Human Papillomavirus Vaccine Impact Monitoring Project Across CT (HPV-IMPACT)


HPV is the primary cause of cervical cancer. It has also been shown to be responsible for several other cancers as well, causing significant morbidity and mortality. In 2006, the FDA licensed a quadrivalent vaccine that protects against four types of HPV (6, 11, 16, 18). HPV types 16 and 18 are responsible for approximately 70% of cervical cancers. HPV types 6 and 11 are the main cause of genital warts. In 2014, a nine-valent vaccine became available. In addition to the four types of HPV that were covered in the quadrivalent vaccine, the nine-valent vaccine protects against five additional cancer-causing types of HPV (31, 33, 45, 52, 58) that are associated with another 20% of cervical cancers. In 2008, HPV-IMPACT began collecting data to study the impact of the HPV vaccine on high-grade cervical lesions (HGCLs). HGCLs are pre-cancerous lesions that can develop into cancer if not detected and treated in time.


This project aims to monitor the impact of HPV vaccine on population health by tracking HGCLs and the HPV types associated with those lesions. These lesions occur in greater numbers and develop over a shorter time frame than cervical cancer, making them an efficient endpoint when examining vaccine effectiveness. In addition, these lesions are important because they can incur substantial morbidity, treatment costs, and psychological stress.   

Goals & Objectives

  • Monitor HPV vaccine impact on HGCLs also known as cervical intraepithelial neoplasia (CIN) grades 2 and 3 and adenocarcinoma in situ (AIS).
  • Monitor HPV vaccine impact on HPV types associated with CIN 2/3 and AIS lesions.
  • Improve public health practice through local population-based surveillance of HPV-related cervical cancer precursors.   
  • Estimate cervical cancer screening rates in Connecticut.


  • Statewide passive monitoring of CIN2/3 and AIS diagnoses from pathology laboratories
  • Population-based active surveillance for CIN2/3 and AIS in New Haven county
  • Enhanced data collection through patient interviews and medical record reviews to determine HPV vaccination status
  • Specimen collection to determine HPV type associated with CIN2/3 and AIS diagnoses
  • Laboratory and physician surveys
  • Estimation of cervical cancer screening in Connecticut

Select List of Publications

1.Hariri S, Markowitz LE, Bennett NM, Niccolai LM, Schafer S, Bloch K, Park IU, Scahill MW, Julian P, Abdullah N, Levine D, Whitney E, Unger ER, Steinau M, Bauer HM, Meek J, Hadler J, Sosa L, Powell SE, Johnson ML. Monitoring effect of human papillomavirus vaccines in US population, Emerging Infections Program, 2008–2012. Emerging Infectious Diseases 2015;21:1557–61.

2.Hariri S, Bennett NM, Niccolai LM, Schafer S, Park I, Bloch K, Unger ER, Whitney E, Julian P, Scahill MW, Abdullah N, Levine D, Johnson ML, Steinau M, Markowitz LE.. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States, 2008–2012. Vaccine 2015;33:1608–13.

3.Niccolai LM, McBride V, Julian PR. Sources of information for assessing human papillomavirus vaccination histories in young women. Vaccine  2014;32:2945-7.

4.Waggaman C, Julian P, Niccolai LM. Interactive effects of individual and neighborhood race and ethnicity on rates of high-grade cervical lesions.Cancer Epidemiology 2014;38:248-52.

5.Niccolai LM, Julian P, Meek J, McBride V, Hadler J, Sosa L. Declining rates of high-grade cervical lesions in young women in Connecticut, 2008-2011.Cancer Epidemiology, Biomarkers & Prevention 2013;22:1446–50. 

6.Niccolai LM, Russ C, Julian PJ, Hariri S, Sinard J, Meek JI, McBride V, Markowitz LE, Unger ER, Hadler JL, Sosa LE.  Individual and geographic disparities in human papillomavirus types 16/18 in high-grade cervical lesions: Associations with race, ethnicity, and poverty.Cancer 2013;119:3052–8.


Related Links

Connecticut HPV-IMPACT: Summary of Findings, 2008-2014

CT DPH makes CIN2/3 and AIS reportable conditions

 Article about the CT HPV-IMPACT project in the Fall 2011 issue of Yale Public Health:  Tracking HPV.

Project Contact Person
Monica Brackney, MS
Project Coordinator
Connecticut Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510
(203) 764-9705