Human Papillomavirus Vaccine Impact Monitoring Project Across CT (HPV-IMPACT)

Background

HPV is the primary cause of cervical cancer. It has also been shown to be responsible for several other cancers as well, causing significant morbidity and mortality. In 2006, the FDA licensed a quadrivalent vaccine that protects against four types of HPV (6, 11, 16, 18). HPV types 16 and 18 are responsible for approximately 70% of cervical cancers. HPV types 6 and 11 are the main cause of genital warts. In 2014, a nine-valent vaccine became available. In addition to the four types of HPV that were covered in the quadrivalent vaccine, the nine-valent vaccine protects against five additional cancer-causing types of HPV (31, 33, 45, 52, 58) that are associated with another 20% of cervical cancers. In 2008, HPV-IMPACT began collecting data to study the impact of HPV vaccination on high-grade cervical lesions (HGCLs). HGCLs are pre-cancerous lesions that can develop into cancer if not detected and treated in time. In addition, HPV-IMPACT collects data on invasive cervical cancer in collaboration with the Connecticut Tumor Registry.

Purpose

This project aims to monitor the impact of HPV vaccination on population health by tracking both HGCLs and cervical cancer. HGCLs occur in greater numbers and develop over a shorter time frame than cervical cancer, making them an efficient endpoint when examining vaccine effectiveness. In addition, these lesions are important because they can incur substantial morbidity, treatment costs, and psychological stress. The goal of HPV vaccination is to greatly reduce the number of cervical cancer cases.

Goals & Objectives

Monitor HPV vaccination impact on trends in incidence of HGCLs also known as cervical intraepithelial neoplasia (CIN) grades 2 and 3 adenocarcinoma in situ (AIS) and cervical cancer, collectively known as CIN2+.
Monitor HPV vaccination impact on HPV types associated with CIN2+.
Improve public health practice through local population-based surveillance of HPV-related CIN2+
Estimate cervical cancer screening rates in Connecticut.
Estimate vaccine effectiveness

Activities

Statewide passive monitoring of CIN2+ diagnoses from pathology laboratories
Population-based active surveillance CIN2+ in New Haven county (2008-2023); Naugatuck Valley and South Central Council of Governments (2024-ongoing)
Enhanced data collection through patient interviews and medical record reviews to determine HPV vaccination status
Specimen collection to determine HPV genotype associated with CIN2+ diagnoses
Laboratory and healthcare provider surveys
Estimation of cervical cancer screening in Connecticut
Analyses of population databases for other HPV indicators such as anogenital warts

Contributions from students at Yale and other universities

Potential Impact of Covid-19-Related Disruptions to Cervical Cancer Screening on Future Disease Burden: A Modeling Study. Guinevere Oliver (2022) MPH Thesis. Yale School of Public Health.
Geospatial Analysis of High-Grade Cervical Lesions to Address Health Disparities. Savanah Russ (2019) MPH Thesis. Yale School of Public Health.
Increasing Human Papillomavirus Vaccine Uptake in Adolescents: A Targeted Intervention Approach. AmberJean Hansen (2016) MPH Capstone. University of New England.
Trends in HPV 16/18-Associated Cervical Lesions in New Haven County, Connecticut, 2008-2014. Susan Hannagan (2016) MPH Thesis. Yale School of Public Health.
Sociodemographic Differences in Human Papillomavirus Vaccine Impact: a Systematic Review. Alexandra Montano (2016) MPH Thesis. Yale School of Public Health.
Spatial Distribution of High Grade Cervical Lesions in Connecticut, 2008-2013. Aref Seno (2015) MPH Thesis. Yale School of Public Health.
Provider Survey to Identify Pathology Laboratories, 2015. Adam Misiorski (2015) Undergraduate Internship. Southern Connecticut State University.
HPV Vaccine Effectiveness in New Haven County, Connecticut Women Aged 18-39, 2008-2012. Jennifer Berry (2014) MPH Thesis. Yale School of Public Health.
HPV Type Distribution in New Haven County, Connecticut Among Women with CIN2+ Diagnoses from 2008-2010. Chelsea Russ (2012) MPH Thesis. Yale School of Public Health.
The Prevalence of HPV Associated Disease in Women under Age 21: Who will be missed under the new cervical cancer screening guidelines? Amanda DeCew (2012) MPH Thesis. Yale School of Public Health.
HPV Vaccination Histories among High-Risk Women in New Haven County: Disparities and Barriers. Niti Mehta (2011) MPH Thesis. Yale School of Public Health.
Social Economic Characteristics and Cervical Abnormalities in Connecticut. James Santinelli (2010) MPH Thesis. Yale School of Public Health.

