Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-30 (of 34 Records) |
Query Trace: Gottlieb SL [original query] |
---|
Vaccine value profile for Neisseria gonorrhoeae
Lyu Y , Choong A , Chow EPF , Seib KL , Marshall HS , Unemo M , de Voux A , Wang B , Miranda AE , Gottlieb SL , Mello MB , Wi T , Baggaley R , Marshall C , Abu-Raddad LJ , Abara WE , Chen XS , Ong JJ . Vaccine 2023 Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports. |
Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis
Smith ER , Oakley E , Grandner GW , Ferguson K , Farooq F , Afshar Y , Ahlberg M , Ahmadzia H , Akelo V , Aldrovandi G , Tippett Barr BA , Bevilacqua E , Brandt JS , Broutet N , Fernández Buhigas I , Carrillo J , Clifton R , Conry J , Cosmi E , Crispi F , Crovetto F , Delgado-López C , Divakar H , Driscoll AJ , Favre G , Flaherman VJ , Gale C , Gil MM , Gottlieb SL , Gratacós E , Hernandez O , Jones S , Kalafat E , Khagayi S , Knight M , Kotloff K , Lanzone A , Le Doare K , Lees C , Litman E , Lokken EM , Laurita Longo V , Madhi SA , Magee LA , Martinez-Portilla RJ , McClure EM , Metz TD , Miller ES , Money D , Moungmaithong S , Mullins E , Nachega JB , Nunes MC , Onyango D , Panchaud A , Poon LC , Raiten D , Regan L , Rukundo G , Sahota D , Sakowicz A , Sanin-Blair J , Söderling J , Stephansson O , Temmerman M , Thorson A , Tolosa JE , Townson J , Valencia-Prado M , Visentin S , von Dadelszen P , Adams Waldorf K , Whitehead C , Yassa M , Tielsch JM . BMJ Glob Health 2023 8 (1) INTRODUCTION: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS: This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol. |
Gonococcal vaccines: Public health value and preferred product characteristics; report of a WHO global stakeholder consultation, January 2019
Gottlieb SL , Ndowa F , Hook EW3rd , Deal C , Bachmann L , Abu-Raddad L , Chen XS , Jerse A , Low N , MacLennan CA , Petousis-Harris H , Seib KL , Unemo M , Vincent L , Giersing BK . Vaccine 2020 38 (28) 4362-4373 Renewed interest in developing vaccines against Neisseria gonorrhoeae has been sparked by the increasing threat of gonococcal antimicrobial resistance (AMR) and growing optimism that gonococcal vaccines are biologically feasible. Evidence suggests serogroup B Neisseria meningitidis vaccines might provide some cross-protection against N. gonorrhoeae, and new gonococcal vaccine candidates based on several approaches are currently in preclinical development. To further stimulate investment and accelerate development of gonococcal vaccines, greater understanding is needed regarding the overall value that gonococcal vaccines might have in addressing public health and societal goals in low-, middle-, and high-income country contexts and how future gonococcal vaccines might be accepted and used, if available. In January 2019, the World Health Organization (WHO) convened a multidisciplinary international group of experts to lay the groundwork for understanding the potential health, economic, and societal value of gonococcal vaccines and their likely acceptance and use, and for developing gonococcal vaccine preferred product characteristics (PPCs). WHO PPCs describe preferences for vaccine attributes that would help optimize vaccine value and use in meeting the global public health need. This paper describes the main discussion points and conclusions from the January 2019 meeting of experts. Participants emphasized the need for vaccines to control N. gonorrhoeae infections with the ultimate goals of preventing adverse sexual and reproductive health outcomes (e.g., infertility) and reducing the impact of gonococcal AMR. Meeting participants also discussed important PPC considerations (e.g., vaccine indications, target populations, and potential immunization strategies) and highlighted crucial research and data needs for guiding the value assessment and PPCs for gonococcal vaccines and advancing gonococcal vaccine development. |
Advancing the public health applications of Chlamydia trachomatis serology
Woodhall SC , Gorwitz RJ , Migchelsen SJ , Gottlieb SL , Horner PJ , Geisler WM , Winstanley C , Hufnagel K , Waterboer T , Martin DL , Huston WM , Gaydos CA , Deal C , Unemo M , Dunbar JK , Bernstein K . Lancet Infect Dis 2018 18 (12) e399-e407 Genital Chlamydia trachomatis infection is the most commonly diagnosed sexually transmitted infection. Trachoma is caused by ocular infection with C trachomatis and is the leading infectious cause of blindness worldwide. New serological assays for C trachomatis could facilitate improved understanding of C trachomatis epidemiology and prevention. C trachomatis serology offers a means of investigating the incidence of chlamydia infection and might be developed as a biomarker of scarring sequelae, such as pelvic inflammatory disease. Therefore, serological assays have potential as epidemiological tools to quantify unmet need, inform service planning, evaluate interventions including screening and treatment, and to assess new vaccine candidates. However, questions about the performance characteristics and interpretation of C trachomatis serological assays remain, which must be addressed to advance development within this field. In this Personal View, we explore the available information about C trachomatis serology and propose several priority actions. These actions involve development of target product profiles to guide assay selection and assessment across multiple applications and populations, establishment of a serum bank to facilitate assay development and evaluation, and development of technical and statistical methods for assay evaluation and analysis of serological findings. The field of C trachomatis serology will benefit from collaboration across the public health community to align technological developments with their potential applications. |
Review of mathematical models of HSV-2 vaccination: Implications for vaccine development
