D3a Monitoring HPV Vaccine Impact On Cervical Cancer Precursors: Preliminary Results From the HPV-IMPACT Monitoring Project

Thursday, March 11, 2010: 8:30 AM
Grand Ballroom B (M4) (Omni Hotel)
Susan Hariri, PhD1, Nasreen Abdullah, MD, MPH2, Nancy Bennett, MD, MS3, Karen Bloch, MD, MPH4, Ghinwa Dumyati, MD3, James Gaudino Jr., MD, MS, MPH, FACPM5, Sharon Jotblad, MPH6, Pamela Julian, MPH7, Diane Levine, MPH4, Linda Niccolai, PhD7, Erin Whitney, MPH6, Elizabeth Unger, MD, PhD8 and Lauri Markowitz, MD1, 1Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 2Public Health Division, Oregon Immunization Program (formerly) and Acute & Communicable Disease (currently), Oregon Department of Human Services, Portland, OR, 3Center for Community Health, University of Rochester Medical Center, Rochester, NY, 4Department of Medicine (Infectious Diseases) and Preventive Medicine, Vanderbilt University Medical Center, Nashville, TN, 5Public Health Division-Immunization Prg and Acute & Communicable Disease Prevention, Oregon Department of Human Services, Portland, OR, 6STD Control Branch and California Emerging Infections Program, California Department of Public Health, Richmond, CA, 7Emerging Infections Program, Yale School of Public Health, New Haven, CT, 8National Center for Zoonotic, Vector-borne, and Enteric Diseases, Centers for Disease Control and Prevetion, Atlanta, GA

Background: Population-based monitoring of HPV type-specific cervical cancer precursors may be an early indicator of HPV vaccine impact on cervical disease. In 2007, the CDC, in collaboration with the Emerging Infections Programs (EIP) Network piloted a multi-site population and laboratory-based system (HPV-IMPACT) to monitor cervical intraepithelial neoplasia (CIN) 2/3 and adenocarcinoma in situ (AIS).

Objectives: To describe the epidemiology of CIN2/3 and AIS diagnoses before HPV vaccine impact.

Methods: Active CIN2/3 and AIS case ascertainment is ongoing in 5 well-defined catchments with a combined population of about 1.4 million females ≥18.  Cases are obtained by direct reporting from pathology laboratories serving catchment residents.  Vaccine history and HPV types associated with lesions are determined on 18-39 year-old cases. Representativeness of data is monitored by regular contact and periodic laboratory audits of labs.

Results: In 2008, diagnosis rates per 1000 population in CT, NY and CA in 18-39 year-old females were 5.1 , 4.8, and 2.3, respectively.  The distribution of CIN grades were: 57% CIN2, 28% CIN3, 14% CIN2/3 in CT, 58% CIN2, 23% CIN3, 16% CIN2/3 in NY, 42% CIN2, 30% CIN3, 25% CIN2/3 in CA. AIS represented <2% of cases in all sites.  The majority of cases (~60%) occurred in 18-29 year olds in CT and NY compared with 43% in CA; 30-39 year olds represented ~20% of cases in CT and NY and 35% in CA. 

Conclusions: Continuous CIN2/3 and AIS data collection is ongoing in 5 HPV-IMPACT sites.  Differences by site may reflect incomplete reporting or CIN2/3 ascertainment.  Data from the first years of this project will provide important information to evaluate future impact of HPV vaccine on cervical cancer precursors.   

Implications for Programs, Policy, and/or Research:Implementation of a sustainable monitoring system for HPV-associated disease will enable evaluation of the direct impact of the vaccine.

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