Examination of links between herpes zoster incidence and childhood varicella vaccination.

BACKGROUND: Introduction of a universal varicella vaccine program for U.S. children in 1996 sparked concern that less-frequent exposure to varicella would decrease external boosting of immunity to varicella zoster virus and thereby increase incidence of herpes zoster (HZ). OBJECTIVE: To determine whether the varicella vaccination program has influenced trends in HZ incidence in the U.S. population older than 65 years. DESIGN: Retrospective study of Medicare claims. SETTING: Medicare, 1992 through 2010. PARTICIPANTS: 2 848 765 beneficiaries older than 65 years. MEASUREMENTS: Annual HZ incidence from 1992 through 2010; rate ratios (RRs) for HZ incidence by age, sex, and race or ethnicity; and state-level varicella vaccination coverage. RESULTS: 281 317 incident cases of HZ occurred. Age- and sex-standardized HZ incidence increased 39% from 10.0 per 1000 person-years in 1992 to 13.9 per 1000 person-years in 2010 with no evidence of a statistically significant change in the rate of increase after introduction of the varicella vaccination program. Before introduction of this program, HZ incidence was higher in women (RR, 1.21 [95% CI, 1.19 to 1.24]) than men and was lower in black persons (RR, 0.51 [CI, 0.48 to 0.53]) and Hispanic persons (RR, 0.76 [CI, 0.72 to 0.81]) than white persons. In a model adjusted for sex, age, and calendar year from 1997 to 2010, HZ incidence did not vary by state varicella vaccination coverage (RR, 0.9998 [CI, 0.9993 to 1.0003]). LIMITATION: Uncertain level and consistency of health-seeking behavior and access and uncertain accuracy of disease coding. CONCLUSION: Age-specific HZ incidence increased in the U.S. population older than 65 years even before implementation of the childhood varicella vaccination program. Introduction and widespread use of the vaccine did not seem to affect this increase. This information is reassuring for countries considering universal varicella vaccination. PRIMARY FUNDING SOURCE: None.

Sex and age correlates of Chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: implications for screening policy.

OBJECTIVES: To evaluate sex and age correlates of chlamydia prevalence in incarcerated populations. METHODS: Cross-sectional analysis of chlamydia prevalence by demographic characteristics from incarcerated females and males entering selected juvenile and adult correctional facilities (jails) in the United States in 2005. RESULTS: A total of 97,681 and 52,485 incarcerated persons aged >/=12 years were screened for chlamydia in 141 juvenile and 22 adult correctional facilities, respectively. Overall, chlamydia prevalence was high in females (14.3% and 7.5%) in both juvenile and adult facilities when compared with that in males (6.0% and 4.6%). The chlamydia prevalence was higher in incarcerated females than in incarcerated males for persons 40 years; in males it was 8.8% in 18- to 20-year olds compared with 1.4% in those >40 years. CONCLUSIONS: The consistently high chlamydia prevalence among females in juvenile facilities and females (

Estimates of Chlamydia trachomatis infections among men: United States.

OBJECTIVE: To describe the epidemiology of genital Chlamydia trachomatis infections among men in the United States. STUDY DESIGN: Data from the notifiable disease case surveillance system, the National Health and Nutrition Examination Survey (NHANES), the National Longitudinal Study of Adolescent Health (AddHealth), the National Job Training Program, the Men Having Sex with Men (MSM) Prevalence Monitoring Project, and adult and juvenile corrections facilities were used to summarize national chlamydia case and prevalence rates. Data were stratified by age and race/ethnicity. RESULTS: In 2005, 232,781 chlamydia cases among men were reported, corresponding to a rate of 161.1 cases per 100,000 men, an increase of 43.5% compared with the case rate in 2001 (112.3). Population-based chlamydia prevalence rates from NHANES (1999-2002) were highest among men aged 20 to 29 years (3.2%); men aged 18 to 26 years participating in AddHealth (2001-2002) had a 3.7% prevalence rate. Rates were highest among black men in both NHANES (5.3%) and AddHealth (11.1%). The prevalence rate among men (aged 16-24 years) participating in the National Job Training Program was 8.1%. Among MSM, the 2005 median urethral chlamydia prevalence rate was 6%. Overall, chlamydia rates were highest in adult corrections facilities; the 2005 positivity rate among men aged 21 to 25 years was 7.8%. In juvenile corrections facilities, the 2005 positivity rate among men aged 15 to 17 years was 6.7%. CONCLUSIONS: Rates of genital C. trachomatis infections among men are persistently high, particularly among men entering the National Job Training Program and men in corrections facilities. The burden of disease is generally highest among young men and black men.

Factors associated with recurrent chlamydial infection and failure to return for retesting in young women entering national job training program, 1998--2005.

OBJECTIVES: To evaluate factors associated with recurrent chlamydial infection and failure to return for retesting in socioeconomically disadvantaged women (aged 16-24 years) entering the National Job Training Program, 1998--2005. GOAL: To evaluate sociodemographic characteristics of young women associated with recurrent chlamydial infection. STUDY DESIGN: We computed chlamydia prevalence at initial visit and recurrent infection (defined as a positive chlamydia test 1-2 months after completing treatment) and percent of infected women who were retested by sociodemographic variables. RESULTS: At entrance, women had a high prevalence of chlamydia infection (10.7%). Chlamydia prevalence varied by age, race/ethnicity, and place of residence (South, Midwest, Northeast, and West), year of test, and type of test. Among women infected at initial visit, younger aged women (16-17 years), blacks and Hispanics, those who resided in the South and Midwest, and those tested in 1998--2000 were less likely to be retested. Of the 13,550 infected women, 5,892 (43.5%) were retested. Of those retested, 332 (5.6%) had recurrent infection 1-2 months after completing treatment. Although chlamydia prevalence at retesting did not differ significantly by sociodemographic characteristics, the pattern of the prevalence was similar to the pattern at the initial test. Multivariate logistic regression analyses showed similar findings. CONCLUSIONS: The high prevalence of recurrent infection in these women may be due to reinfection and/or treatment failure. The findings of this analysis underscore the need for retesting infected women regardless of their demographic characteristics.