Spicknall IH , Looker KJ , Gottlieb SL , Chesson HW , Schiffer JT , Elmes J , Boily MC . Vaccine 2018 37 (50) 7396-7407 Development of a vaccine against herpes simplex virus type 2 (HSV-2), a life-long sexually-transmitted infection (STI), would be a major step forward in improving global sexual and reproductive health. In this review, we identified published literature of dynamic mathematical models assessing the impact of either prophylactic or therapeutic HSV-2 vaccination at the population level. We compared each study's model structure and assumptions as well as predicted vaccination impact. We examined possible causes of heterogeneity across model predictions, key gaps, and the implications of these findings for future modelling efforts. Only eight modelling studies have assessed the potential public health impact of HSV-2 vaccination, with the majority focusing on impact of prophylactic vaccines. The studies showed that even an imperfect prophylactic HSV-2 vaccine could have an important public health impact on HSV-2 incidence, and could also impact HIV indirectly in high HIV prevalence settings. Therapeutic vaccines also may provide public health benefits, though they have been explored less extensively. However, there was substantial variation in predicted population-level impact for both types of vaccine, reflecting differences in assumptions between model scenarios. Importantly, many models did not account for heterogeneity in infection rates such as by age, sex and sexual activity. Future modelling work to inform decisions on HSV vaccine development and implementation should consider cost-effectiveness, account for additional HSV-2 sequelae such as neonatal transmission, and model greater heterogeneity in infection rates between individuals, more realistic vaccine deployment, and more thorough sensitivity and uncertainty analyses. |
Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies
Torrone EA , Morrison CS , Chen PL , Kwok C , Francis SC , Hayes RJ , Looker KJ , McCormack S , McGrath N , van de Wijgert Jhhm , Watson-Jones D , Low N , Gottlieb SL . PLoS Med 2018 15 (2) e1002511 BACKGROUND: Estimates of sexually transmitted infection (STI) prevalence are essential for efforts to prevent and control STIs. Few large STI prevalence studies exist, especially for low- and middle-income countries (LMICs). Our primary objective was to estimate the prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, herpes simplex virus type 2 (HSV-2), and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population type. METHODS AND FINDINGS: We analyzed individual-level data from 18 HIV prevention studies (cohort studies and randomized controlled trials; conducted during 1993-2011), representing >37,000 women, that tested participants for >/=1 selected STIs or BV at baseline. We used a 2-stage meta-analysis to combine data. After calculating the proportion of participants with each infection and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each infection and 95% confidence interval (CI) across ages, regions, and population types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across the three primary region/population groups (South Africa community-based, Southern/Eastern Africa community-based, and Eastern Africa higher-risk), prevalence was higher among 15-24-year-old than 25-49-year-old women for all STIs except HSV-2. In general, higher-risk populations had greater prevalence of gonorrhea and syphilis than clinic/community-based populations. For chlamydia, prevalence among 15-24-year-olds was 10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%) among women specifically recruited from higher-risk settings for HIV in Eastern Africa and was 15.1% (95% CI: 12.7%, 17.8%; I2 = 82.3%) in South African clinic/community-based populations. Among clinic/community-based populations, prevalence was generally greater in South Africa than in Southern/Eastern Africa for most STIs; for gonorrhea, prevalence among 15-24-year-olds was 4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%) in South Africa and was 1.7% (95% CI: 1.2%, 2.6%; I2 = 55.2%) in Southern/Eastern Africa. Across the three primary region/population groups, HSV-2 and BV prevalence was high among 25-49-year-olds (ranging from 70% to 83% and 33% to 44%, respectively). The main study limitation is that the data are not from random samples of the target populations. CONCLUSIONS: Combining data from 18 HIV prevention studies, our findings highlight important features of STI/BV epidemiology among sub-Saharan African women. This methodology can be used where routine STI surveillance is limited and offers a new approach to obtaining critical information on STI and BV prevalence in LMICs. |
Modelling efforts needed to advance herpes simplex virus (HSV) vaccine development: Key findings from the World Health Organization Consultation on HSV Vaccine Impact Modelling
Gottlieb SL , Giersing B , Boily MC , Chesson H , Looker KJ , Schiffer J , Spicknall I , Hutubessy R , Broutet N . Vaccine 2017 37 (50) 7336-7345 Development of a vaccine against herpes simplex virus (HSV) is an important goal for global sexual and reproductive health. In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in 2015 the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling. The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine. This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters. |
The global roadmap for advancing development of vaccines against sexually transmitted infections: Update and next steps
