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 the HPV vaccine on high-grade cervical lesions (HGCLs). HGCLs are pre-cancerous lesions that can develop into cancer if not detected and treated in time.

Purpose

This project aims to monitor the impact of HPV vaccine on population health by tracking HGCLs and the HPV types associated with those lesions. These lesions 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.

Goals & Objectives

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

Activities

Statewide passive monitoring of CIN2/3 and AIS diagnoses from pathology laboratories
Population-based active surveillance for CIN2/3 and AIS in New Haven county
Enhanced data collection through patient interviews and medical record reviews to determine HPV vaccination status
Specimen collection to determine HPV type associated with CIN2/3 and AIS diagnoses
Laboratory and physician 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

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 Hanagan (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

Select List of Publications

1.Niccolai LM, Meek JI, Brackney M, Hadler JL, Sosa LE, Weinberger DM. Declines in human papillomavirus (HPV)-associated high-grade cervical lesions after introduction of HPV vaccines in Connecticut, United States, 2008-2015. Clinical Infectious Diseases 2017;65:884-9.

2.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. Monitoring effect of human papillomavirus vaccines in US population, Emerging Infections Program, 2008–2012. Emerging Infectious Diseases 2015;21:1557–61.

3.Hariri S, Bennett NM, Niccolai LM, Schafer S, Park I, Bloch K, Unger ER, Whitney E, Julian P, Scahill MW, Abdullah N, Levine D, Johnson ML, Steinau M, Markowitz LE.. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States, 2008–2012. Vaccine 2015;33:1608–13.

4.Niccolai LM, McBride V, Julian PR. Sources of information for assessing human papillomavirus vaccination histories in young women. Vaccine 2014;32:2945-7.

5.Waggaman C, Julian P, Niccolai LM. Interactive effects of individual and neighborhood race and ethnicity on rates of high-grade cervical lesions.Cancer Epidemiology 2014;38:248-52.

6.Niccolai LM, Julian P, Meek J, McBride V, Hadler J, Sosa L. Declining rates of high-grade cervical lesions in young women in Connecticut, 2008-2011.Cancer Epidemiology, Biomarkers & Prevention 2013;22:1446–50.

7.Niccolai LM, Russ C, Julian PJ, Hariri S, Sinard J, Meek JI, McBride V, Markowitz LE, Unger ER, Hadler JL, Sosa LE. Individual and geographic disparities in human papillomavirus types 16/18 in high-grade cervical lesions: Associations with race, ethnicity, and poverty.Cancer 2013;119:3052–8.