HPV vaccine

HPV vaccines are a group of vaccines have been developed to protect again human papillomavirus infection, which may lead to certain types of cancers. HPV refers to a very large group of viruses, and some of these, including HPV 16 and HPV 18, cause cervical cancer, anal cancer, genital warts, and other serious illness.

Available vaccines protect against either two, four, or nine types of HPV. All vaccines protect against at least HPV type 16 and 18 that cause the greatest risk of cervical cancer.

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.

Controversy

• Should Your Child Get the HPV Vaccine?
• 2012, The HPV Vaccine Controversy
• 2014, Pros, cons, and ethics of HPV vaccine in teens—Why such controversy?
• Gøtzsche et al. (2021) criticized the European Medicines Agency report on HPV vaccine safety for being overly confident and relying too heavily on data on serious adverse events reported by the manufacturers during clinical trials, and also made criticisms of the Cochrane review process. They referred to previous investigations into rates of raised particular concerns about rates of POTS, ME/CFS and Chronic Regional Pain Syndrome (CRPS) after HPV vaccination, and to rates of post-vaccination in POTS compared to POTS rates after other vaccines. However, Gøtzsche et al avoided stating that the HPV vaccines were not safe and they present any analysis of data, or draw their own conclusions about the HPV vaccines.

ME/CFS

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.

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

Notable studies and scientific publications

• 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
• 2018, Autonomic dysfunction and HPV immunization: an overview. (ABSTRACT)

  This article reviews the case series reported from several countries describing patients with suspected severe side effects to the HPV vaccines. The described symptom clusters are remarkably similar and include disabling fatigue, headache, widespread pain, fainting, gastrointestinal dysmotility, limb weakness, memory impairment episodes of altered awareness, and abnormal movements. This constellation of symptoms and signs has been labeled with different diagnoses such as complex regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS), small fiber neuropathy (SFN), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), or fibromyalgia. It is known that autoimmunity and autoantibodies are present in a subset of patients with CRPS, POTS, SFN, ME/CFS, and fibromyalgia. This article proposes that vaccine-triggered, immune-mediated autonomic dysfunction could lead to the development of de novo post-HPV vaccination syndrome possibly in genetically susceptible individuals. Being cognizant that a temporal relationship between vaccination and symptom onset does not necessarily equate to causality, mounting evidence of case series calls for well-designed case-control studies to determine the prevalence and possible causation between these symptom clusters and HPV vaccines. Since personalized medicine is gaining momentum, the use of adversomics and pharmacogenetics may eventually help identify individuals who are predisposed to HPV vaccine adverse events.

• 2021, EMA's mishandling of an investigation into suspected serious neurological harms of HPV vaccines - (Full text)

See also

• Human papillomavirus
• Vaccine
• Epidemiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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
• HPV vaccines and safety - World Health Organization
• Dec 2017, Observed Rates of Vaccine Reactions, Human Papillomavirus Vaccine (leaflet) - World Health Organization

See postural orthostatic tachycardia syndrome.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.