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HPV-IMPACT

Oregon HPV-IMPACT Program through EIP


Human Papillomavirus Vaccine IMPACT On This page:

  • HPV-IMPACT Surveillance Activities
  • HPV Types Covered by the 9-Valent Vaccine
  • How Data Is Used


    • Background

    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?

    Emerging Infections Programs Logo

    • 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
         

    Number of HPV-Associated and Estimated Number of HPV-Attributable Cancer Cases Per Year in United States

    Cancer site
    		Gender
    Average number of
    cancers per year in sites
    where HPV is often found
    (HPV-associated cancers)
    Percentage probably
    caused by any HPV typea
    Estimated number probably
    caused by any HPV typea
    Cervix
    		Female
    		 11,959
    		91%
    		10,800
    Vagina
    		Female
    		 898
    		75%
    		700
    Vulva
    		Female
    		 4,418
    		69%
    		3,000
    Penis
    		Male
    		 1,381
    		63%
    		900
    Anusb

    		 Total
    		 7,854
    		91%
    		7,200
    Female
    		5,363
    		93%
    		5,000
    Male
    		2,491
    		89%
    		2,200
    Oropharynx
    		Total
    		21,474
    		70%
    		15,200
    Female
    		 3,642
    		63%
    		2,300
    Male
    		 17,832
    		72%
    		12,900
    TOTAL
    		To
    		47,984
    		79%
    		37,800
    Female
    		26,280
    		84%
    		21,800
    Male
    		21,704
    		74%
    		16,000

    aHPV types detected in genotyping study; most were high-risk HPV types known to cause cancer (Saraiya M, et al. U.S. assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst. 2016;107:djv086. Estimates were rounded to the nearest 100. Estimated counts might not sum to total because of rounding.

    bIncludes anal and rectal squamous cell carcinomas.

    Data are from population-based cancer registries participating in CDC's National Program of Cancer Registries (NPCR) and/or the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program for 2017 to 2021, covering 98% of the United States population.

    For data specific to Oregon, visit the Oregon State Cancer Registry data portal here.


    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.

     

    HPV IMPACT Surveillance Areas Map

    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. Estimate and monitor trends in cervical cancer screening utilization among residents of the catchment areas; and
    4. Estimate the proportion of patients with CIN2+ who received the HPV vaccine and estimate vaccine effectiveness

    Surveillance Methods

    Figure Represents the Portland Metropolitan 28-zip code Surveillance Area
    HPV-IMPACT Surveillance Methods Map

    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. 

    Lab Report Image

    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.



    ALERT Immunization Information System

    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).


    HPV6.jpg


    HPVTimeline.jpg

    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. 


    Cervical precancers decreased after HPV vaccine was introduced in the USA in 2006

    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 Project Coordinator
    Sara Ehlers, MPH
    800 NE Oregon St, Suite 772
    Portland, Oregon 97232
    OHD.ACDP@oha.oregon.gov

     
    HPV-IMPACT Staff
    Dr. Emilio DeBess – HPV-IMPACT Principal Investigator

    Kameny Chan, MPH – Epidemiologist

    Sara Ehlers, MPH – HPV-IMPACT Project Coordinator

    Bradley Beauchamp – Electronic Publishing Design Specialist