1. Chlamydia control in Europe
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

2. 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

3. 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

4. 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

5. 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.)

6. 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

7. ECDC Guidance Chlamydia control in Europe
Video on Chlamydia control

8. 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

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

10. 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

11. 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