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Canadian Journal of Public Health

, Volume 101, Issue 5, pp 420–424 | Cite as

Upsurge of Chlamydial Reinfection in a Large Canadian City: An Indication of Suboptimal Chlamydia Screening Practices?

  • Mélissa Généreux
  • Pascale Leclerc
  • Lucie Bédard
  • Robert Allard
Quantitative Research

Abstract

Objectives

Given the limited knowledge on chlamydial reinfection (CR) in Canada, we examined the extent and predictors of CR in Montréal, a large Canadian city.

Methods

We retrospectively studied all Montréal residents aged ≥10 years for whom ≥1 laboratory-confirmed chlamydial infection was reported to the public health department between 1988 and 2007 (n=44,580). Each person was passively followed for two years after baseline infection or until reinfection. Socio-demographic factors and histories of other notifiable diseases were examined as potential predictors. Cox multivariate regression was used to model the time to CR. Survival analyses were stratified by age group (<25 vs. ≥25 years).

Results

We estimated an overall two-year CR rate of 6.4%, an incidence density of 3.5 per 100 person-years, and a median time to reinfection of nine months. CR significantly increased over time. Among persons <25 years, reinfection was significantly more likely among females [adjusted hazard ratio (AHR): 1.58] and younger participants (10–14 years: AHR: 2.98; 15–19 years: AHR: 1.81). Residing within the South Central sector was deleterious for six months following initial infection after which it became protective. Among persons ≥25 years, a history of sexually transmitted infections increased the risk of reinfection (AHR: 1.79).

Conclusion

CR is a significant and growing problem in Montréal. The current recommendation for a single repeat screening six months post-treatment might be usefully complemented with additional screenings. Our results also underscore the importance of screening high-risk populations, particularly young women.

Key words

Chlamydia trachomatis urban spatial distribution epidemiologic determinant public health infectious disease reporting survival analysis 

Résumé

Objectifs

Étant donné les connaissances limitées sur la récidive de chlamydiose au Canada, nous avons examiné son ampleur ainsi que ses déterminants dans une grande ville Canadienne.

Méthodes

Nous avons inclus dans cette étude rétrospective tous les résidents de Montréal ≥10 ans avec ≥1 épisode de chlamydiose confirmé en laboratoire et rapporté à la Direction de santé publique entre 1988 et 2007 (n=44 580). Chaque personne a été suivie passivement pour une période de deux ans suivant l’infection initiale ou jusqu’à la récidive. Les facteurs sociodémographiques et les antécédents d’autres maladies à déclaration obligatoire ont été examinés en tant que déterminants. Une régression multivariée de Cox a été utilisée pour modéliser le temps jusqu’à la récidive. Les analyses de survie ont été stratifiées selon le groupe d’âge (<25 contre ≥25 ans).

Résultats

Nous avons estimé un taux de récidive sur deux ans de 6,4 %, une densité d’incidence de 3,5/100 personne-années, et un temps médian de récidive de neuf mois. Parmi les personnes <25 ans, la récidive était significativement plus fréquente chez les femmes [ratio de risque ajusté (RRA): 1,58] et chez les adolescents (10–14 ans: RRA: 2,98; 15–19 ans: RRA: 1,81). Vivre dans le secteur centre-sud était délétère au cours des six premiers mois suivant l’infection initiale puis devenait par la suite un facteur protecteur. Chez les personnes ≥25 ans, un antécédent d’infection transmise sexuellement augmentait le risque de récidive (RRA: 1,79).

Conclusion

La récidive de chlamydiose est un problème préoccupant et grandissant à Montréal. La recommandation actuelle de répéter le dépistage six mois suivant une première infection gagnerait à être accompagnée de dépistages additionnels. Nos résultats supportent aussi le dépistage des populations à haut risque, particulièrement les jeunes femmes.

Mots clés

Chlamydia trachomatis distribution spatiale déterminants de la santé santé publique maladies à déclaration obligatoire analyse de survie 

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Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Mélissa Généreux
    • 1
    • 2
  • Pascale Leclerc
    • 3
  • Lucie Bédard
    • 3
    • 4
  • Robert Allard
    • 3
    • 4
    • 5
  1. 1.Département des sciences de la santé communautaire, Pavillon Gérald-LasalleFaculté de médecine et des sciences de la santé, Université de SherbrookeSherbrookeCanada
  2. 2.Direction de santé publique et de l’évaluation de l’Agence de la santé et des services sociaux de l’EstrieSherbrookeCanada
  3. 3.Direction de santé publique de l’Agence de la santé et des services sociaux de MontréalMontréalCanada
  4. 4.Département de médecine sociale et préventive, Faculté de médecineUniversité de MontréalMontréalCanada
  5. 5.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalCanada

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