Cancer Causes & Control

, Volume 23, Issue 2, pp 281–288 | Cite as

The HPV vaccine impact monitoring project (HPV-IMPACT): assessing early evidence of vaccination impact on HPV-associated cervical cancer precursor lesions

  • Susan Hariri
  • Elizabeth R. Unger
  • Suzanne E. Powell
  • Heidi M. Bauer
  • Nancy M. Bennett
  • Karen C. Bloch
  • Linda M. Niccolai
  • Sean Schafer
  • Lauri E. Markowitz
  • The HPV-IMPACT Working Group
Original paper


The following paper describes a collaboration between the Centers for Disease Control and Prevention and five Emerging Infections Program sites to develop a comprehensive population-based approach to monitoring human papillomavirus (HPV) vaccine impact on cervical cancer precursors and associated HPV genotypes. The process of establishing this novel monitoring system is described, and development details such as enumeration of sources for reporting cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ, approaches to case ascertainment, electronic reporting, and HPV typing are outlined. Implementation of a feasible and sustainable surveillance system for HPV-associated cervical precancers will enable evaluation of the direct impact of HPV vaccination.


Human Papillomavirus (HPV) Cervical intraepithelial neoplasia (CIN) Cervical adenocarcinoma in situ (AIS) Post-licensure vaccine effectiveness Vaccine impact Surveillance 


  1. 1.
    Watson M, Saraiya M, Benard V, Coughlin SS, Flowers L, Cokkinides V, Schwenn M, Huang Y, Giuliano A (2008) Burden of cervical cancer in the United States, 1998–2003. Cancer 113(10 Suppl):2855–2864PubMedCrossRefGoogle Scholar
  2. 2.
    Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV (2002) The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 55(4):244–265PubMedCrossRefGoogle Scholar
  3. 3.
    Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER (2007) Quadrivalent human papillomavirus vaccine: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 56(RR-2):1–24Google Scholar
  4. 4.
    FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP) (2010). MMWR 59(20):626–629Google Scholar
  5. 5.
    Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G et al (2009) A pooled analysis of continued prophylactic efficacy of quadrivalent human papillomavirus (Types 6/11/16/18) vaccine against high-grade cervical and external genital lesions. Cancer Prev Res (Phila) 2(10):868–878CrossRefGoogle Scholar
  6. 6.
    Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D et al (2009) Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet 374(9686):301–314PubMedCrossRefGoogle Scholar
  7. 7.
    Watson M, Saraiya M, Ahmed F, Cardinez CJ, Reichman ME, Weir HK, Richards TB (2008) Using population-based cancer registry data to assess the burden of human papillomavirus-associated cancers in the United States: overview of methods. Cancer 113(10 Suppl):2841–2854PubMedCrossRefGoogle Scholar
  8. 8.
    Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S (2007) Human papillomavirus and cervical cancer. Lancet 370(9590):890–907PubMedCrossRefGoogle Scholar
  9. 9.
    The FUTURE II, Group Study (2007) Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 356(19):1915–1927CrossRefGoogle Scholar
  10. 10.
    Mullins R, Wakefield M, Broun K (2008) Encouraging the right women to attend for cervical cancer screening: results from a targeted television campaign in Victoria, Australia. Health Educ Res 23(3):477–486PubMedCrossRefGoogle Scholar
  11. 11.
    Macansh S (2001) The role of the New South Wales Pap test register in monitoring the cervical screening process in New South Wales. N S W Public Health Bull 12(4):99–102PubMedCrossRefGoogle Scholar
  12. 12.
    Schuchat A, Hilger T, Zell E, Farley MM, Reingold A, Harrison L, Lefkowitz L, Danila R, Stefonek K, Barrett N, Morse D, Pinner R (2001) Active bacterial core surveillance of the emerging infections program network. Emerg Infect Dis 7(1):92–99PubMedCrossRefGoogle Scholar
  13. 13.
    National vaccination coverage among adolescents aged 13-17 years–United States, 2006 (2007) MMWR 56(34):885–888Google Scholar
  14. 14.
    National, state, and local area vaccination coverage among adolescents aged 13–17 years–United States, 2008 (2009) MMWR 58(36):997–1001Google Scholar
  15. 15.
    National and state vaccination coverage among adolescents aged 13 through 17 years–United States, 2010 (2011) MMWR 60(33):1117–1123Google Scholar
  16. 16.
    Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, Clifford GM (2007) Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer 121(3):621–632PubMedCrossRefGoogle Scholar
  17. 17.
    Rauscher GH, Johnson TP, Cho YI, Walk JA (2008) Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 17(4):748–757PubMedCrossRefGoogle Scholar
  18. 18.
    Dasbach EJ, Elbasha EH, Insinga RP (2006) Mathematical models for predicting the epidemiologic and economic impact of vaccination against human papillomavirus infection and disease. Epidemiol Rev 28:88–100PubMedCrossRefGoogle Scholar
  19. 19.
    Elbasha EH, Dasbach EJ, Insinga RP (2007) Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis 13(1):28–41PubMedCrossRefGoogle Scholar
  20. 20.
    Garnett GP, Kim JJ, French K, Goldie SJ (2006) Chapter 21: modelling the impact of HPV vaccines on cervical cancer and screening programmes. Vaccine 24(Suppl 3):S178–S186Google Scholar
  21. 21.
    Insinga RP, Glass AG, Rush BB (2004) Diagnoses and outcomes in cervical cancer screening: a population-based study. Am J Obstet Gynecol 191(1):105–113PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. (outside the USA)  2011

Authors and Affiliations

  • Susan Hariri
    • 1
  • Elizabeth R. Unger
    • 3
  • Suzanne E. Powell
    • 2
  • Heidi M. Bauer
    • 4
  • Nancy M. Bennett
    • 5
  • Karen C. Bloch
    • 6
  • Linda M. Niccolai
    • 7
  • Sean Schafer
    • 8
  • Lauri E. Markowitz
    • 2
  • The HPV-IMPACT Working Group
  1. 1.Division of STD PreventionNational Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Division of STD PreventionNational Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA
  3. 3.Division of High-Consequence Pathogens and PathologyNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionAtlantaUSA
  4. 4.STD Control Branch, California Department of HealthRichmondUSA
  5. 5.Center for Community Health and Department of MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  6. 6.Departments of Medicine and Preventive MedicineVanderbilt University Medical CenterNashvilleUSA
  7. 7.Division of Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenUSA
  8. 8.HIV/STD/TB Program, Division of STD, Oregon Department of Human ServicesPortlandUSA

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