title: Impact of human papillomavirus (HPV) vaccination on HPV 16/18-related prevalence in precancerous cervical lesions.
abstract: BACKGROUND
  Vaccination against human papillomavirus (HPV) types 16 and 18 is recommended for girls aged 11 or 12 years with catch-up vaccination through age 26 in the U.S. Cervical intraepithelial neoplasia (CIN) grade 2 or 3 and adenocarcinoma in situ (CIN2+) are used to monitor HPV vaccine impact on cervical disease. This report describes vaccination status in women diagnosed with CIN2+ and examines HPV vaccine impact on HPV 16/18-related CIN2+.
  
  
  METHODS
  As part of a vaccine impact monitoring project (HPV-IMPACT), females 18-31 years with CIN2+ were reported from pathology laboratories in CA, CT, NY, OR, TN from 2008 to 2011. One diagnostic block was selected for HPV DNA typing with Roche Linear Array. Demographic, abnormal Papanicolaou (Pap) test dates and vaccine status information were collected. The abnormal Pap test immediately preceding the CIN2+ diagnosis was defined as the 'trigger Pap'.
  
  
  RESULTS
  Among 5083 CIN2+ cases reported to date, 3855 had vaccination history investigated; 1900 had vaccine history documented (vaccinated, with trigger Pap dates, or unvaccinated). Among women who initiated vaccination >24 months before their trigger Pap, there was a significantly lower proportion of CIN2+ lesions due to 16/18 compared to women who were not vaccinated (aPR=.67, 95% CI: .48-.94). Among the 1900 with known vaccination status, 20% initiated vaccination on/after their trigger screening. Women aged 21-23 years were more likely to initiate vaccination on/after the trigger Pap compared to 24-26 year olds (29.0% vs. 19.6%, p=.001), as were non-Hispanic blacks compared to non-Hispanic whites (27.3% vs. 19.0%, p=.001) and publicly compared to privately insured women (38.1% vs. 17.4%, p<.0001).
  
  
  CONCLUSIONS
  We found a significant reduction in HPV 16/18-related lesions in women with CIN2+ who initiated vaccination at least 24 months prior to their trigger Pap. These preliminary results suggest early impact of the HPV vaccine on vaccine-type disease, but further evaluation is warranted.
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, NE MS-E02, Atlanta, GA 30333, USA. gpf7@cdc.gov
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Powell
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.forename: Martin
authors.initials: M
authors.lastname: Steinau
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Bauer
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bennett
authors.forename: Karen C
authors.initials: KC
authors.lastname: Bloch
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.forename: Sean
authors.initials: S
authors.lastname: Schafer
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Unger
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Markowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D052162:Human papillomavirus 16 / Q000472:pathogenicity; D052161:Human papillomavirus 18 / Q000472:pathogenicity; D006801:Humans; D027383:Papillomaviridae / Q000472:pathogenicity; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D002577:Uterine Cervical Diseases / Q000276:immunology* / Q000517:prevention & control*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000276:immunology* / Q000517:prevention & control*
chemical_list: D053918:Papillomavirus Vaccines