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Quadrivalent HPV Vaccination and Risk of Multiple Sclerosis and Other Demyelinating Diseases of the Central Nervous System
- Source :
- JAMA. 313:54
- Publication Year :
- 2015
- Publisher :
- American Medical Association (AMA), 2015.
-
Abstract
- Importance Case reports have suggested a link between human papillomavirus (HPV) vaccination and development of multiple sclerosis and other demyelinating diseases. Objective To investigate if quadrivalent HPV (qHPV) vaccination is associated with an increased risk of multiple sclerosis and other demyelinating diseases. Design, Setting, and Participants Using nationwide registers we identified a cohort of all females aged 10 years to 44 years in Denmark and Sweden, followed up from 2006 to 2013, information on qHPV vaccination, and data on incident diagnoses of multiple sclerosis and other demyelinating diseases. The primary analysis used a cohort design including vaccinated and unvaccinated study participants. A secondary analysis used a self-controlled case-series design including only cases. Both analyses used a 2-year risk period following vaccination. Exposures Information on qHPV vaccination was obtained through the national vaccination and prescription registers. Main Outcomes and Measures The primary outcomes were multiple sclerosis and a composite end point of other demyelinating diseases. Incidence rate ratios were estimated using Poisson regression, comparing rates of events in the 2-year risk periods following vaccination and in unvaccinated time periods. Results The study included 3 983 824 females, among whom 789 082 received a total of 1 927 581 qHPV vaccine doses. During follow-up, 4322 multiple sclerosis cases and 3300 cases of other demyelinating diseases were identified, of which 73 and 90, respectively, occurred within the risk period. In the cohort analysis, there was no increased risk of multiple sclerosis (crude incidence rates, 6.12 events/100 000 person-years [95% CI, 4.86-7.69] and 21.54 events/100 000 person-years [95% CI, 20.90-22.20] for the vaccinated and unvaccinated periods; adjusted rate ratio, 0.90 [95% CI, 0.70-1.15]) or other demyelinating diseases (crude incidence rates, 7.54 events/100 000 person-years [95% CI, 6.13-9.27] and 16.14 events/100 000 person-years [95% CI, 15.58-16.71]; adjusted rate ratio, 1.00 [95% CI, 0.80-1.26]) associated with qHPV vaccination. Similarly, no increased risk was found using the self-controlled case-series design (multiple sclerosis: incidence ratio, 1.05 [95% CI, 0.79-1.38]; other demyelinating diseases: incidence ratio, 1.14 [95% CI, 0.88-1.47]). Conclusions and Relevance In this study with nationwide coverage of 2 Scandinavian countries, qHPV vaccination was not associated with the development of multiple sclerosis or other demyelinating diseases. These findings do not support concerns about a causal relationship between qHPV vaccination and demyelinating diseases.
- Subjects :
- Adult
Risk
Pediatrics
medicine.medical_specialty
Multiple Sclerosis
Adolescent
Denmark
Rate ratio
Cohort Studies
Young Adult
symbols.namesake
Humans
Medicine
Papillomavirus Vaccines
Poisson regression
Young adult
Child
Sweden
business.industry
Incidence
Incidence (epidemiology)
Multiple sclerosis
Papillomavirus Infections
Vaccination
General Medicine
medicine.disease
Immunology
Cohort
symbols
Female
business
Demyelinating Diseases
Cohort study
Subjects
Details
- ISSN :
- 00987484
- Volume :
- 313
- Database :
- OpenAIRE
- Journal :
- JAMA
- Accession number :
- edsair.doi.dedup.....17735b762c05042f1761228514e31032
- Full Text :
- https://doi.org/10.1001/jama.2014.16946