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Urogenital Block > L22 - Sex, germs and vaccines > Flashcards

L22 - Sex, germs and vaccines Flashcards

1
Q

Epidemiological Triangle of STI

A

1) Host: Human
2) Etiological Agents: STI agents
3) Environment

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2
Q

Etiological agents of STIs

A

Bacterial: Syphilis, gonorrhea, chlamydia

Viral: HPV, HBV, HIV, HSV

Protozoal: trichomoniasis

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3
Q

Environmental factor of STI

A

Transmission dynamics of STIs subject to continuous change of high level of clustering driven by:

  • spatial location
  • race
  • culture
  • religious belief
  • sexual activity level
  • socio-economic status
  • education level
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4
Q

Levels of effect of STI

A

(in order of number of people affected)

1) Individual
2) Sexual partners and unborn child
3) Population

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5
Q

Risk of sexual practise and infection

A

Higher risk of sexual practices - infection less asymptomatic

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6
Q

STI transmission dynamics

A
  • infectiousness may persist for extended periods due to natural history and asymptomatic infections (most STI rarely generate a solidly protective immune response)
  • Sexual behaviour heterogenous within populations
  • Core group -> bull’s eye for preventive program
  • Not only sexually active persons are affected by STIs (mother-to-child, blood transfusion)
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7
Q

Core Group examples

A
  • CSW: Commercial Sex Workers
  • IDU: Injecting Drug Users
  • MSM: Men who have sex with men
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8
Q

STI epidemic determinants

A

1) Sexual Structure
2) Societal Determinants
3) Interventions

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9
Q

Sexual structure

A
  • Age of sex debut
  • Sexual orientation and attitudes
  • Number of sex partners (past year, lifetime)
  • Sex practice (e.g. vaginal, oral, anal)
  • Concurrency of sexual partnerships
  • Pattern of serial monogamy
  • Frequency of sex without condoms
  • Frequency of casual and paid sex
  • Size and distribution of high risk/core groups
  • Sexual mixing between groups odf different attributes
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10
Q

Societal determinants of STI determinants

A

Stigma

culture

level of poverty

income

socio-economic status

literacy and education

employment

status of women

volume of mobility and migration

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11
Q

Interventions of STI epidemic

A

1) Diagnostic tools
2) Medical Treatments
3) Screening programs
4) Education and awareness programs
5) Prevention programs (e.g. partner notification, use of condoms)

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12
Q

While routes of transmission and preventive measures of STIs sufficiently understood, why is preventive control not effective?

A

STIs remain somewhat of a social taboo

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13
Q

Elimination of STIs in revolutionary China

A
  • Training of paraprofessional and public health personnel, e.g. barefoor doctors
  • Mass screening and treatment under the cooperative health insurance system: surveys -> diagnostics -> treatment
  • Propaganda that targets STIs instead of patients; culprit identified as western civilization and capitalism; elimination of STI considered patriotic
  • Complete elimination of prostitution (incarceration, reeducation and improvement of women status)
  • Place chief emphasis of prevention: immunity through knowledge
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14
Q

100% Condom Campaign (Thailand)

A

Enforce condom use in commercial sex (main source of heterosexual HIV infection)

  • government supplied as many condoms to sex establishments as needed
  • Non-compliant sex establishments sanctioned
  • Mass media campaign to stress that men should use condoms with prostitutes
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15
Q

Sexual Mixing

A

Sexual mixing is strongly associated with social structure and values (see sexual structure)

Can be classified into three types:

1) Assortative (like with like)
2) Proportionate (random)
3) Disassortative (dislike)

It is usually assortative for most attributes (age, sexual activeness, race, socio-economical statis); in the case of clubbing, while apparently proportionate, it is still assortative as the clubbing population/group is characteristic

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16
Q

Sexual network

A
  • Few empirical studies due to practical and ethical difficulties
  • Most studies focus on networks in the context of disease transmission
  • Not just an individual’s number of partners that determines the risk of STI acquisition, but their partners’ partners and beyond, i.e. the entire sexual network
17
Q

HPV and Cervical Cancer

A
  • Cervical cancer is caused by persistent infection of high-risk HPV (type 16, 18 account for 70% of cervical cancers)
  • HPV infection is most common STI worldwide
  • Most HPV infection is harmless and clears within 12 months
  • Incubation time is years to decades
  • HPV type 6, 11 accounts over 90% of genital warts
  • Weak natural immunity (common reinfection)
18
Q

Available commercial HPV vaccines

A

1) Gardasil (Merck): >90% efficacious against type 6, 11, 16, 18
2) Cervarix (GSK): >90% efficacious against type 16, 18

19
Q

Herd immunity

A

Part of vaccine effectiveness - vaccinating an individual indirectly reduces the risk of infection of his contacts, contacts’ contacts and so on, ultimately protecting the whole population

(Australian free Gardasil vaccination for 12-26yr women; significant decline of genital warts among young females and young heterosexual males)

20
Q

Health economics

A

Problem: healthcare system do not have resources to every clinically effective intervention to all persons who can benefit

Resolution: health services should prioritize clinical practices that yield a relatively high health gain per dollar spent over those that give a smaller health gain per dollar spent (prioritize interventions that are the most cost-effective).

21
Q

Cost-effectiveness Analysis (CEA) Overview

A
  • WHO recommend CEA of vaccination considered before national programs
  • CEA require expertise in infectious disease epidemiology (assess effectiveness) and health economics (asset costs)
22
Q

CEA calculations

A

Cost

  • medical costs
  • productivity loss

Health outcome

  • Life-year
  • Quality-adjusted life year (QALY)
  • Disability-adjusted Life year (DALY)
  • (herd immunity in case of vaccine)

ICER (Incremental cost-effectiveness ratio)

Difference in cost / difference in health outcome

Analysis

An intervention is cost-effective if its ICER is smaller than the cost-effectiveness threshold (see graph)

Urogenital Block (39 decks)

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