From Abacus to Electronic Repository …..and HPV, CIN along the way Karla Schmitt, PhD, MPH, ARNP Florida Department of Health

Acknowledgements The initial roadway construction: The repavement: Phil Moncrief, Kim Quinn, Stacy Shiver, stakeholders across the state The repavement: Adrian Cooksey, Sara Forhan, Sami Gottlieb, Lauri Markowitz Many colleagues within the department

Goal Create baseline surveillance data on high risk HPV strains and abnormal cytologies, histologies Create viable surveillance system that would support future analysis to understand natural history, notably in the presence of co-morbidity with other STDs at the population level to evaluate HPV vaccine efficacy

The Rule “Adoption” Process Opportunity/outcome of the Re-Write Reduce language redundancy Enhance communicable disease reporting – unified reporting timeframes single unified practitioner report form Clarify testing requirements Comply with new statutory requirements Mandated electronic reporting high level HL-7 Drive health policy issues, e.g., child abuse reporting, public health preparedness, and HPV issues

Passive System Practitioners report: Laboratories report: BOTH report to single central location: Bureau of Sexually Transmitted Disease Prevention and Control, department headquarters Practitioners report: positive high risk HPV strains Laboratories report: DNA typing of high risk strains Abnormal cytologies Abnormal histologies

One year later….. Nov 2007 Sought evaluation assistance from CDC colleagues Streamline functions of new surveillance system Assess practitioner and laboratory data Address case definition

Laboratory Data to Date HPV is but an aspect of electronic reporting data stream In STD we nightly upload average 1,200 positive test results Six major laboratories at present Additional daily average 4,000 negative field screening results Appear on “task list” within PRISM Annual aggregate report

Practitioner Data About 2,500 responses from select practitioners Inconsistent quality Reported both high and low risk results Often attached laboratory results Treatment field often included next planned evaluation, or was left blank Challenge to Code requirements

The Complex Challenge ……….thanks to CDC Colleague Dr. Forhan At two layers : (1) Distinguishing the test (HPV test, Pap, or histology) and (2) identifying the subset of those tests that yield reportable results. See handout

LabCorp Data 45,567 HPV results for 2007 HPV clean per standards set Pap and histology files in test Note: Local moderate size pathology practice in development for cytology & histology electronic transmission

Age distribution of reports are comparable for rural and urban areas of the state Age distribution by high risk strain greater among younger females in rural areas by 2:1 And less at age 45+ by 1/3 …the same at 24-29

New Case Definition For laboratory reporting: 1. Positive test for any high-risk HPV type (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 59, 68, etc.) 2. Abnormal cervical and anogenital cytology, consistent with Bethesda 2001 Terminology, including ASC, AGC, LSIL, and HSIL 3. Abnormal histology: a. Cervical intraepithelial neoplasia (CIN 1, 2, 3, or carcinoma in situ (CIS)) b. Adenocarcinoma in situ of cervix (AIS) c. Vulvar intraepithelial neoplasia (VIN)* d. Vaginal intraepithelial neoplasia (VAIN)* e. Anal intraepithelial neoplasia (AIN)* For health care practitioner reporting: Only persons licensed as pathologists are required to report conditions under laboratory reporting noted above.

HPV Vaccine Commenced to distribute late spring 2007 Update notably better than last several new vaccines Among 9-18 year olds: 78,251 (59.3%) first dose 39,955 (30.3%) second dose 12,436 (9.4%) third dose Source: Florida SHOTS