Gottlieb SL , Deal CD , Giersing B , Rees H , Bolan G , Johnston C , Timms P , Gray-Owen SD , Jerse AE , Cameron CE , Moorthy VS , Kiarie J , Broutet N . Vaccine 2016 34 (26) 2939-2947 In 2014, the World Health Organization, the US National Institutes of Health, and global technical partners published a comprehensive roadmap for development of new vaccines against sexually transmitted infections (STIs). Since its publication, progress has been made in several roadmap activities: obtaining better epidemiologic data to establish the public health rationale for STI vaccines, modeling the theoretical impact of future vaccines, advancing basic science research, defining preferred product characteristics for first-generation vaccines, and encouraging investment in STI vaccine development. This article reviews these overarching roadmap activities, provides updates on research and development of individual vaccines against herpes simplex virus, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, and discusses important next steps to advance the global roadmap for STI vaccine development. |
Trends and patterns of sexual behaviors among adolescents and adults aged 14 to 59 years, United States
Liu G , Hariri S , Bradley H , Gottlieb SL , Leichliter JS , Markowitz LE . Sex Transm Dis 2015 42 (1) 20-6 BACKGROUND: Evaluation of sexual behaviors is essential to better understand the epidemiology of sexually transmitted infections and their sequelae. METHODS: The National Health and Nutrition Examination Surveys (NHANES) is an ongoing probability sample survey of the US population. Using NHANES sexual behavior data from 1999 to 2012, we performed the following: (1) trend analyses among adults aged 25 to 59 years by 10-year birth cohorts and (2) descriptive analyses among participants aged 14 to 24 years. Sex was defined as vaginal, anal, or oral sex. RESULTS: Among adults aged 25 to 59 years, median age at sexual initiation decreased between the 1940-1949 and 1980-1989 cohorts from 17.9 to 16.2 among females (Ptrend < 0.001) and from 17.1 to 16.1 among males (Ptrend < 0.001). Median lifetime partners increased between the 1940-1949 and 1970-1979 cohorts, from 2.6 to 5.3 among females (Ptrend < 0.001) and from 6.7 to 8.8 among males (Ptrend < 0.001). The percentage of females reporting ever having a same-sex partner increased from 5.2% to 9.3% between the 1940-1949 and 1970-1979 cohorts (Ptrend < 0.001). Among participants aged 14 to 24 years, the percentage having had sex increased with age, from 12.5% among females and 13.1% among males at age 14 years to more than 75% at age 19 years for both sexes. Among sexually experienced 14- to 19-year-olds, 45.2% of females and 55.0% of males had at least 3 lifetime partners; 39.4% of females and 48.6% of males had at least 2 partners in the past year. The proportion of females aged 20 to 24 years who reported ever having a same-sex partner was 14.9%. The proportion of participants aged 14-19 or 20-24 years reporting ever having sex did not differ by survey year from 1999 to 2012 for either males or females. CONCLUSIONS: Sexual behaviors changed with successive birth cohorts, with more pronounced changes among females. A substantial proportion of adolescents are sexually active and have multiple partners. These data reinforce existing recommendations for sexual health education and sexually transmitted infection prevention targeting adolescents before sexual debut. |
Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines
Gottlieb SL , Low N , Newman LM , Bolan G , Kamb M , Broutet N . Vaccine 2014 32 (14) 1527-35 An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts. |
Screening and treating Chlamydia trachomatis genital infection to prevent pelvic inflammatory disease: interpretation of findings from randomized controlled trials
Gottlieb SL , Xu F , Brunham RC . Sex Transm Dis 2013 40 (2) 97-102 We critically reviewed randomized controlled trials evaluating chlamydia screening to prevent pelvic inflammatory disease (PID) and explored factors affecting interpretation and translation of trial data into public health prevention. Taken together, data from these trials offer evidence that chlamydia screening and treatment is an important and useful intervention to reduce the risk of PID among young women. However, the magnitude of benefit to be expected from screening may have been overestimated based on the earliest trials. It is likely that chlamydia screening programs have contributed to declines in PID incidence through shortening prevalent infections, although the magnitude of their contribution remains unclear. Program factors such as screening coverage as well as natural history factors such as risk of PID after repeat chlamydia infection can be important in determining the impact of chlamydia screening on PID incidence in a population. Uptake of chlamydia screening is currently suboptimal, and expansion of screening among young, sexually active women remains a priority. To reduce transmission and repeat infections, implementation of efficient strategies to treat partners of infected women is also essential. Results of ongoing randomized evaluations of the effect of screening on community-wide chlamydia prevalence and PID will also be valuable. |
Human papillomavirus vaccine discussions: an opportunity for mothers to talk with their daughters about sexual health
McRee AL , Gottlieb SL , Reiter PL , Dittus PJ , Tucker Halpern C , Brewer NT . Sex Transm Dis 2012 39 (5) 394-401 PURPOSE: Mother-daughter communication about sex is associated with healthier behavior during adolescence. We sought to characterize mothers' communication with their daughters about human papillomavirus (HPV) vaccine and the potential for these discussions to provide an opportunity for talking about sexual health. METHODS: During December 2009, we conducted an online survey with a nationally representative sample of US mothers of girls aged 11 to 14 years (n = 900; response rate = 66%). We used 3 complimentary approaches to assess HPV vaccine as an opportunity for mother-daughter communication about sex. Estimates are weighted. RESULTS: Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have also talked with their daughters about sex (92% vs. 74%, OR = 3.25, CI = 1.57-6.68, P < 0.05), in multivariate analyses. Among mothers who talked about sex when they talked about HPV vaccine, many felt that HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%). CONCLUSIONS: HPV vaccine discussions provide a cue to mother-daughter communication about sex that is as important as some more widely recognized cues. Discussions about HPV vaccine are an acceptable opportunity for mothers to talk with their daughters at an age when communication about sex is most influential. It may be possible for parents to capitalize on HPV vaccine discussions already happening in many families to promote sexual health. |
