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HPV Impact

Oregon HPV-IMPACT Program through EIP

The Human Papillomavirus Impact Monitoring Project (HPV-IMPACT) is a component of the U.S. Centers for Disease Control and Prevention (CDC)  Emerging Infections Programs (EIP), a collaboration between CDC, state health departments, and universities. 

HPV-IMPACT is a population-based surveillance system that evaluates the impact and effectiveness of the HPV vaccination program by monitoring trends in cervical precancers and cervical cancers.

Why are we concerned about HPV?

  • HPV, the human papillomavirus, is the most common sexually transmitted infection
  • An estimated 13 million persons are newly infected with a disease-associated type every year in the US
  • In the pre-vaccination era, more than 80% of men and women were infected by 45 years old
  • HPV causes cancers of the cervix, vagina, vulva, penis, anus, and oropharynx (throat)
  • Almost all cervical cancers are due to genital HPV infection, and about 70% are caused by two high risk types, HPV-16 and -18.
HPV-IMPACT Surveillance Activities
HPV-IMPACT conducts surveillance for cervical precancers and cancers:

  • Cervical intraepithelial neoplasia grade 2 (CIN-2)
  • Cervical intraepithelial neoplasia grade 2/3 (CIN-2/3)
  • Cervical intraepithelial neoplasia grade 3 (CIN-3)
  • Adenocarcinoma in situ (AIS)
  • Invasive cervical cancer
We also estimate cervical cancer screening utilization rates and HPV vaccine rates among cases.


Surveillance Objectives

  1. Monitor trends in overall incidence of CIN2+ (including precancers and invasive cancer) over time in defined populations
  2. Monitor prevalence and distribution of HPV genotypes in CIN2+ precancer cases aged 18-39 years and in cancer cases aged ≥18 years
  3. Describe the demographic, clinical, and HPV type characteristics among patients with CIN2+
  4. Estimate and monitor trends in cervical cancer screening utilization among residents of the catchment areas; and
  5. Estimate the proportion of patients with CIN2+ who received the HPV vaccine and estimate vaccine effectiveness

Surveillance Methods

Case Definition: A case is defined as a person at least 18 years of age at the time of diagnosis who is living in a 28 zip code area in the Portland metropolitan area, which spans parts of Multnomah and Washington Counties.  Cases must have a histologically confirmed diagnosis of cervical intraepithelial neoplasia (CIN) grades 2 or 3, or adenocarcinoma in situ (collectively referred to as CIN2+) on or after January 1, 2008. 

Case Identification: We receive electronic laboratory reports from pathology laboratories.  Oregon law, Oregon Administrative Rule 333-010-0032,  requires pathology labs to report cervical biopsy reports that show evidence of high-grade dysplasia.

Data Collection: We conduct-enhanced surveillance for select cases and receive additional information, such as screening history and HPV vaccine history, from provider offices, medical chart review, the Oregon immunization registry (ALERT), the Oregon State Cancer Registry (OSCaR), and Oregon Vital Statistics data.

Laboratory Methods: To determine the HPV types leading the infection, cervical tissue for CIN cases in women 18-39 years of age and all cervical cancer cases is submitted to CDC for HPV typing. PCR assays is used to detect HPV type-specific DNA.  DNA is extracted and tested for 28 HPV types (6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 68, 69, 70, 73, and 82).  These types include all types targeted by HPV vaccines and other types that can infect genital tissues.  (Note in 2019, manufacture of a 37-type assay was discontinued, and genotyping was switched to the current 28-type assay. The previous assay detected HPV 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89, IS39).   

How Data is Used

We produce estimates of disease burden over time for various population groups, and we measure impact of vaccine on cervical disease.  CDC and site partners analyze data and disseminate results in a variety of formats, whether through local, regional, state, national or international conferences, presentations, newsletters, peer-reviewed papers, articles, etc.  Our data is used in conjunction with other work to inform policy and evaluate local, state, national, and international goals. 


Department of Health and Human Services (HHS) National Vaccine Plan Goals:

  • Goal 3: Increase knowledge of and confidence in routinely recommended vaccines.
  • Goal 4: Increase access to and use of all routinely recommended vaccines.

CDC Healthy People 2030 Goals:

  • Increase the proportion of teens who receive the recommended doses of the HPV vaccine
  • Reduce infections of HPV types prevented by the HPV vaccine in young adults
  • Increase the proportion of females screened for cervical cancer
  • Reduce the overall cancer mortality rates
World Health Organization (WHO) Global Initiative to Eliminate Cervical Cancer – 2030 Targets
  •  Increase HPV vaccination
    • 90% of females receive HPV vaccination by age 15
  •  Increase screening
    • 70% of women screened using a high-performance test by age 35 and again by age 45
  •  Increase treatment
    • 90% of women identified with cervical disease (either precancer or cancer) receive treatment
 Select Reports and Publications 

Other Important Information

Project Contact
HPV-IMPACT Program Coordinator
Sara Ehlers, MPH
800 NE Oregon St, Suite 772
Portland, Oregon 97232

Dr. Emilio DeBess – HPV-IMPACT Principal Investigator
Kameny Chan, MPH – Epidemiologist
Bradley Beauchamp – Research Analyst 1