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Vaccination does not increase risk of infertility in teenagers
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Immunizations with HPV, Tdap, inactivated influenza and meningococcal conjugate vaccines are not associated with an increased risk of primary ovarian insufficiency in adolescent girls, according to an analysis of almost 200,000 patients.
“Concern about infertility after HPV vaccination developed after case series were published describing the onset of primary ovarian insufficiency, also known as [premature ovarian failure (POI)] or premature menopause, within 12 months after vaccination in six young women from 13 to 21 years of age,” Allison L. Naleway, PhD, senior investigator and associate director of science programs at the Kaiser Permanente Center for Health Research, and colleagues wrote.
The researchers said the topic of fertility loss following HPV vaccination has gained national media attention — including on social media — but Naleway and colleagues noted that no population-based studies on this subject have been conducted.
The researchers examined the rate and risk of POI diagnosis after HPV immunization as well as Tdap, inactivated influenza and meningococcal conjugate (MenACWY) vaccination in 199,078 female patients aged 11 to 34 years between 2006 and 2014. Among these patients, the researchers identified 120 diagnoses that indicated POI. Known causes were found for 26 of these cases and were excluded from the study. Idiopathic causes of POI were confirmed for 46 patients.
Patients aged between 11 and 14 years had lower rates of diagnosis (0.87 per 1,000,000 person-months). The incidence of POI increased as patients aged. Naleway and colleagues observed one patient who was clinically evaluated for delayed menarche 23 months after HPV vaccination.
The researchers calculated an adjusted HR of 0.30 following immunization against HPV (95% CI, 0.07-1.36). The adjusted HR was higher for vaccination with Tdap (0.88; 95% CI, 0.37-2.10), inactivated influenza (1.42; 95% CI, 0.59-3.41) and MenACWY (0.94; 95% CI, 0.27-3.23). They noted that these risks were not statistically significant.
“Despite the challenges and limitations [of this study], we believe this study should lessen concern surrounding potential impact on fertility from HPV or other adolescent vaccination,” Naleway and colleagues wrote. – by Katherine Bortz
Disclosures: Naleway reports receiving research funding from AstraZeneca, MedImmune, Merck and Pfizer for unrelated studies. Please see the study for all other authors’ relevant financial disclosures.
Perspective
Back to TopAmy B. Middleman, MD, MSEd, MPH
This study emphasizes a critical element in the establishment of vaccine safety: evidence-based research. Adolescent vaccines are frequent targets of anecdotal concerns regarding vaccine safety, likely because they are among the newest recommended vaccines. Case reports that describe temporal relationships to undesirable outcomes seem to make headlines, yet the hypothesis-driven research revealing no truly causal relationships accumulates without public notice.
This study was conducted after case reports linking vaccination with the HPV vaccine to primary ovarian insufficiency (POI) were published. The authors used the Vaccine Safety Datalink, one of the safety systems developed by the CDC to examine potential relationships between vaccines and adverse outcomes, to examine the relationship between POI and all the vaccines routinely recommended at the 11- to 12-year health visit. The researchers found no evidence of a causal relationship between any of the vaccines and POI.
This paper is one of multiple papers that continues to support the safety of HPV and other adolescent vaccines. It is important to address all potential safety concerns about any vaccine because the public deserves to know that any and all vaccines recommended by medical professionals are safe. However, there may come a time when we must examine why so many concerns are cropping up for one vaccine over others. The HPV vaccine has been much more controversial than other vaccines, likely due to the mode of transmission of the target disease. The evidence clearly supports the safety of the HPV vaccine. How do we bring this issue back to the basics of disease prevention — regardless of the target disease? What message is the public missing, and what message are we missing?
Infectious Diseases in Children Editorial Board member
Professor of pediatrics
Chief of adolescent medicine
University of Oklahoma Health Sciences Center
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