Case-crossover analysis of condom use and herpes simplex virus type 2 acquisition
Stanaway JD , Wald A , Martin ET , Gottlieb SL , Magaret AS . Sex Transm Dis 2012 39 (5) 388-93 BACKGROUND: Although growing evidence suggests that condoms offer moderate protection against herpes simplex virus type 2 (HSV-2), inability to control for unknown or unmeasured confounders associated with sexual activity may reduce the accuracy of the estimates. The case-crossover design offers increased control of individual-level confounders, and was thus used with the aim of producing a more accurate estimate of the effect of condom use on HSV-2 acquisition. METHODS: Data were pooled from 6 prospective studies that measured HSV-2 status at enrollment and over follow-up, and included periodic self-reported condom use and sexual activity. Sexual activity contemporaneous with acquisition was assigned to a case period; earlier sexual activity was assigned to a control period. Conditional logistic regression was used to assess differences in behavior during the case and control periods. RESULTS: One hundred ninety-one eligible participants acquired HSV-2 during follow-up. This approach detected a 3.6% increase in the odds of HSV-2 acquisition with each unprotected act (odds ratio = 1.036; 95% confidence interval: 1.021-1.052), but no increase in the odds of acquisition associated with protected acts (odds ratio = 1.008; 95% confidence interval: 0.987-1.030). CONCLUSIONS: This analysis suggests that condoms offer significant protection against HSV-2 transmission. |
Acceptability of school requirements for human papillomavirus vaccine
Smith JS , Brewer NT , Chang Y , Liddon N , Guerry S , Pettigrew E , Markowitz LE , Gottlieb SL . Hum Vaccin 2011 7 (9) 952-7 We characterized parental attitudes regarding school HPV vaccination requirements for adolescent girls. Study participants were 889 parents of 10-18 year-old girls in areas of North Carolina with elevated cervical cancer incidence. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Approximately half (47%) of parents agreed that laws requiring HPV immunization for school attendance "are a good idea" when opt-out provisions were not mentioned. Far more agreed that "these laws are okay only if parents can opt out if they want to" (84%). Predictors of supporting requirements included believing HPV vaccine is highly effective against cervical cancer (OR=2.5, 95%CI:1.7-5.0) or is more beneficial if provided at an earlier age (OR=16.1, 95%CI:8.4-30.9). Parents were less likely to agree with vaccine requirements being a good idea if they expressed concerns related to HPV vaccine safety (OR=0.3, 95%CI:0.1-0.5), its recent introduction (OR=0.3,95%CI:0.2-0.6), or its potential to increase their daughters' sexual activity (OR=0.4,95%CI:0.2-0.6). Parental acceptance of school requirements appears to depend on perceived HPV vaccine safety and efficacy, understanding of the optimal age for vaccine administration, and inclusion of opt-out provisions. |
A prospective study of the psychosocial impact of a positive Chlamydia trachomatis laboratory test
Gottlieb SL , Stoner BP , Zaidi AA , Buckel C , Tran M , Leichliter JS , Berman SM , Markowitz LE . Sex Transm Dis 2011 38 (11) 1004-11 BACKGROUND: Few data exist on potential harms of chlamydia screening. We assessed the psychosocial impact of receiving a positive Chlamydia trachomatis test result. METHODS: We prospectively studied women ≥16 years of age undergoing chlamydia testing in 2 Midwestern family planning clinics. We surveyed women at baseline and about 1 month after receiving test results, using 9 validated psychosocial scales/subscales and chlamydia-specific questions. Changes in scale scores were calculated for each woman. Mean percent changes in scores for chlamydia-positive and -negative women were compared using a t test. RESULTS: We enrolled 1807 women (response rate, 84%). Of the 1688 women with test results, 149 (8.8%) tested positive. At follow-up, chlamydia-positive women (n = 71) had a 75% increase in anxiety about sexual aspects of their life on the Multidimensional Sexual Self-Concept Questionnaire (P < 0.001), significantly greater than the 26% increase among 280 randomly selected chlamydia-negative women (P = 0.02). There were no differences for the other 8 scales/subscales, including general measures of anxiety, depression, and self-esteem. Chlamydia-positive women were more likely than chlamydia-negative women to be "concerned about chlamydia" (80% vs. 40%, P < 0.001) and to report breaking up with a main partner (33% vs. 11%, P < 0.001) at follow-up. Women testing positive reported a range of chlamydia-specific concerns. CONCLUSIONS: Chlamydia-positive women had significant increases in anxiety about sex and concern about chlamydia, but did not have marked changes in more general measures of psychosocial well-being about 1 month after diagnosis. Chlamydia diagnoses were associated with some disruption of relationships with main partners. Chlamydia-specific concerns may guide counseling messages to minimize psychosocial impact. |
Parent attitudes about school requirements for human papillomavirus vaccine in high-risk communities of Los Angeles, CA
