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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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