Prevalence trends in chlamydial infections among young women entering the national job training program, 1998-2004.

OBJECTIVES: To assess the trends and risk factors of chlamydial infections in disadvantaged women aged 16 to 24 years entering a national job training program. GOAL: To assess the impact of chlamydia screening program on chlamydia trend. STUDY DESIGN: The authors calculated the prevalence of chlamydia by demographic and geographic characteristics from 106,377 women who were screened from 1998 through 2004. RESULTS: Chlamydia prevalence was inversely associated with age, decreasing from 12.7% in women aged 16 to 17 years to 6.6% in women aged 22 to 24 years. Blacks had the highest prevalence (13.1%). Chlamydia prevalence significantly decreased from 11.7% in 1998 to 10.0% in 2003 and then slightly increased to 10.3% in 2004. After direct standardization and adjustment for the laboratory test type, a similar trend was observed by age and race/ethnicities. CONCLUSIONS: Among disadvantaged women aged 16 to 24 years entering a national job training program, the chlamydia prevalence and racial disparities in prevalence were consistently high from 1998 to 2004, especially among younger black women.

Prevalence of Chlamydia in young men in the United States from newly implemented universal screening in a national job training program.

OBJECTIVE: The objective of this study was to examine chlamydia prevalence and its risk factors from the first universal screening in socioeconomically disadvantaged young men. GOAL: The goal of this study was to evaluate the need for universal screening in young men. STUDY DESIGN: We calculated chlamydia prevalence by demographic and geographic characteristics from 51,478 men aged 16 to 24 years who were screened from July 2003 to December 2004. RESULTS: Overall, chlamydia prevalence was 8.2%. Only 2.4% of the young men had sexually transmitted disease symptoms. Blacks had the highest prevalence (13.0%), whereas non-Hispanic whites had the lowest (3.1%). Men who smoked marijuana had a significantly higher prevalence compared with those who did not (11.9% vs. 6.4%). Men who used cocaine or PCP also had a significantly higher chlamydia prevalence compared with those who did not. Men who lived in the southern region of the United States had the highest prevalence. CONCLUSIONS: Chlamydial infection is highly prevalent among socioeconomically disadvantaged young men. Young men entering the National Job Training Program represent an important population for screening.

Sexually transmitted diseases in incarcerated adolescents.

PURPOSE OF REVIEW: The objectives of this review are to summarize recent developments in the epidemiology of sexually transmitted disease in incarcerated adolescents and to review screening and treatment recommendations for sexually transmitted disease in juvenile corrections facilities. RECENT FINDINGS: The introduction of non-invasive, urine-based nucleic acid-amplification tests for chlamydia and gonorrhea has led to a dramatic increase in the ability to screen for chlamydia and gonorrhea in non-traditional settings, including corrections facilities. The prevalence of chlamydia and gonorrhea has been uniformly high in incarcerated adolescents. The prevalences of chlamydia and gonorrhea in adolescents aged 18-19 years incarcerated in adult corrections facilities were higher than those incarcerated in juvenile facilities. The prevalence was higher in incarcerated adolescent women than adolescent men and in black adolescents than non-black adolescents. Screening for chlamydia in incarcerated adolescents has been shown to be a cost-effective strategy for preventing adverse health consequences. Syphilis prevalence in incarcerated adolescents is relatively low. Hepatitis B is relatively common among incarcerated adolescents. SUMMARY: The high prevalence of chlamydia in incarcerated adolescents and gonorrhea in incarcerated adolescent women suggests that screening of these populations should be a priority. The reasons for the higher prevalence of chlamydia and gonorrhea in young adults aged 18-19 years incarcerated in selected adult corrections facilities compared with those incarcerated in juvenile facilities should be investigated. Hepatitis B virus vaccination in juvenile correction facilities is recommended to prevent and control the transmission of this disease.

Changing patterns in sexually transmitted disease syndromes in Kenya after the introduction of a syndromic management program.

OBJECTIVE: The objective of this study was to evaluate patterns in sexually transmitted disease (STD) syndromes after the introduction of an STD syndromic management program. STUDY: We used the HIV sentinel surveillance in patients with STDs (1990-2001) to compute the proportions of STD syndromes (as a proportion of all patients with STDs) before and after the introduction of the syndromic management program. RESULTS: A decline in the proportion of genital ulcer disease (GUD), urethral discharge (UD), and vaginal discharge (VD) was observed from the baseline (1990-1994) to the year 2000 (P <0.0001). GUD declined from 27.6% at baseline to 11.0% in 2000; UD from 31.8% at baseline to 22.2% in 2000; and VD from 36.7% at baseline to 20.1% in 2000. Similar declines for these syndromes were also observed in sex and age groups. The proportions of GUD, UD, and UV increased again in 2001. CONCLUSIONS: These changing patterns of STD syndromes were coincident with the introduction of the STD syndromic management program in 1995 and the termination of free STD medication in 2001.