Robitz R , Gottlieb SL , De Rosa CJ , Guerry SL , Liddon N , Zaidi A , Walker S , Smith JS , Brewer NT , Markowitz LE . Cancer Epidemiol Biomarkers Prev 2011 20 (7) 1421-9 BACKGROUND: Human papillomavirus (HPV) immunization requirements for school entry could increase HPV vaccine uptake but are controversial. This study assessed parents' attitudes about HPV immunization requirements. METHODS: During October 2007-June 2008, we conducted telephone surveys with 484 parents of girls attending middle/high schools serving communities in Los Angeles County with elevated cervical cancer rates. RESULTS: Parents were mostly Hispanic (81%) or African-American (15%); 71% responded in Spanish. Many parents did not know if HPV vaccine works well (42%) or is unsafe (41%). Overall, 59% of parents agreed that laws requiring HPV vaccination for school attendance "are a good idea." In multivariable analysis, African-Americans and Hispanics responding in English were less likely than Hispanics responding in Spanish to agree (aOR 0.4, CI 0.2-0.8; aOR 0.1, CI 0.1-0.3, respectively). Parents were less likely to agree with these laws if they did not believe the vaccine works well (aOR 0.2, CI 0.1-0.5) but more likely to agree if they believed the vaccine is not "too new for laws like these" (aOR 4.5, CI 2.6-8.0). Agreement with laws increased to 92% when including agreement that "these laws are okay only if parents can opt out." CONCLUSIONS: In this at-risk community, over half of parents agreed with HPV immunization requirements generally, and the vast majority agreed when including opt-out provisions. Impact: Support for HPV vaccine requirements may depend on race/ethnicity and inclusion of opt-out provisions. Information about vaccine efficacy and safety may increase support and reduce uncertainty about HPV vaccine in high risk populations. |
Mothers' support for voluntary provision of HPV vaccine in schools
Kadis JA , McRee AL , Gottlieb SL , Lee MR , Reiter PL , Dittus PJ , Brewer NT . Vaccine 2011 29 (14) 2542-7 HPV vaccination rates among adolescents in the United States lag behind some other developed countries, many of which routinely offer the vaccine in schools. We sought to assess mothers' willingness to have their adolescent daughters receive HPV vaccine at school. A national sample of mothers of adolescent females ages 11-14 completed our internet survey (response rate=66%). The final sample (n=496) excluded mothers who did not intend to have their daughters receive HPV vaccine in the next year. Overall, 67% of mothers who intended to vaccinate their daughters or had vaccinated their daughters reported being willing to have their daughters receive HPV vaccine at school. Mothers were more willing to allow their daughters to receive HPV vaccine in schools if they had not yet initiated the vaccine series for their daughters or resided in the Midwest or West (all p<.05). The two concerns about voluntary school-based provision of HPV vaccine that mothers most frequently cited were that their daughters' doctors should keep track of her shots (64%) and that they wished to be present when their daughters were vaccinated (40%). Our study suggests that most mothers who support adolescent vaccination for HPV find school-based HPV vaccination an acceptable option. Ensuring communication of immunization records with doctors and allowing parents to be present during immunization may increase parental support. |
Mother-daughter communication about HPV vaccine
McRee AL , Reiter PL , Gottlieb SL , Brewer NT . J Adolesc Health 2011 48 (3) 314-7 PURPOSE: Parent-child conversations about human papillomavirus (HPV) vaccine may provide parents with the opportunity to talk with their daughters about sexual health. We sought to characterize mothers' communication with their adolescent daughters about HPV vaccine. METHODS: We surveyed 609 mothers of girls aged between 11 and 20 years living in North Carolina in Fall 2008. We used logistic regression to identify the correlates of mother-daughter communication. RESULTS: Most mothers (81%) reported having discussed HPV vaccine with their daughters. For almost half of these families (47%), discussion of HPV vaccine led to a conversation about sex. This was more common among mothers who believed that their daughters may be sexually active (odds ratio [OR]: 1.88; 95% confidence interval [CI]: 1.25-2.83), had greater knowledge of HPV vaccine (OR: 2.46; 95% CI: 1.07-5.64), lived in urban areas (OR: 1.75; 95% CI: 1.21-2.54), or reported being born-again Christians (OR: 1.74; 95% CI: 1.17-2.58). Most mothers who talked with their daughters about HPV vaccine reported having discussed the reasons for and against getting vaccinated (86%). Mothers most commonly reported having discussed the potential HPV vaccine benefits, usually protection against cervical cancer (56%), and less frequently reported having discussed the perceived disadvantages of HPV vaccine. CONCLUSIONS: HPV vaccine conversations may provide opportunities for sexual health promotion and sexually transmitted infection (STI) prevention. |
Human papillomavirus vaccine initiation among adolescent girls in high-risk communities
Guerry SL , De Rosa CJ , Markowitz LE , Walker S , Liddon N , Kerndt PR , Gottlieb SL . Vaccine 2011 29 (12) 2235-41 BACKGROUND: We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents' intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer. METHODS: Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11-18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County. RESULTS: We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n=387), 62% said they "probably/definitely will" vaccinate within the next year and 21% were undecided or didn't know; only 11% said they definitely won't. CONCLUSIONS: About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents. |
Correlates of receiving recommended adolescent vaccines among adolescent females in North Carolina
