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HPV Vaccine Does Not Increase Risk for Autoimmune Disease in Teen Girls
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The risk for autoimmune disease among teenage girls does not increase after they receive the quadrivalent HPV vaccine, according to findings published in the Canadian Medical Association Journal.
“Despite demonstrated effectiveness in real-world settings, concerns continue to persist regarding the safety of the [quadrivalent human papillomavirus (HPV4)] vaccine,” Jeffrey Kwong, MD, MSc, a coauthor of the study and senior scientist at the Institute for Clinical Evaluative Sciences and Public Health Ontario, Toronto, said in a press release. “In light of these concerns, we wanted to study the HPV4 vaccination since it was being offered free to all grade 8 girls in Ontario through school-based clinics.”
To determine the risk for autoimmune disorders — including rheumatoid arthritis, Bell’s palsy, optic neuritis and Graves’ disease — following HPV4 vaccination among teenage girls, the researchers conducted a population-based retrospective study of 290,939 girls aged 12 to 17 who were eligible for Ontario’s school-based vaccination program between 2007 and 2013.
Using the self-controlled case series method, the researchers compared the rate of a composite endpoint of autoimmune disease, identified among participants from 7 to 60 days following vaccination, to that of any other time. The researchers then repeated this process to assess whether history of immune-mediated conditions or time since vaccination influenced the findings. In addition, the researchers completed analyses evaluating rate ratios and confidence intervals for individual autoimmune diseases.
Among the participants, 62.2% received at least one dose of the HPV4 vaccine, and 37.8% remained unvaccinated. Among those who were vaccinated, 81.8% received all three doses. According to the researchers, there were 681 cases of autoimmune disorders diagnosed in participants who received the vaccination (RR = 1.12; 95% CI, 0.85-1.47), of which 77 occurred 7 to 60 days after receiving the vaccine. The lack of an association between the vaccine and autoimmune risk was unchanged by patient history and time since vaccination, the researchers found. In addition, exploratory analyses of individual diseases also found no significant risks associated with HPV4 vaccination, including for Bell’s palsy (RR = 1.73; 95% CI, 0.77-3.89), optic neuritis (RR = 1.57; 95% CI, 0.74-3.33) and Graves’ disease (RR = 1.55; 95% CI, 0.92-2.63).
“We did not find a significantly increased risk for autoimmune disorders following HPV4 vaccination in this large population of girls aged 12 to 17 years, including in those with pre-existing immune-mediated diseases,” Kwong and colleagues wrote. “The association was also unaffected by time since vaccination. Moreover, our results were robust to numerous sensitivity analyses.” – by Jason Laday
Disclosure: Kwong reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Eileen J. Lydon, MA, RN, ANP-BC
Liu and colleagues reported on the risk of autoimmune disorders following HPV4 vaccination among girls age 12-17 who were eligible for the school-based vaccination program in Ontario, Canada. Of the 181,00 girls vaccinated, 681 later developed an autoimmune disorder, which was similar to the diagnosis rate of unvaccinated girls. These results, along with those of previous studies using registries in Denmark and Sweden, have found no increased risk for autoimmune disorders.
HPV is the most common sexually transmitted disease worldwide and associated with cervical, anal, vaginal, vulvar and penile cancers; most often, HPV goes away by itself, but certain populations, including the immunocompromised, are at increased risk of developing these malignancies.
Unfortunately, these potentially deadly effects do occur among those with rheumatologic disorders. The autoimmune disease, along with immunosuppressants used, pose a higher risk, therefore the importance of prevention cannot be understated. These results should offer reassurance regarding safety, as these vaccines have the capability of preventing a considerable portion of HPV-related cancers.
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