Program Schedule

Evaluating the Population Impact of HPV Vaccine on High Grade Cervical Intraepithelial Neoplasia Rates in an Era of Decreasing Screening

Session: Poster Abstract Session: Vaccines: HPV
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDweek_poster_upload_DevenP.pdf (337.4 kB)
  • Background: Vaccination for two oncogenic human papillomavirus (HPV) types has been available since 2006. Current efforts focus on the effectiveness of this vaccination in reducing the risk of high grade cervical intraepithelial neoplasia (CIN). Monitoring of the impact of vaccine on CIN grade 2 or higher (CIN2+) has been ongoing in Monroe County, NY since 2008 as one of five sites participating in the HPV-IMPACT study which is part of the Centers for Disease Control (CDC) Emerging Infections Program. Because CIN2+ cases are detected through routine cervical cancer screening and can be impacted by changes in screening, screening rates in the HPV-IMPACT catchments are also estimated as part of the project. To elucidate the potential independent impact of HPV vaccination, we examined the reduction in CIN2+ case rates while adjusting for the change in screening rates.

    Methods: Screening rates and CIN2+ incidence rates from 2008-2012 were calculated for females aged 18-29, in Monroe County, New York. Screening data were obtained from three local laboratories that collectively process all Monroe County PAP smear test specimens. Cases of CIN2+ were ascertained according to the HPV-IMPACT protocol from all pathology laboratories serving Monroe County residents. The 2010 Census population was used as the denominator for both rates. Poisson regression was used to determine Rate Ratios (RRs) and 95% CIs of CIN2+ cases over 5 years using 2008 as reference year, with and without adjusting for change in screening rates.

    Results : From 2008-2012, rates of screening and CIN2+ cases declined by 34.9% and 49%, respectively. The crude RR for screening [0.64 (0.63, 0.65)] and CIN2+ incidence [0.51 (0.44, 0.60,)] indicate declines in 2012 compared to 2008. While adjusting for screening rates somewhat attenuated the RR for CIN2+ incidence, it remained lower in 2012 than in 2008 [0.71 (0.60, 0.84)].

    Conclusion: CIN2+ cases and cancer screening rates have both declined since 2008. CIN2+ incidence rates declined independently of screening rates, suggesting that HPV vaccination may have contributed to the reduction of CIN2+ disease incidence.

    Deven Patel, MPH1,2, Mary Scahill1, Susan Hariri, PhD3, Lauri Markowitz, MD4, Edwin Van Wijngaarden, PhD2, Gary Hollick, PhD5 and Nancy M. Bennett, MD6, (1)Center for Community Health, University of Rochester Medical Center, Rochester, NY, (2)Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, (3)Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, (4)Centers for Disease Control and Prevention, Atlanta, GA, (5)Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, (6)University of Rochester Medical Center, Rochester, NY


    D. Patel, None

    M. Scahill, None

    S. Hariri, None

    L. Markowitz, None

    E. Van Wijngaarden, None

    G. Hollick, None

    N. M. Bennett, None

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