EXECUTIVE SUMMARY

In a study of more than 3 million adult women in Denmark and Sweden, results indicate that human papillomavirus (HPV) vaccination was not connected with 44 serious chronic diseases.

  • These findings expand the HPV vaccine knowledge base, since the majority of post-licensure evidence comes from young adolescents targeted by immunization guidelines.
  • Every year in the United States, more than 31,000 women and men are diagnosed with a cancer caused by persistent HPV infection. Adult women up to age 26 who have not previously received the HPV vaccine need three doses instead of two to be protected against cancers caused by HPV.

In a study of more than 3 million adult women in Denmark and Sweden, results indicate that human papillomavirus (HPV) vaccination was not connected with 44 serious chronic diseases.1 These findings expand the HPV vaccine knowledge base, since the majority of post-licensure evidence comes from young adolescents targeted by immunization guidelines.

“This is the most comprehensive study of HPV vaccination safety in adult women to date,” said lead author Anders Hviid, MSc, DMSc, senior investigator in the Department of Epidemiology Research at the Statens Serum Institut in Copenhagen, Denmark, in a press statement. “It is not unreasonable to expect different safety concerns in adult women compared with young girls, and our study is an important supplement to the safety studies in young girls.”

In conducting the cohort study, researchers looked at Danish and Swedish nationwide healthcare registers to compare incidence rate ratios (RRs) of 45 preselected serious chronic diseases in quadrivalent HPV-vaccinated and unvaccinated adult women ages 18-44. A total of 3,126,790 women (1,195,865 [38%] Danish and 1,930,925 [62%] Swedish) were followed for 16,386,459 person-years. Scientists looked for diseases or conditions such as epilepsy, paralysis, lupus, psoriasis, type 1 diabetes, rheumatoid arthritis, thyroid issues, and Crohn’s disease.

After taking multiple testing into account and conducting self-controlled case series analyses, celiac disease (RR 1.56; 95% confidence interval, 1.29-1.89) was the only remaining association, the analysis suggests.1 The increased risk association with celiac disease, an autoimmune condition triggered by dietary gluten, was observed only in Denmark. Because previous research indicated that celiac disease is underdiagnosed in the general adult population in Denmark, scientists surmise the findings may be a result of unmasking a pre-existing disease.2

Immunize Adult Women

Adult women also are receiving HPV vaccination through catch-up programs or by choice at their own expense. How important is it that woman ages 18-26 be vaccinated for HPV?

HPV vaccination is the best way to protect against cancers and other diseases caused by HPV infections, notes Lauri Markowitz, MD, HPV Team Lead in the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases’ Division of Viral Diseases.

“Every year in the United States, over 31,000 women and men are diagnosed with a cancer caused by persistent HPV infection,” says Markowitz. “Most of these cancers could be prevented by HPV vaccination.”

Vaccination also can prevent testing and treatment that is uncomfortable, even for cervical precancers, notes Markowitz. Each year in the United States, more than 300,000 women undergo invasive testing and treatment for lesions on the cervix that can develop into cancers.3 Markowitz says that the testing and treatment for these precancers can have lasting effects.

“In the 10 years since HPV vaccine was introduced, we have seen that it works extremely well,” Markowitz comments. “Since the vaccine was introduced, infections with the HPV types that cause most of these cancers and genital warts has dropped by 71% among teen girls ages 14-19 and 61% among young women ages 20-24.”4

Follow the Schedules

Do you know the schedule when it comes to HPV vaccinations? Routine HPV vaccination is recommended at 11 or 12 years of age, says Markowitz. The vaccine will provide the most protection when it is administered in early adolescence before exposure to HPV, she says. HPV vaccination also is recommended for girls and women through age 26 who were not adequately vaccinated previously, says Markowitz.

“People who start the vaccination series after their 15th birthday need three doses instead of two to be protected against cancers caused by HPV,” says Markowitz. “Women should also start getting regular Pap tests at age 21 to screen for cervical cancers and precancers.”

In October 2016, the Advisory Committee on Immunization Practices approved the following HPV immunization schedule:

  • Adult females through age 26 and adult males through age 21 who have not received any HPV vaccine should receive a three-dose series of HPV vaccine at zero, one to two, and six months. Males ages 22-26 years may be vaccinated with a three-dose series of HPV vaccine at zero, one to two, and six months.
  • Adult females through age 26 and adult males through age 21 (and males ages 22-26 years who may receive HPV vaccine) who the initiated HPV vaccination series before age 15 and received two doses at least five months apart are considered adequately vaccinated and do not need an additional dose of HPV vaccine.
  • Adult females through age 26 and adult males through age 21 (and males ages 22-26 who may receive HPV vaccine) who initiated the HPV vaccination series before age 15 years and received only one dose, or two doses less than five months apart, are not considered adequately vaccinated and should receive one additional dose of HPV vaccine.

 

REFERENCES

  1. Hviid A, Svanström H, Scheller NM, et al. Human papillomavirus vaccination of adult women and risk of autoimmune and neurological diseases. J Intern Med 2017; doi: 10.1111/joim.12694.
  2. Bodé SH, Gudmand-Høyer E. Incidence and prevalence of symptomatic celiac disease among adults in Denmark. Ugeskr Laeger 1998;160:2100-2104.
  3. Saslow D, Castle PE, Cox JT, et al; Gynecologic Cancer Advisory Group, Garcia F. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin 2007;57:7-28.
  4. Oliver SE, Unger ER, Lewis R, et al. Prevalence of human papillomavirus among females after vaccine introduction – National Health and Nutrition Examination Survey, United States, 2003-2014. J Infect Dis 2017;216:594-603.
  5. Kim DK, Riley LE, Harriman KH, et al. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older – United States, 2017. MMWR Morb Mortal Wkly Rep 2017;66:136-138.