Appendix A: Disease-Specific Chapters

Transcription

1 Infectious Diseases Protocol Appendix A: Disease-Specific Chapters Chapter: Chlamydia trachomatis infections Revised January 2014

2 Chlamydia trachomatis infections Communicable Virulent Health Protection and Promotion Act: Ontario Regulation 558/91 Specification of Communicable Diseases Health Protection and Promotion Act: Ontario Regulation 559/91 Specification of Reportable Diseases 1.0 Aetiologic Agent Chlamydia trachomatis is an obligate intracellular bacterium causing genital infections and other forms of infections including chlamydial conjunctivitis and pneumonia Surveillance Case Definition See Appendix B 1.2 Outbreak Case Definition The outbreak case definition varies with the outbreak under investigation.consideration should be given to the provincial surveillance case definition and the following criteria when establishing an outbreak case definition: 1. Clinical, laboratory and/or epidemiological criteria; 2. The time frame for occurrence; 3. A geographic location(s) or place(s) where cases live or became ill/exposed; and, 4. Special attributes of cases (e.g., age, underlying conditions). Outbreak cases may be classified by levels of probability (i.e., confirmed, probable and/or suspect). 2.0 Identification 2.1 Clinical Presentation Chlamydia infection is often asymptomatic including pharyngeal and rectal infections. If symptoms are present in rectal infections individuals often display rectal discharge and pain. Males may present with urethral discharge, dysuria and frequency, non-specific urethral symptoms such as redness, itching, and swelling. 1, 2 Females may present with cervical infection that includes the following signs and symptoms: a mucopurulent endocervical discharge with edema, dysuria, dyspareuira, erythema and easily induced endocervical bleeding. Complications and sequelae include salpingitis pelvic inflammatory disease with subsequent risk of infertility. Salpingitis and pelvic inflammatory disease can also be symptoms of chlamydia requiring treatment. Up to 70% of sexually active females with chlamydia infection are asymptomatic. 1 2

3 Can present as chlamydial pneumonia and conjunctivitis (Ophthalmia neonatorum) in infants. 1 For more information regarding chlamydial conjunctivitis in infants, please refer to the Ophthalmia neonatorum Disease-Specific Chapter. 2.2 Diagnosis See Appendix B for diagnostic criteria relevant to the Case Definitions. For further information about human diagnostic testing, contact the Public Health Ontario Laboratories or refer to the Public Health Ontario Laboratory Services webpage: px 3.0 Epidemiology 3.1 Occurrence Common worldwide. 1 In Ontario, chlamydia is the most commonly reported sexually transmitted infection (STI). Between 2007 and 2011, an average of 29,632 chlamydia cases was reported each year. The rate of chlamydia is higher among females, and has been rising up to the end of Reported rates are highest among youth and young adults aged 15 to 24 years. For more information on infectious diseases activity in Ontario, refer to the current versions of the Ontario Annual Infectious Diseases Epidemiology Reports and the Monthly Infectious Diseases Surveillance Report. 3, Reservoir Humans Modes of Transmission Sexual contact via oral, vaginal, cervical, urethral or anal routes; in children, exposure to infected genitals (consider the possibility of sexual abuse in these cases); newborns: during delivery from infected mother. 1, Incubation Period From time of exposure to onset of symptoms is 2-3 weeks, but can be as long as 6 weeks Period of Communicability Unknown; may extend for months or longer if untreated, especially in asymptomatic persons; re-infections are common; effective treatment ends infectivity. 1 If receiving single dose therapy, individuals should abstain from unprotected sexual activity for 7 days. 2 Re-infection is common (e.g. after 28 days). For surveillance purposes, if the four factors noted in the Provincial Case Definition for Chlamydia are met, health units may consider 28 days for re-infection 3