Connecticut HPV-IMPACT Newsletter

Recent Publications

Trends in Cervical Precancers Identified Through Population-Based Surveillance - Human Papillomavirus Vaccine Impact Monitoring Project, Five Sites, United States, 2008-2022.Gargano JW, Stefanos R, Dahl RM, Castilho JL, Bostick EA, Niccolai LM, Park IU, Blankenship S, Brackney MM, Chan K, Delikat EL, Ehlers S, Barrera KG, Kurtz R, Meek JI, Whitney E, Vigar M, Unger ER, Markowitz LE. MMWR Morb Mortal Wkly Rep. 2025 Feb 27; 2025 Feb 27. PMID: 40014651.
U.S. Women with Invasive Cervical Cancer: Characteristics and Potential Barriers to Prevention.Rosenblum HG, Gargano JW, Cleveland AA, Dahl RM, Park IU, Whitney E, Castilho JL, Sackey E, Niccolai LM, Brackney M, Debess E, Ehlers S, Bennett NM, Kurtz R, Unger ER, Markowitz LE. J Womens Health (Larchmt). 2024 May; 2024 Apr 12. PMID: 38608239.
HPV type-specific trends in cervical precancers in the United States, 2008 to 2016.Gargano JW, McClung N, Lewis RM, Park IU, Whitney E, Castilho JL, Pemmaraju M, Niccolai LM, Brackney M, DeBess E, Ehlers S, Bennett NM, Scahill M, Cleveland AA, Querec TD, Unger ER, Markowitz LE. Int J Cancer. 2023 Jan 15; 2022 Sep 26. PMID: 35904861.
Trends in Precancerous Cervical Lesions by Area-Based Measures of Poverty, Race, and Ethnicity, Connecticut, 2008-2018.Brackney MM, Weinberger DM, Higgins K, Meek J, Niccolai LM. Public Health Rep. 2022 Nov-Dec; 2021 Nov 2. PMID: 34727517.
Increases in Human Papillomavirus Testing Preceding Diagnosis of Cervical Precancer in 5 US States, 2008-2016.Cleveland AA, Gargano JW, Griffin MR, Park IU, Niccolai LM, Bennett NM, Pemmaraju M, Fink D, Brackney M, Scahill M, Ehlers SJ, Unger ER, Markowitz LE. J Low Genit Tract Dis. 2021 Jul 1. PMID: 33797511.
Human Papillomavirus 16/18-Associated Cervical Lesions: Differences by Area-Based Measures of Race and Poverty.Brackney MM, Gargano JW, Hannagan SE, Meek J, Querec TD, Niccolai LM. Am J Prev Med. 2020 May; 2020 Jan 28. PMID: 32001053.
Effectiveness of 1, 2, and 3 Doses of Human Papillomavirus Vaccine Against High-Grade Cervical Lesions Positive for Human Papillomavirus 16 or 18.Johnson Jones ML, Gargano JW, Powell M, Park IU, Niccolai LM, Bennett NM, Griffin MR, Querec T, Unger ER, Markowitz LE. Am J Epidemiol. 2020 Apr 2. PMID: 31680146.
Cervical adenocarcinoma in situ: Human papillomavirus types and incidence trends in five states, 2008-2015.Cleveland AA, Gargano JW, Park IU, Griffin MR, Niccolai LM, Powell M, Bennett NM, Saadeh K, Pemmaraju M, Higgins K, Ehlers S, Scahill M, Johnson Jones ML, Querec T, Markowitz LE, Unger ER. Int J Cancer. 2020 Feb 1; 2019 May 6. PMID: 30980692.
Missed Opportunities for HPV Vaccination Among Vaccine-Eligible Women with High Grade Cervical Lesions.Russ SM, Brackney M, Meek J, Niccolai LM. Vaccine. 2019 Jul 18; 2019 Jun 24. PMID: 31248688.
Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women - United States, 2008 and 2016.McClung NM, Gargano JW, Park IU, Whitney E, Abdullah N, Ehlers S, Bennett NM, Scahill M, Niccolai LM, Brackney M, Griffin MR, Pemmaraju M, Querec TD, Cleveland AA, Unger ER, Markowitz LE. MMWR Morb Mortal Wkly Rep. 2019 Apr 19; 2019 Apr 19. PMID: 30998672.
Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008-2015.Gargano JW, Park IU, Griffin MR, Niccolai LM, Powell M, Bennett NM, Johnson Jones ML, Whitney E, Pemmaraju M, Brackney M, Abdullah N, Scahill M, Dahl RM, Cleveland AA, Unger ER, Markowitz LE. Clin Infect Dis. 2019 Apr 8. PMID: 30137283.
Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008-2014.McClung NM, Gargano JW, Bennett NM, Niccolai LM, Abdullah N, Griffin MR, Park IU, Cleveland AA, Querec TD, Unger ER, Markowitz LE. Cancer Epidemiol Biomarkers Prev. 2019 Mar; 2019 Feb 21. PMID: 30792242.
Declines in Human Papillomavirus (HPV)-Associated High-Grade Cervical Lesions After Introduction of HPV Vaccines in Connecticut, United States, 2008-2015.Niccolai LM, Meek JI, Brackney M, Hadler JL, Sosa LE, Weinberger DM. Clin Infect Dis. 2017 Sep 15. PMID: 28520854.
Monitoring Effect of Human Papillomavirus Vaccines in US Population, Emerging Infections Program, 2008-2012.Hariri S, Markowitz LE, Bennett NM, Niccolai LM, Schafer S, Bloch K, Park IU, Scahill MW, Julian P, Abdullah N, Levine D, Whitney E, Unger ER, Steinau M, Bauer HM, Meek J, Hadler J, Sosa L, Powell SE, Johnson ML. Emerg Infect Dis. 2015 Sep. PMID: 26291379.
Population-based trends in high-grade cervical lesions in the early human papillomavirus vaccine era in the United States.Hariri S, Johnson ML, Bennett NM, Bauer HM, Park IU, Schafer S, Niccolai LM, Unger ER, Markowitz LE. Cancer. 2015 Aug 15; 2015 Jun 22. PMID: 26098295.
Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States - 2008-2012.Hariri S, Bennett NM, Niccolai LM, Schafer S, Park IU, Bloch KC, Unger ER, Whitney E, Julian P, Scahill MW, Abdullah N, Levine D, Johnson ML, Steinau M, Markowitz LE. Vaccine. 2015 Mar 24; 2015 Feb 11. PMID: 25681664.
HPV type attribution in high-grade cervical lesions: assessing the potential benefits of vaccines in a population-based evaluation in the United States.Hariri S, Unger ER, Schafer S, Niccolai LM, Park IU, Bloch KC, Bennett NM, Steinau M, Johnson ML, Markowitz LE. Cancer Epidemiol Biomarkers Prev. 2015 Feb; 2014 Nov 21. PMID: 25416715.
Sources of information for assessing human papillomavirus vaccination history among young women.Niccolai LM, McBride V, Julian PR. Vaccine. 2014 May 23; 2014 Apr 5. PMID: 24713369.
Impact of human papillomavirus (HPV) vaccination on HPV 16/18-related prevalence in precancerous cervical lesions.Powell SE, Hariri S, Steinau M, Bauer HM, Bennett NM, Bloch KC, Niccolai LM, Schafer S, Unger ER, Markowitz LE. Vaccine. 2012 Dec 17; 2012 Nov 6. PMID: 23137842.
Human papillomavirus genotypes in high-grade cervical lesions in the United States.Hariri S, Unger ER, Powell SE, Bauer HM, Bennett NM, Bloch KC, Niccolai LM, Schafer S, Steinau M, Markowitz LE. J Infect Dis. 2012 Dec 15; 2012 Oct 8. PMID: 23045628.
The HPV vaccine impact monitoring project (HPV-IMPACT): assessing early evidence of vaccination impact on HPV-associated cervical cancer precursor lesions.Hariri S, Unger ER, Powell SE, Bauer HM, Bennett NM, Bloch KC, Niccolai LM, Schafer S, Markowitz LE. Cancer Causes Control. 2012 Feb; 2011 Nov 23. PMID: 22108842.

Project Contact Person

Monica Brackney, MS
Program Manager, HPV-IMPACT
Connecticut Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510
203-737-6199
Monica.Brackney@yale.edu

HPV-IMPACT Staff:

Kyle Higgins
Adeline Morris, MPH
Anna Trinh