Reiter PL , McRee AL , Gottlieb SL , Brewer NT . Hum Vaccin 2011 7 (1) 67-73 BACKGROUND: Immunization is a successful and cost-effective method for preventing disease, yet many adolescents do not receive recommended vaccines. We assessed correlates of uptake of three vaccines (tetanus booster, meningococcal, and human papillomavirus [HPV] vaccines) recommended for adolescent females. METHODS: We examined cross-sectional data from 647 parents of 11-20 year-old females from North Carolina who completed the Carolina HPV Immunization Measurement and Evaluation (CHIME) Project follow-up survey in late 2008. Analyses used ordinal and binary logistic regression. RESULTS: Only 17% of parents indicated their daughters had received all three vaccines. Eighty-seven percent of parents indicated their daughters had received tetanus booster vaccine, 36% reported vaccination against meningococcal disease, and 36% reported HPV vaccine initiation. Daughters aged 13-15 years (OR=1.70, 95% CI: 1.09-2.64) or 16-20 years (OR=2.28, 95% CI: 1.51-3.44) had received a greater number of these vaccines compared to daughters aged 11-12 years. Daughters who had preventive care visits in the last year (OR=4.81, 95% CI: 3.14-7.34) or whose parents had at least some college education (OR=1.90, 95% CI: 1.29-2.80) had also received a greater number of these vaccines. CONCLUSIONS: Few daughters, particularly 11-12 years olds, had received all three vaccines recommended for adolescent females. Ensuring annual preventive care visits and increasing concomitant administration of adolescent vaccines may help increase vaccine coverage. |
Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area
Brewer NT , Gottlieb SL , Reiter PL , McRee AL , Liddon N , Markowitz L , Smith JS . Sex Transm Dis 2011 38 (3) 197-204 BACKGROUND: Human papillomavirus (HPV) vaccine uptake is low among adolescent girls in the United States. We sought to identify longitudinal predictors of HPV vaccine initiation in populations at elevated risk for cervical cancer. METHODS: We interviewed a population-based sample of parents of 10- to 18-year-old girls in areas of North Carolina with elevated cervical cancer rates. Baseline interviews occurred in summer 2007 and follow-up interviews in fall 2008. Measures included health belief model constructs. RESULTS: Parents reported that 27% (149/567) of their daughters had initiated HPV vaccine between baseline and follow-up. Of parents who at baseline intended to get their daughters the vaccine in the next year, only 38% (126/348) had done so by follow-up. Of parents of daughters who remained unvaccinated at follow-up but had seen a doctor since baseline, only 37% (122/388) received an HPV vaccine recommendation. Rates of HPV vaccine initiation were higher among parents who at baseline perceived lower barriers to getting HPV vaccine, anticipated greater regret if their daughters got HPV because they were unvaccinated, did not report "needing more information" as the main reason they had not already vaccinated, intended to get their daughters the vaccine, or were not born-again Christians. CONCLUSIONS: Missed opportunities to increase HPV vaccine uptake included unrealized parent intentions and absent doctor recommendations. While several health belief model constructs identified in early acceptability studies (e.g., perceived risk, perceived vaccine effectiveness) were not longitudinally associated with HPV vaccine initiation, our findings suggest correlates of uptake (e.g., anticipated regret) that offer novel opportunities for intervention. |
The association between cervical abnormalities and attitudes toward cervical cancer prevention
Salz T , Gottlieb SL , Smith JS , Brewer NT . J Womens Health (Larchmt) 2010 19 (11) 2011-6 BACKGROUND: We investigated whether a history of cervical abnormalities predicts responses to cervical cancer prevention for women and their daughters. METHODS: In 2007, we interviewed 832 mothers of adolescent daughters from North Carolina counties with elevated rates of cervical cancer. We measured the association of experiences with cervical abnormalities and emotions, beliefs, attitudes, and behaviors related to cervical cancer and its prevention. RESULTS: Anxiety about cervical cancer was higher among women who had cervical cancer, hysterectomies, and abnormal Pap test results (including false positives) than in women who had experienced none of these (each p < 0.05). Pap tests were perceived as being more effective at reducing the chance of developing cervical cancer by women with a history of cancer and women who reported hysterectomies relative to women with normal Pap results (each p < 0.05). Intentions to vaccinate their daughters against human papillomavirus (HPV) were highest among women who had cervical cancer, women who had hysterectomies, and women who were treated for precancerous lesions (each p < 0.05). CONCLUSIONS: Women with histories of cervical health abnormalities reported more favorable views of Pap testing and HPV vaccination than women who had received only normal Pap testing results. They also reported higher levels of anxiety about cervical cancer. |
HPV vaccine for adolescent males: acceptability to parents post-vaccine licensure
Reiter PL , McRee AL , Gottlieb SL , Brewer NT . Vaccine 2010 28 (38) 6292-7 We examined mothers' willingness to get their adolescent sons HPV vaccine. In December 2009, 2 months after approval of HPV vaccine for males, we surveyed a national sample of mothers with sons aged 9-18 (n=406). More mothers were definitely or probably willing to get their sons HPV vaccine if the vaccine were free (47%) than if it cost $400 out of pocket (11%). The importance of HPV vaccine possibly protecting their sons' future female partners from HPV-related disease was the strongest correlate of willingness. These findings are important to increasing acceptability to parents of HPV vaccine for their sons. |
Human papillomavirus vaccination practices: a survey of US physicians 18 months after licensure
