Rise and fall of the new variant of Chlamydia trachomatis in Sweden: mathematical modelling study

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Smid, Joost H.Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (author)

Rise and fall of the new variant of Chlamydia trachomatis in Sweden : mathematical modelling study

Article/chapterEnglish2020

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2019-10-05
BMJ Publishing Group Ltd,2020
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LIBRIS-ID:oai:DiVA.org:oru-84689
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-84689URI
https://doi.org/10.1136/sextrans-2019-054057DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-402244URI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Funding Agencies:Swiss National Science Foundation (SNSF) 160320National Institute for Health Research (NIHR) RP-PG-0614-20009
OBJECTIVES: A new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden in 2006. The nvCT has a plasmid deletion, which escaped detection by two nucleic acid amplification tests (Abbott-Roche, AR), which were used in 14 of 21 Swedish counties. The objectives of this study were to assess when and where nvCT emerged in Sweden, the proportion of nvCT in each county and the role of a potential fitness difference between nvCT and co-circulating wild-type strains (wtCT).METHODS: We used a compartmental mathematical model describing the spatial and temporal spread of nvCT and wtCT. We parameterised the model using sexual behaviour data and Swedish spatial and demographic data. We used Bayesian inference to fit the model to surveillance data about reported diagnoses of chlamydia infection in each county and data from four counties that assessed the proportion of nvCT in multiple years.RESULTS: Model results indicated that nvCT emerged in central Sweden (Dalarna, Gävleborg, Västernorrland), reaching a proportion of 1% of prevalent CT infections in late 2002 or early 2003. The diagnostic selective advantage enabled rapid spread of nvCT in the presence of high treatment rates. After detection, the proportion of nvCT decreased from 30%-70% in AR counties and 5%-20% in counties that Becton Dickinson tests, to around 5% in 2015 in all counties. The decrease in nvCT was consistent with an estimated fitness cost of around 5% in transmissibility or 17% reduction in infectious duration.CONCLUSIONS: We reconstructed the course of a natural experiment in which a mutant strain of C. trachomatis spread across Sweden. Our modelling study provides support, for the first time, of a reduced transmissibility or infectious duration of nvCT. This mathematical model improved our understanding of the first nvCT epidemic in Sweden and can be adapted to investigate the impact of future diagnostic escape mutants.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Infektionsmedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Infectious Medicine hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Klinisk laboratoriemedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Clinical Laboratory Medicine hsv//eng
Chlamydia trachomatis
Sweden
basic reproduction number
mathematical model
nucleic acid amplification test

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Althaus, Christian L.Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (author)
Low, NicolaInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (author)
Unemo, Magnus,1970-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Laboratory Medicine, Clinical Microbiology(Swepub:oru)muo (author)
Herrmann, Björn,1955-Uppsala universitet,Klinisk mikrobiologi(Swepub:uu)bjorherr (author)
Institute of Social and Preventive Medicine, University of Bern, Bern, SwitzerlandInstitutionen för medicinska vetenskaper (creator_code:org_t)

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In:Sexually Transmitted Infections: BMJ Publishing Group Ltd96:5, s. 375-3791368-49731472-3263

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