Læknablaðið - 15.07.1995, Blaðsíða 12

528
LÆKNABLAÐIÐ 1995; 81
Chlamydia in Sweden
Anders Hallén
Hallcn A
Læknablaðið 1995; 81: 528-30
In the end of the 70s only five laboratories in Swe-
den could perform Chlamydial culture. Today more
than 33 laboratories perform some kind of Chlamy-
dial identification but a number of different tests are
used and there is a lack of standardisation. Probably
the introduction of tests based on DNA amplifica-
tion will improve the situation.
Up to the beginning of the 80s Chlamydial disease in
Sweden was in an uncontrolled hyper endemic state.
The number of Chlamydial infections has been esti-
mated to about 100,000 per year, that is more than
twice the number of gonococcal infections in the
peak year of 1970. During the 80s culture was in-
creasingly used to identify new cases. With the new
act on contagious diseases in 1988 an epidemiolog-
ical approach was generally adopted.
Chlamydial epidemiology
In contrast to gonococcal disease the epide-
miological information on Chlamydial disease
is by far shorter. Voluntary reporting from the
laboratories was instituted in 1983. As can be
seen in figure 1 there was a rapid increase of
cases in the middle of the 80s. After 1988 num-
bers have been decreasing with a tendency to
levelling off during the last years.
From figure 2 it is evident that the increase
during the beginning of the 80s was due to
rapidly increasing diagnostic efforts. The num-
ber of positive cases started to decline before
the decrease in taking of specimens.
During the last years there has been a con-
stant decrease in number of cultures (figure 3).
From the Department of Dermatology and Venereology,
Akademiska sjukhuset, University Hospital, S-751 85 Up-
psala, Sweden.
The percentage of positive cultures is now
rather constant about 4%.
Reporting of clinical cases was not intro-
duced until 1988. Figure 4 shows the same kind
of drop on a slightly lower level. The number
of clinical cases in 1994 was 13,625.
The distribution of cases from 1993 in the
age groups 15 to 30 can be seen in figure 5. For
women the peak is in the age 19-20 and for
men two years later. From the age of 25 there
is no difference in number of cases between the
sexes.
Legislation
Probably the most important inipact of legis-
lation on the STD situation in Sweden is first of
all the rather good quality of reported figures
due to the compulsory reporting system and
secondly the fact that legislation has forced the
granting authorities to allocate resources to
STD health care. Acts relating to STDs have
been passed in Sweden in 1919, 1969 and the
present act on communicable diseases effec-
tive from 1988 regulates four STDs - syphilis,
gonoccocal and Chlamydial disease and infec-
tion with HlV-virus.
The basic principles for all acts during the
century has been STD care free of charge, a
nation-wide case reporting system from clin-
icians as well as from laboratories, partner
tracing and notification. The present law has
introduced regional epidemiologists supervis-
ing the local situation for all communicable
diseases.
The law requires the physician in charge of
the patient to inform the patient properly, to
perform the contact tracing and follow up on
contacts, to report the case to the national
register and if necessary notify the county epi-
demiologist.
The county epidemiologist is a central asset
in the field of communicable diseases as well as
an independent authority which both can re-