4 3.6 Host Susceptibility and Resistance General susceptibility Reporting Requirements 4.1 To local Board of Health Individuals who have or may have chlamydia shall be reported to the medical officer of health by persons required to do so under the Health Protection and Promotion Act, R.S.O (HPPA) To the Ministry of Health and Long-Term Care (the ministry) or Public Health Ontario (PHO), as specified by the ministry Report only case classifications specified in the case definition. Cases shall be reported using the integrated Public Health Information System (iphis), or any other method specified by the Ministry within five (5) business days of receipt of initial notification as per iphis Bulletin Number 17: Timely Entry of Cases and Outbreaks. 6 The minimum data elements to be reported for each case is specified in the following: Ontario Regulation 569 (Reports) under the HPPA; 7 The iphis User Guides published by PHO; and, Bulletins and directives issued by PHO. 5.0 Prevention and Control Measures 5.1 Personal Prevention Measures Preventive measures include education about safer sex practices including use of condoms and early detection of infection by screening those at risk. 2 Screening should be offered to all sexually active persons as per the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2008 (or as current). 5.2 Infection Prevention and Control Strategies Refer to Public Health Ontario s website at to search for the most up-to-date Provincial Infectious Diseases Advisory Committee (PIDAC) best practices on Infection Prevention and Control (IPAC). PIDAC best practice documents can be found at: AC_Documents.aspx. 5.3 Management of Cases Case management should consider the PIDAC Sexually Transmitted Infections Case Management and Contact Tracing Best Practice Recommendations, April 2009 (or as current). 8 4

5 Treatment determined as per attending health care provider; refer to the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2008 (or as current) for a list of publicly funded STI medications, and the Canadian Guidelines on Sexually Transmitted Infections, 2008 edition (or as current), 2 for treatment recommendations. 5.4 Management of Contacts For recommendations on contact management refer to PIDAC Sexually Transmitted Infections Case Management and Contact Tracing Best Practice Recommendations, April 2009 (or as current) 8 and the Canadian Guidelines on Sexually Transmitted Infections, 2008 edition (or as current). 2 Contact management of cases should be guided by the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2008 (or as current). 5.5 Management of Outbreaks Consult Public Health Ontario if an outbreak is suspected. Provide public health management of outbreaks or clusters in order to identify the source of illness and stop the outbreak. As per the Infectious Diseases Protocol, 2008 (or as current) outbreak management shall comprise of but not be limited to the following general steps: Confirm diagnosis and verify the outbreak; Establish an outbreak team; Develop an outbreak case definition; Implement prevention and control measures; Implement and tailor communication and notification plans depending on the scope of the outbreak; Conduct epidemiological analysis on data collected; Conduct environmental inspections of implicated premise where applicable; Coordinate and collect appropriate clinical specimens where applicable; Prepare a written report; and, Declare the outbreak over in collaboration with the outbreak team currently reviewing them. 6.0 References 1. Heymann DL, editor. Control of communicable diseases manual. 19th ed. Washington, DC: American Public Health Association; Expert Working Group on the Canadian Guidelines on Sexually Transmitted Infections; Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections. Evergreen ed. Ottawa, ON: Her Majesty the Queen in Right of Canada; 2013 [cited 2013 Aug 27]. Available from: 3. Ontario. Ministry of Health and Long-Term Care. Ontario annual infectious diseases epidemiology report, Toronto, ON: Queen s Printer for Ontario; 2009 (or as current). Available from: 5

