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==Risk in developing ME/CFS == According to the 2018 version of ''The Clinician’s Vaccine Safety Resource Guide Vaccines'': "Vaccines currently routinely recommended to the general population in the U.S. have not been shown to cause [[fibromyalgia]] or [[chronic fatigue syndrome]] (CFS)."<ref name="Dudley2018" /> A 2015 complete population study of data from 2009 to 2012 in [[Norway]], following the country's mass vaccination during the 2009 influenza A (H1N1) pandemic, found that vaccination produced no increased risk of ME/CFS. By contrast, infection with [[influenza|flu]] more than doubled the risk of developing CME/CFS.<ref name=":6">{{Cite journal | last =Magnus | first = Per | last2=Gunnes | first2 = Nina | last3 = Tveito | first3 = Kari | last4 = Bakken | first4=Inger Johanne | last5 = Ghaderi | first5 = Sara | last6 = Stoltenberg | first6 = Camilla | last7 = Hornig | first7 = Mady | last8 = Lipkin | first8 = W. Ian | last9 = Trogstad | first9 = Lill | date = 2015-11-17 | title = Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine|url=https://www.ncbi.nlm.nih.gov/pubmed/26475444|journal=Vaccine|volume=33|issue=46|pages=6173–6177|doi=10.1016/j.vaccine.2015.10.018|issn=1873-2518|pmid=26475444}}</ref> A minority of people with [[ME/CFS]] have reported developing it after receiving a vaccination, but a causal relationship has not been shown.<ref name="ICP2011primer" /> In one case, a 43-year-old man with no previous ill health developed CFS after having five vaccinations, all containing aluminium adjuvants, within the same month.<ref name="Exley2009">{{Cite journal | last =Exley | first = Christopher | last2=Swarbrick | first2 = Louise | last3 = Gherardi | first3 = Rhomain K. | last4 = Authier | first4=Francois-Jérôme | date = 2009-02-01 | title = A role for the body burden of aluminium in vaccine-associated macrophagic myofasciitis and chronic fatigue syndrome|url=https://www.sciencedirect.com/science/article/pii/S0306987708004933|journal=Medical Hypotheses|language=en|volume=72|issue=2|pages=135–139|doi=10.1016/j.mehy.2008.09.040|issn=0306-9877}}</ref> Based on this case, Exley et al. (2009) anticipated that the mass human papillomavirus (HPV) vaccination program then recently begun in the UK would carry related risks, as that vaccine also used an aluminium-based adjuvant. That was not borne out: a number of different studies concluded there is no evidence Cervarix,<ref name="Donegan2013">{{Cite journal | first = Katherine | last =Donegan | first2 =Raphaelle | last2 = Beau-Lejdstrom | first3 = Bridget | last3 = King | first4 = Suzie | last4 = Seabroke | first5 = Andrew | last5 = Thomson | first6 = Philip | last6 = Bryan | date = 2013-10-09 | title = Bivalent human papillomavirus vaccine and the risk of fatigue syndromes in girls in the UK|url=https://www.sciencedirect.com/science/article/pii/S0264410X13011158|journal=Vaccine|language=en|volume=31|issue=43|pages=4961–4967|doi=10.1016/j.vaccine.2013.08.024|issn=0264-410X}}</ref> or the later Gardasil<ref name="Liu2016">{{Cite journal | last =Liu | first = Xianfang C. | last2 = Bell | first2 = Christopher A. | last3 = Simmonds | first3=Kimberley A. | last4 = Svenson | first4 = Lawrence W. | last5 = Russell | first5 = Margaret L. | date = 2016-04-04 | title = Adverse events following HPV vaccination, Alberta 2006-2014|url=https://pubmed.ncbi.nlm.nih.gov/26921782/|journal=Vaccine|volume=34|issue=15|pages=1800–1805|doi=10.1016/j.vaccine.2016.02.040|issn=1873-2518|pmid=26921782}}</ref><ref name="PHA-Canada2018">{{Cite web|url=https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2012-38/canada-communicable-disease-report.html | title = NACI Statement: HPV vaccine update | last =Public Health Agency of Canada | first = | authorlink = | date = 2012-01-18 | website = canada.ca|archive-url=|archive-date=|url-status=|access-date=2021-09-30}}</ref><ref name="Feiring2018">{{Cite journal | last = Feiring | first = Berit | last2 = Laake | first2 = Ida | last3 = Bakken | first3=Inger Johanne | last4 = Greve-Isdahl | first4 = Margrethe | last5 = Wyller | first5 = Vegard Bruun | authorlink5 = Vegard Bruun Wyller | last6 = Håberg | first6 = Siri E. | last7 = Magnus | first7 = Per | last8 = Trogstad | first8 = Lill | date = 2017-07-24 | title = HPV vaccination and risk of chronic fatigue syndrome/myalgic encephalomyelitis: A nationwide register-based study from Norway|url=https://www.sciencedirect.com/science/article/pii/S0264410X17308083|journal=Vaccine|language=en|volume=35|issue=33|pages=4203–4212|doi=10.1016/j.vaccine.2017.06.031|issn=0264-410X}}</ref><ref name="Galan2014">{{Cite journal | last =Rodríguez-Galán | first = M. A. | last2 = Pérez-Vilar | first2 = S. | last3 = Díez-Domingo | first3 = J. | last4 = Tuells | first4=J. | last5 = Gomar-Fayos | first5 = J. | last6 = Morales-Olivas | first6 = F. | last7 = Pastor-Villalba | first7 = E. | date = 2014-11-01 | title = Notificación de reacciones adversas a la vacuna frente al virus del papiloma humano en la Comunidad Valenciana (2007-2011)|url=https://www.sciencedirect.com/science/article/pii/S1695403313004980|journal=Anales de Pediatría|language=es|volume=81|issue=5|pages=303–309|doi=10.1016/j.anpedi.2013.11.031|issn=1695-4033}}</ref> and Gardasil 9,<ref name="Liu2016" /> HPV vaccines lead to developing [[chronic fatigue syndrome]].<ref name="NHS-HPV-safety">{{Cite web|url=https://www.nhs.uk/conditions/vaccinations/hpv-vaccine-cervarix-gardasil-safety/ | title = HPV vaccine safety | last = | first = | authorlink = | date = 2019-07-31 | website = National Health Service|language=en|archive-url=|archive-date=|url-status=|access-date=2021-09-30}}</ref><ref name="Arbyn2018">{{Cite journal | last = Arbyn | first = M. | last2 = Xu | first2 = L. | date = 2018-12-02 | title = Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of randomized trials|url=https://doi.org/10.1080/14760584.2018.1548282|journal=Expert Review of Vaccines|volume=17|issue=12|pages=1085–1091|doi=10.1080/14760584.2018.1548282|issn=1476-0584|pmid=30495978}}</ref>
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