Despite its frequency, little is known about the parameters that govern its transmission, including the average duration of infectiousness, the per-partner transmission efficiency, or the basic or effective reproductive numbers (R0 and R, respectively).;In the first study, a general method was developed to estimate the duration of infectiousness among individuals infected with C. trachomatis infections in an inner-city population of persons aged 14-24 years. Prevalence and recall data were combined with a susceptible-infectious-susceptible compartmental model and the exponential survival equation to estimate the duration of infectiousness and to compare these estimates between females and males. Duration of infectiousness was estimated to be 6.4 months, and did not vary between females (6.5 months) and males (6.2 months; recovery rate ratio = 0.95, 95% confidence interval (CI): 0.61, 1.5), in contrast to several previous studies. There was some evidence that study site was an effect measure modifier. In Boston, MA, the recovery rate ratio = 0.67, 95% Cl: 0.3, 2; in Indianapolis, IN, the recovery rate ratio = 1.0, 95% CI: 0.6, 1.8.;In the second study, the basic and effective reproductive numbers and 95% simulation intervals (SI) were estimated among cases in a cross-sectional study. The basic reproductive number (R0) describes the epidemic potential of a pathogen when a small number of cases are introduced into a population where most individuals are susceptible. The effective reproductive number (R) describes transmission when a pathogen has already established itself. In this study, R0 = 1.0, 95% SI: 0.7, 1.6. Thus, on average, each infectious host spread C. trachomatis to one sex partner while infectious. However, given a prevalence of 44%, C. trachomatis already has a foothold in the study population. The effective reproductive number, R, was therefore appropriate to describe the epidemic potential of C. trachomatis: R = 0.56, 95% SI: 0.41, 0.87. This indicated that fewer than one susceptible individual was infected by each infectious host. The elevated prevalence in the study population may dampen or may have dampened the potential for an epidemic to occur. Despite substantial heterogeneity in the contact rate, the assumption of random mixing was met: prevalence was nearly equal in all quintiles of the average weighted contact rate. Though counterintuitive, reducing the number of partners per unit time, a common strategy in STD prevention, may not result in a subsequent decrease in prevalence without first initiating a mass screening and treatment campaign.;In study three, the relation between age (10-19 years vs. 20 years and over) at the first reported C. trachomatis infection and the hazard of repeat infection was examined using routinely collected STD data from the Chicago Department of Public Health. Those aged 10-19 years at the initial report were 2.26 times more likely to have a repeat infection over follow-up than those aged 20 years and older. When five-year age strata were examined, there was an inverse association between age and the hazard of repeat infection. Those aged 10-14 years were almost 7 times more likely to have a repeat C. trachomatis infection over follow-up than those aged 35 years and older (hazard ratio = 6.9, 95% CI = 6.3, 7.5).;These three studies have brought together aspects of transmission dynamics and epidemiologic methods in order to provide estimates of key transmission parameters that influence the spread of C. trachomatis. , Though often difficult to estimate, obtaining valid and precise estimates of these parameters is critical in order to evaluate current practices and to develop new strategies to halt the spread of STDs, generally, and C. trachomatis, in particular.
机译：疾病控制与预防中心（CDC）估计，每年发生3-4百万个沙眼衣原体生殖器感染，使其成为美国最常报告的性传播疾病（STD）。尽管其频率很高，但控制其传播的参数知之甚少，包括平均传染性持续时间，每位伴侣的传播效率或基本或有效生殖数（分别为R0和R）。开发了一种通用方法来估计在城市中心年龄为14-24岁的人群中被沙眼衣原体感染的个体的传染性持续时间。患病率和召回率数据与易感性-传染性-易感性区室模型和指数生存方程相结合，以估计传染性的持续时间，并在男性和女性之间比较这些估计。传染病的持续时间估计为6.4个月，女性（6.5个月）和男性（6.2个月；恢复率= 0.95，95％置信区间（CI）：0.61、1.5）之间没有差异。学习。有证据表明，研究地点是一种效果量度的改进剂。在马萨诸塞州波士顿，回收率比= 0.67，95％Cl：0.3，2；在印第安纳州印第安纳波利斯，恢复率= 1.0，95％CI：0.6，1.8。在第二项研究中，横断面研究的病例中估计了基本有效生殖数和95％模拟间隔（SI） 。基本生殖数（R0）描述了当少数病例被引入到大多数易感人群中时的病原体流行潜力。有效生殖数（R）描述了病原体已经建立的传播。在这项研究中，R0 = 1.0，95％SI：0.7、1.6。因此，平均而言，每个感染宿主在感染时会将沙眼衣原体传播给一个性伴侣。但是，鉴于流行率为44％，沙眼衣原体已经在研究人群中立足。因此，有效生殖数R适合描述沙眼衣原体的流行潜力：R = 0.56，95％SI：0.41，0.87。这表明每个感染宿主感染的感染个体少于一个。研究人群中较高的患病率可能会抑制或可能已经抑制了发生流行病的可能性。尽管接触率存在很大的异质性，但可以满足随机混合的假设：在所有五分位数的平均加权接触率中，患病率几乎相等。尽管违反直觉，减少性病预防中的常见策略是减少每单位时间的伴侣数量，但未先启动大规模筛查和治疗运动可能不会导致随后的患病率下降。；在研究三中，年龄之间的关系（10-首次报告的沙眼衣原体感染为19岁vs. 20岁及20岁以上），并使用从芝加哥公共卫生部常规收集的STD数据检查了重复感染的危害。在初次报告中，年龄在10-19岁的人在重复随访中发生重复感染的可能性是20岁以上的人的2.26倍。当检查五岁年龄层时，年龄与重复感染的危险性之间呈负相关。这三项研究的结果是，年龄在10至14岁之间的人在随访中重复发生沙眼衣原体感染的几率是35岁以上的人的7倍（危险比= 6.9，95％CI = 6.3，7.5）。为了提供影响沙眼衣原体传播的关键传播参数的估计值，已经将传播动力学和流行病学方法结合在一起。 ，尽管通常难以估计，但是获得这些参数的有效和精确的估计对于评估当前的实践并制定新的策略来制止性传播疾病（尤其是沙眼衣原体）的传播至关重要。

著录项

  • 作者

    Christiansen, Demian.;

  • 作者单位

    Boston University.;

  • 授予单位 Boston University.;
  • 学科 Epidemiology.
  • 学位 Sc.D.
  • 年度 2007
  • 页码 150 p.
  • 总页数 150
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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