6 port_2009.pdf 4. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Monthly infectious diseases surveillance report. Toronto, ON: Queen s Printer for Ontario; Available from: nthly-infectious-diseases-surveillance-report.aspx 5. Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Available from 6. Ontario. Ministry of Health and Long-Term Care. Timely entry of cases and outbreaks. iphis bulletin. Toronto, ON: Queen s Printer for Ontario; 2012:17 (or as current). 7. Reports, R.R.O. 1990, Reg Available from: 8. Provincial Infectious Diseases Advisory committee (PIDAC), Ontario. Ministry of Health and Long-Term Care. Sexually transmitted infections case management and contact tracing best practice recommendations. Toronto, ON: Queen s Printer for Ontario; Available from: ontact%20tracing.pdf 7.0 Additional Resources Ontario. Ministry of Health and Long-Term Care. Sexual health and sexually transmitted infections prevention and control protocol, 2013 (revised). Toronto, ON: Queen s Printer for Ontario; 2013 Available from: _sti.pdf Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Routine practices and additional precautions in all health care settings. 3rd ed. Toronto, ON: Queen s Printer for Ontario; Available from: Document History Table 1: History of Revisions Revision Date Document Section Description of Revisions January 2014 General New template. Title of Section 3.6 changed from Susceptibility and Resistance to Host Susceptibility and Resistance Title of Section 4.2 changed from To Public Health Division (PHD) to To the Ministry of Health and Long-Term Care (the ministry) or Public Health Ontario (PHO), as specified by the 6

7 Revision Date Document Section Description of Revisions 1.2 Outbreak Case Definition 2.1 Clinical Presentation ministry Section 8.0 Document History added. Entire section revised. First paragraph changed from Chlamydia infection is frequently asymptomatic. to Chlamydia infection is often asymptomatic including pharyngeal and rectal infections. If symptoms are present in rectal infections individuals often display rectal discharge and pain. Addition of fourth paragraph Complications Final paragraph changed from Can present as Chlamydia pneumonia in infants. to Can present as chlamydial pneumonia and conjunctivitis (Ophthalmia neonatorum) in infants. For more information regarding chlamydial conjunctivitis in infants, please refer to the Ophthalmia neonatorum Disease-Specific Chapter. 2.2 Diagnosis Addition of the second paragraph: For further information 3.1 Occurrence First paragraph changed from Common worldwide; high rates of infection among sexually active persons. to Common worldwide. Second paragraph changed from In Ontario, Chlamydia is the most commonly reported STI. The rate of Chlamydia is higher among females, and has been rising. Reported rates are highest among youth and young adults aged 15 to 24 years. to In Ontario, chlamydia is the most commonly reported sexually transmitted infection (STI). Between 2007 and 2011, an average of 29,632 chlamydia cases was reported each year. The rate of chlamydia is higher among females, and has been rising up to the end of Reported rates are highest among youth and young adults aged 15 to 24 years. Addition of third paragraph For more 7

8 Revision Date Document Section Description of Revisions information 3.4 Incubation Period First sentence changed from.onset of infection to onset of symptoms 3.5 Period of Communicability 3.6 Host Susceptibility and Resistance First paragraph, addition of second sentence If receiving Addition of second paragraph Re-infection is common First and second paragraph replaced with General susceptibility. 5.2 Infection Prevention and Control Strategies 5.3 Management of Cases Entire section revised. First two paragraphs were deleted: Refer to Ontario Regulation 569 for relevant data to collect and ensure to inquire about the following: history of exposure; contact history and assess for risk factors and Provide education about and promote safer sex practices and advise about the need to test for HIV infection and other STIs if indicated (2). Reference to PIDAC Sexually Transmitted Infections Case Management and Contract Tracing Best Practice Recommendations, April 2009 added. Final paragraph changed from Treatment determined as per attending health care provider; refer to the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2008 (or as current) for the following sections, and the Canadian Guidelines on Sexually Transmitted Infections, Public Health Agency of Canada, 2008 edition. to Treatment determined as per attending health care provider; refer to the Sexual Health and Sexually Transmitted Infections Prevention and Control Protocol, 2008 (or as current) for a list of publicly funded STI medications, and the 8

9 Revision Date Document Section Description of Revisions 5.4 Management of Contacts 5.5 Management of Outbreaks 6.0 References Updated. 7.0 Additional Resources Canadian Guidelines on Sexually Transmitted Infections, 2008 edition (or as current), 2 for treatment recommendations. Entire section revised. Entire section revised. Updated. 9

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