ECDC Chlamydia Control in Europe Guidance 2015 – Advancing Chlamydia Prevention and Control Activities in the European Union/European Economic Area (EU/EEA)

Background:  Chlamydia trachomatis is the most frequently reported sexually transmitted infection in the EU/EEA, with 396,128 cases reported in 2014, 63% among 15-24 year-olds. National rates ranged from <1 to 549 diagnoses per 100,000 population, reflecting differences in control activities intensity and surveillance across countries. The recentely published ECDC Chlamydia Control in Europe Guidance 2015 is an update of the 2009 edition and aims at supporting EU/EEA countries to develop, implement and improve their chlamydia control activities.

Methods:  A technical group convened by ECDC critically reviewed the scientific evidence on the epidemiology and natural history of chlamydia and on the clinical impact and cost-effectiveness of screening programmes. This evidence was supplemented by a mapping of chlamydia control policies through a EU/EEA countries survey in 2012 and a qualitative assessment of the 2009 guidance impact on chlamydia policy changes. An expert panel consultation in 2014 provided further insight about the use of guidance first edition, discussed the evidence-review and survey findings and made suggestions for guidance revision.

Results:  Evidence was found that widespread testing can reduce the risk of pelvic inflammatory disease within one year after testing (RR= 0.64 [95%CI 0.44-0.9]) but not the prevalence of infection. The 2009 guidance has been used for policy changes by 11/25 countries. The minimum level for chlamydia prevention and control activities recommended by 2015 guidance includes: a national strategy/plan for STIs control, primary STIs prevention activities, evidence-based case management guidelines (with partner notification), surveillance of diagnosed cases and evaluation plan for the strategy. Widespread opportunistic testing or a screening programme is recommended if resources exist and adequate monitoring and evaluation implemented.

Conclusions:  Although the evidence-base for chlamydia control policies has advanced since 2009, future research is needed on the natural history of infection and the impact of interventions at population level.  ECDC’s guidance policy options should be considered by Member States according to their specific epidemiological, healthcare and resource environments.