Daley MF , Crane LA , Markowitz LE , Black SR , Beaty BL , Barrow J , Babbel C , Gottlieb SL , Liddon N , Stokley S , Dickinson LM , Kempe A . Pediatrics 2010 126 (3) 425-33 OBJECTIVES: The objectives of this study were to assess, in a nationally representative network of pediatricians and family physicians, (1) human papillomavirus (HPV) vaccination practices, (2) perceived barriers to vaccination, and (3) factors associated with whether physicians strongly recommended HPV vaccine to 11- to 12-year-old female patients. METHODS: In January through March 2008, a survey was administered to 429 pediatricians and 419 family physicians. RESULTS: Response rates were 81% for pediatricians and 79% for family physicians. Ninety-eight percent of pediatricians and 88% of family physicians were administering HPV vaccine in their offices (P<.001). Among those physicians, fewer strongly recommended HPV vaccination for 11- to 12-year-old female patients than for older female patients (pediatricians: 57% for 11- to 12-year-old patients and 90% for 13- to 15-year-old patients; P<.001; family physicians: 50% and 86%, respectively; P<.001). The most-frequently reported barriers to HPV vaccination were financial, including vaccine costs and insurance coverage. Factors associated with not strongly recommending HPV vaccine to 11- to 12-year-old female patients included considering it necessary to discuss sexuality before recommending HPV vaccine (risk ratio: 1.27 [95% confidence interval: 1.07-1.51]) and reporting more vaccine refusals among parents of younger versus older adolescents (risk ratio: 2.09 [95% confidence interval: 1.66-2.81]). CONCLUSIONS: Eighteen months after licensure, the vast majority of pediatricians and family physicians reported offering HPV vaccine. Fewer physicians strongly recommended the vaccine for younger adolescents than for older adolescents, and physicians reported financial obstacles to vaccination. |
Statewide HPV vaccine initiation among adolescent females in North Carolina
Reiter PL , Cates JR , McRee AL , Gottlieb SL , Shafer A , Smith JS , Brewer NT . Sex Transm Dis 2010 37 (9) 549-56 BACKGROUND: Cervical cancer incidence in the United States may be greatly reduced through widespread human papillomavirus (HPV) vaccination. We estimated the statewide level of HPV vaccine initiation among adolescent girls in North Carolina and identified correlates of vaccine initiation. METHODS: We used data from 617 parents of adolescent females from North Carolina who completed the population-based 2008 Child Health Assessment and Monitoring Program survey. Analyses used weighted multivariate logistic regression. RESULTS: Overall, 31.3% of parents reported their daughters had received at least 1 dose of HPV vaccine. Vaccine initiation was higher among daughters aged 13 to 15 years (odds ratio [OR] = 2.03, 95% CI, 1.12-3.67) or 16 to 17 years (OR = 3.21, 95% CI, 1.76-5.86) compared with those 10 to 12 years old. Additional correlates of HPV vaccine initiation included the daughter having a preventive check-up in the last 12 months (OR = 5.09, 95% CI, 2.43-10.67), having received meningococcal vaccine (OR = 2.50, 95% CI, 1.55-4.01), or being from an urban area (OR = 1.81, 95% CI, 1.02-3.21). Among parents of unvaccinated daughters, intent to vaccinate in the next year was higher among those with daughters aged 13 to 17 years. Parents of unvaccinated non-Hispanic white daughters reported lower levels of intent to vaccinate within the next year compared with parents of unvaccinated daughters of other races. CONCLUSIONS: HPV vaccine initiation in North Carolina is comparable with other US areas. Potential strategies for increasing HPV vaccination levels include reducing missed opportunities for HPV vaccination at preventive check-ups and increasing concomitant administration of HPV vaccine with other adolescent vaccines. |
Risk of sequelae after Chlamydia trachomatis genital infection in women
Haggerty CL , Gottlieb SL , Taylor BD , Low N , Xu F , Ness RB . J Infect Dis 2010 201 Suppl 2 S134-55 Chlamydia trachomatis infection, the most common reportable disease in the United States, can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Although C. trachomatis is identified among many women who receive a diagnosis of PID, the incidence and timing of PID and long-term sequelae from an untreated chlamydial infection have not been fully determined. This article examines evidence reviewed as part of the Centers for Disease Control and Prevention Chlamydia Immunology and Control Expert Advisory Meeting; 24 reports were included. We found no prospective studies directly assessing risk of long-term reproductive sequelae, such as infertility, after untreated C. trachomatis infection. Several studies assessed PID diagnosis after untreated chlamydial infection, but rates varied widely, making it difficult to determine an overall estimate. In high-risk settings, 2%-5% of untreated women developed PID within the approximately 2-week period between testing positive for C. trachomatis and returning for treatment. However, the rate of PID progression in the general, asymptomatic population followed up for longer periods appeared to be low. According to the largest studies, after symptomatic PID of any cause has occurred, up to 18% of women may develop infertility. In several studies, repeated chlamydial infection was associated with PID and other reproductive sequelae, although it was difficult to determine whether the risk per infection increased with each recurrent episode. The present review critically evaluates this body of literature and suggests future research directions. Specifically, prospective studies assessing rates of symptomatic PID, subclinical tubal damage, and long-term reproductive sequelae after C. trachomatis infection; better tools to measure PID and tubal damage; and studies on the natural history of repeated chlamydial infections are needed. |
Screening and treatment to prevent sequelae in women with Chlamydia trachomatis genital infection: how much do we know?
