HPV vaccine

HPV vaccines have been developed to protect again human papillomavirus infection. HPV refers to a very large group of viruses, and some of these, including HPV 16 and HPV 18, cause cervical cancer or other serious illness. The recent use of different HPV vaccines has led to a number of studies looking at HPV vaccine safety, including whether any of the HPV vaccines may increase the risk of developing ME/CFS.

Types
A number of different vaccines are in use, with bivalent vaccines protecting against two types of HPV, and quadrivalent vaccines protecting against four types of HPV:
 * Bivalent: Ceravix which protects against HPV 16 and HPV 18 only, and contains aluminum hydroxide and monophosphoryl lipid
 * Quadrivalent: Gardasil which protects against HPV 6 and 11, plus HPV 16 and 18, and contains amorphous aluminum hydroxyphosphate sulfate. This is the vaccine currently used in the UK.
 * Nonavalent: Gardasil-9, which protects against 9 types of HPV: HPV 6 and 11, HPV 16 and 18, plus HPV 31, HPV 33, HPV 45, HPV 52, and HPV 58, and contains a larger amount of aluminum hydroxyphosphate sulfate and more than twice as many virus-like particles than the quadrivalent vaccine. Gardasil-9 was approved for use in the United States in 2014.

ME/CFS
Feiring et al. (2007) conducted a national study in Norway covering 6 birth cohorts, and found that CFS/ME was not associated with HPV vaccination in girls, but medical history was associated with a higher number of girls developing CFS/ME within 2 years of HPV vaccine, and lower uptake of HPV vaccination. They commented that ages 10-19 and 30-39 had the highest incidence of CFS/ME.

Notable studies

 * 2007, HPV vaccination and risk of chronic fatigue syndrome/myalgic encephalomyelitis: a nationwide register-based study from Norway - (Full text) - quadrivalent vaccine
 * 2013, Bivalent human papillomavirus vaccine and the risk of fatigue syndromes in girls in the UK - (Full text) - bivalent vaccine
 * 2014, Postural Orthostatic Tachycardia With Chronic Fatigue After HPV Vaccination as Part of the “Autoimmune/Auto-inflammatory Syndrome Induced by Adjuvants”: Case Report and Literature Review - (Full text)
 * 2015, Is Chronic Fatigue Syndrome/Myalgic Encephalomyelitis a Relevant Diagnosis in Patients with Suspected Side Effects to Human Papilloma Virus Vaccine? - (Full text) - quadrivalent vaccine
 * 2018, Autonomic dysfunction and HPV immunization: an overview - (Full text) - all types of vaccine

Learn more

 * HPV vaccine overview - NHS
 * Human Papillomavirus Virus - National Cancer Institute
 * STD Facts - Human papillomavirus (HPV) - Centers for Disease Control
 * HPV/genital warts - Webmd