Protective immunity to Chlamydia trachomatis genital infection: Evidence from human studies

Byron Batteiger, Fujie Xu, Robert E. Johnson, Michael L. Rekart

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background. Some screening and treatment programs implemented to control Chlamydia trachomatis genital infections and their complications have shown initial reductions in infection prevalence, followed by increases to preprogram levels or higher. One hypothesis is that treatment shortens duration of infection, attenuates development of protective immunity, and thereby, increases risk of reinfection. Methods. A literature review was undertaken to assess evidence supporting the concept of protective immunity, its characteristics, and its laboratory correlates in human chlamydial infection. The discussion is organized around key questions formulated in preparation for the Chlamydia Immunology and Control Expert Advisory Meeting held by the Centers for Disease Control and Prevention in April 2008. Results. Definitive human studies are not available, but cross-sectional studies show that chlamydia prevalence, organism load, and concordance rates in couples decrease with age, and organism load is lower in those with repeat infections, supporting the concept of protective immunity. The protection appears partial and can be overcome after reexposure, similar to what has been found in rodent models of genital infection. No data are available to define the duration of infection required to confer a degree of immunity or the time course of immunity after resolution of untreated infection. In longitudinal studies involving African sex workers, a group presumed to have frequent and ongoing exposure to chlamydial infection, interferon-γ production by peripheral blood mononuclear cells in response to chlamydial heat-shock protein 60 was associated with low risk of incident infection. In cross-sectional studies, relevant T helper 1-type responses were found in infected persons, paralleling the studies in animal models. Conclusions. The data support the concept that some degree of protective immunity against reinfection develops after human genital infection, although it appears, at best, to be partial. It is likely that factors besides population levels of immunity contribute to trends in prevalence observed in screening and treatment programs. Future studies of protective immunity in humans will require longitudinal follow-up of individuals and populations, frequent biological and behavioral sampling, and special cohorts to help control for exposure.

Original languageEnglish
JournalJournal of Infectious Diseases
Volume201
Issue numberSUPPL. 2
DOIs
StatePublished - Jun 15 2010

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Chlamydia trachomatis
Immunity
Infection
Chlamydia
Cross-Sectional Studies
Chaperonin 60
Sex Workers
Centers for Disease Control and Prevention (U.S.)
Allergy and Immunology
Interferons
Population
Longitudinal Studies
Rodentia
Blood Cells
Therapeutics
Animal Models

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy
  • Medicine(all)

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Protective immunity to Chlamydia trachomatis genital infection : Evidence from human studies. / Batteiger, Byron; Xu, Fujie; Johnson, Robert E.; Rekart, Michael L.

In: Journal of Infectious Diseases, Vol. 201, No. SUPPL. 2, 15.06.2010.

Research output: Contribution to journalArticle

Batteiger, Byron ; Xu, Fujie ; Johnson, Robert E. ; Rekart, Michael L. / Protective immunity to Chlamydia trachomatis genital infection : Evidence from human studies. In: Journal of Infectious Diseases. 2010 ; Vol. 201, No. SUPPL. 2.
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abstract = "Background. Some screening and treatment programs implemented to control Chlamydia trachomatis genital infections and their complications have shown initial reductions in infection prevalence, followed by increases to preprogram levels or higher. One hypothesis is that treatment shortens duration of infection, attenuates development of protective immunity, and thereby, increases risk of reinfection. Methods. A literature review was undertaken to assess evidence supporting the concept of protective immunity, its characteristics, and its laboratory correlates in human chlamydial infection. The discussion is organized around key questions formulated in preparation for the Chlamydia Immunology and Control Expert Advisory Meeting held by the Centers for Disease Control and Prevention in April 2008. Results. Definitive human studies are not available, but cross-sectional studies show that chlamydia prevalence, organism load, and concordance rates in couples decrease with age, and organism load is lower in those with repeat infections, supporting the concept of protective immunity. The protection appears partial and can be overcome after reexposure, similar to what has been found in rodent models of genital infection. No data are available to define the duration of infection required to confer a degree of immunity or the time course of immunity after resolution of untreated infection. In longitudinal studies involving African sex workers, a group presumed to have frequent and ongoing exposure to chlamydial infection, interferon-γ production by peripheral blood mononuclear cells in response to chlamydial heat-shock protein 60 was associated with low risk of incident infection. In cross-sectional studies, relevant T helper 1-type responses were found in infected persons, paralleling the studies in animal models. Conclusions. The data support the concept that some degree of protective immunity against reinfection develops after human genital infection, although it appears, at best, to be partial. It is likely that factors besides population levels of immunity contribute to trends in prevalence observed in screening and treatment programs. Future studies of protective immunity in humans will require longitudinal follow-up of individuals and populations, frequent biological and behavioral sampling, and special cohorts to help control for exposure.",
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