Gottlieb SL , Berman SM , Low N . J Infect Dis 2010 201 Suppl 2 S156-67 BACKGROUND: An important question for chlamydia control programs is the extent to which finding and treating prevalent, asymptomatic Chlamydia trachomatis genital infection reduces reproductive sequelae in infected women. METHODS: We reviewed the literature to critically evaluate evidence on the effect of chlamydia screening on development of sequelae in infected women. RESULTS: Two randomized controlled trials of 1-time screening for chlamydial infection-in a Seattle-area health maintenance organization and a Danish school district-revealed that screening was associated with an approximately 50% reduction in the incidence of pelvic inflammatory disease over the following year. However, both of these trials had methodological issues that may have affected the magnitude of observed screening benefits and might limit generalizability to other populations. A large, nonrandomized cohort of chlamydia screening among US Army recruits, although limited by lack of outpatient data, did not find a benefit of similar magnitude to the randomized trials. Methodological limitations restrict valid conclusions about individual benefits of screening using data from historical cohorts and ecological studies. We identified no trials directly evaluating the effect of chlamydia screening on subclinical tubal inflammation or damage, ectopic pregnancy, or tubal factor infertility and no studies addressing the effects of >1 round of screening, the optimal frequency of screening, or the benefits of screening for repeat infections. CONCLUSIONS: Additional studies of the effectiveness of chlamydia screening would be valuable; feasible study designs may depend on the degree to which screening programs are already established. In addition, better natural history data on the timing of tubal inflammation and damage after C. trachomatis infection and development of more accurate, noninvasive tools to assess chlamydial sequelae are essential to informing chlamydia control efforts. |
Introduction: The natural history and immunobiology of Chlamydia trachomatis genital infection and implications for chlamydia control
Gottlieb SL , Brunham RC , Byrne GI , Martin DH , Xu F , Berman SM . J Infect Dis 2010 201 Suppl 2 S85-7 Chlamydia trachomatis genital infection is the most common bacterial sexually transmitted infection worldwide [1], and an estimated 3 million cases occur each year in the United States [2]. In women, C. trachomatis genital infection can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy, tubal infertility, and chronic pelvic pain [3]. Because of this, many countries have implemented chlamydia control efforts that have primarily emphasized enhanced detection and treatment of asymptomatic infection in young women and have achieved varying degrees of screening coverage [4–6]. Early reports from regions that were the first to implement chlamydia control activities (during the late 1980s and early 1990s) revealed that both chlamydia case rates and rates of associated complications were decreasing [7–9]. However, since the mid-1990s, in virtually all countries with substantial investment in chlamydia control, the number of C. trachomatis infection case reports has been increasing in the setting of ongoing control efforts [10–12]. In the United States, regions that had initially shown decreases in chlamydia test positivity (prevalence of chlamydia among tested women) have since shown stable or increasing test positivity [11]. Although there are limitations in using these types of surveillance data to assess burden of disease [13], the substantial and continuing decreases in rates of C. trachomatis infection that were expected after implementation of control programs have not been observed [14], and many chlamydia control programs are currently at a crossroads. |
Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States
Forhan SE , Gottlieb SL , Sternberg MR , Xu F , Datta SD , McQuillan GM , Berman SM , Markowitz LE . Pediatrics 2009 124 (6) 1505-12 OBJECTIVE: Most young women initiate sexual activity during adolescence; risk for sexually transmitted infections (STIs) accompanies this initiation. In this study we estimated the prevalence of the most common STIs among a representative sample of female adolescents in the United States. METHODS: Data were analyzed from 838 females who were aged 14 to 19 and participating in the nationally representative National Health and Nutrition Examination Survey 2003-2004. After interview and examination, survey participants provided biological specimens for laboratory testing. The main outcome was weighted prevalence of at least 1 of 5 STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV) (any of 23 high-risk types or type 6 or 11). RESULTS: Prevalence of any of the 5 STIs was 24.1% among all and 37.7% among sexually experienced female adolescents. HPV (23 high-risk types or type 6 or 11) was the most common STI among all female adolescents (prevalence: 18.3%), followed by C trachomatis infection (prevalence: 3.9%). Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner. CONCLUSIONS: The prevalence of STIs among female adolescents is substantial, and STIs begin to be acquired soon after sexual initiation and with few sex partners. These findings support early and comprehensive sex education, routine HPV vaccination at the age of 11 to 12 years, and C trachomatis screening of sexually active female adolescents. |
How much will it hurt? HPV vaccine side effects and influence on completion of the three-dose regimen
Reiter PL , Brewer NT , Gottlieb SL , McRee AL , Smith JS . Vaccine 2009 27 (49) 6840-4 We examined the prevalence of reported pain following human papillomavirus (HPV) vaccination and whether it differed from that for other adolescent vaccines or affected completion of the HPV vaccine regimen. In 2008, we conducted cross-sectional surveys with parents of adolescent girls aged 11-20 living in areas of North Carolina with elevated cervical cancer rates who had received at least one dose of HPV vaccine. Pain from HPV vaccination, while commonly reported by parents, was less frequent compared to other adolescent vaccines and did not appear to affect vaccine regimen completion. These findings may be important to increase HPV vaccination coverage. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 16, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure