Creating a Novel Surveillance System From Scratch: California's Human Papillomavirus (HPV) Vaccine Impact Monitoring Project (HPV-IMPACT)

Background: The CDC-funded HPV-IMPACT project was designed to monitor the short-term impact of the HPV vaccine, and consists of five sentinel sites around the country conducting surveillance of incident cases of cervical dysplasia and associated HPV types in defined geographic areas.  California has participated since 2007; its catchment area has nearly 300,000 adult female residents.  Successes and challenges have informed ongoing efforts.

Objectives: To describe (1) novel approaches to electronic reporting by pathology laboratories, (2) challenges encountered, how they were overcome and (3) successes of the project in California.

Methods: After identifying laboratories serving residents of the catchment area, reporting mechanisms were established, including electronic data transmissions.  Demographic data were requested with the anticipation of collecting additional clinical data, including  vaccine history, from medical providers. 

Results: Eight laboratories serving a majority of catchment area residents participate voluntarily in case reporting.  Methods of case ascertainment, reporting, and data completeness vary across laboratories.  Baseline data for 2008 include 362 cases of high-grade cervical dysplasia among women in the catchment area and an additional 296 cases in the surrounding county.  Challenges include: (1) differing use of codes and terminology for case ascertainment, (2) determining whether cases represent incident or prevalent disease, (3) diverse data systems and lack of a centralized system for electronic data importation.  Three laboratories lack capacity for electronic reporting, but may develop methods as tools become available for tracking clinical data. One managed care organization reports laboratory and clinical data, negating the need for further case investigation. 

Conclusions: We have successfully established a novel surveillance system for cervical dysplasia, with partial electronic case reporting, to monitor the impact of the HPV vaccine.  Ongoing efforts focus on developing capacity to manage electronic data, maintaining collaborations with laboratories, and improving data quality and completeness.

Implications for Programs, Policy, and/or Research: Electronic case reporting holds promise for improving the cost efficiency of disease monitoring.