Etiology
Quadrivalent HPV vaccination was not linked to multiple sclerosis or other demyelinating diseases Clinical impact ratings:
多多多多多多夞
Scheller NM, Svanstro¨m H, Pasternak B, et al. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. JAMA. 2015;313:54-61.
多多多多多多夞
Question Is quadrivalent human papillomavirus (qHPV) vaccination associated with increased risk for multiple sclerosis (MS) or other demyelinating diseases?
Sources of funding: Swedish Foundation for Strategic Research; Novo Nordisk Foundation; Danish Medical Research Council. For correspondence: Dr. N. Scheller, Statens Serum Institute, Copenhagen, Denmark. E-mail [email protected].
Methods
Commentary
Design: Population-based cohort study, with linkage of national vaccination, prescription, and patient registries between 2006 and 2013, comparing vaccinated and unvaccinated participants and periods.
Scheller and colleagues report on the incidence of MS and other demyelinating diseases over a 7-year period in Denmark and Sweden in the context of implementation of qHPV vaccination. The study used national registries to identify vaccination status and disease outcomes. The incidence of MS and other demyelinating diseases was compared in vaccinated and unvaccinated patients within 2 years of vaccine exposure. All incident cases of MS or other demyelinating diseases were also identified, regardless of time since exposure; cases occurring within 2 years of vaccination were compared with those occurring after 2 years in a self-controlled case series. Neither approach showed an association between the vaccine and MS or other demyelinating diseases.
Setting: Denmark and Sweden. Patients: 3 978 271 girls and women 10 to 44 years of age (mean age at vaccination 19 y in Denmark and 15 y in Sweden) who did not have prevalent MS and 3 980 716 girls and women who did not have other prevalent demyelinating diseases. 789 082 girls and women (20%) were vaccinated during the study period. Risk factors: qHPV vaccine, which has a recommended schedule of second and third doses 2 and 6 months after the first dose. Analyses compared events in the 2-year risk periods after each dose with unvaccinated periods and were adjusted for calendar year, age, and country. Outcomes: Incident diagnoses of MS and a composite of other demyelinating diseases (optic neuritis, neuromyelitis optica, transverse myelitis, acute disseminated encephalomyelitis, or other central demyelinating diseases) identified through diagnostic codes in the national patient registers.
Main results qHPV vaccination was not associated with increased risk for MS or other demyelinating diseases (Table).
Conclusion Quadrivalent human papillomavirus vaccination was not associated with increased risk for multiple sclerosis or other demyelinating diseases.
Association between quadrivalent human papillomavirus (qHPV) vaccination and multiple sclerosis or other demyelinating diseases* Outcomes
Crude incidence rates / 100 000 person-y
Adjusted rate ratio
qHPV vaccine
No vaccine
Multiple sclerosis
6.12
21.54
0.90 (0.70 to 1.15)
Other demyelinating diseases†
7.54
16.14
1.00 (0.80 to 1.26)
*Abbreviations defined in Glossary. Rate ratio adjusted for calendar year, age, and country.
These findings from large, comprehensive, national cohorts should allay fears about an increased risk for MS or other demyelinating diseases associated with HPV vaccine. The study assessed the effect of qHPV vaccine, rather than the bivalent HPV vaccine, and men were not included because there was no recommendation at the time for men to receive the vaccine. It was offered to girls and women 10 to 44 years of age, which differs from the age range currently recommended in the USA (9 to 26 y) (1). Although this was not a randomized controlled trial, Denmark and Sweden have national registries that provide comprehensive validated data. A recent study failed to show longterm associations of any immunizations, including HPV, with MS or other demyelinating diseases (2). The benefit of HPV vaccine in reducing the incidence of HPV and HPV-related cancers has been established (3), whereas no evidence links HPV vaccine with MS or demyelinating disease. Bruno Granwehr, MD, MS, FACP University of Texas MD Anderson Cancer Center Houston, Texas, USA References 1. Markowitz LE, Dunne EF, Saraiya M, et al; Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63:1-30. 2. Langer-Gould A, Qian L, Tartof SY, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol. 2014;71:1506-13. 3. Lu B, Kumar A, Castellsague´ X, Giuliano AR. Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review & meta-analysis. BMC Infect Dis. 2011;11:13.
†Composite of optic neuritis, neuromyelitis optica, transverse myelitis, acute disseminated encephalomyelitis, or other central demyelinating diseases.
21 April 2015
Annals of Internal Medicine
ACP Journal Club
JC13
姝 2015 American College of Physicians
Downloaded From: http://annals.org/pdfaccess.ashx?url=/data/journals/aim/933761/ by a University of California San Diego User on 06/09/2017
Quadrivalent HPV vaccination was not linked to multiple sclerosis or other demyelinating diseases Clinical impact ratings:
多多多多多多夞
Scheller NM, Svanstro¨m H, Pasternak B, et al. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. JAMA. 2015;313:54-61.
多多多多多多夞
Question Is quadrivalent human papillomavirus (qHPV) vaccination associated with increased risk for multiple sclerosis (MS) or other demyelinating diseases?
Sources of funding: Swedish Foundation for Strategic Research; Novo Nordisk Foundation; Danish Medical Research Council. For correspondence: Dr. N. Scheller, Statens Serum Institute, Copenhagen, Denmark. E-mail [email protected].
Methods
Commentary
Design: Population-based cohort study, with linkage of national vaccination, prescription, and patient registries between 2006 and 2013, comparing vaccinated and unvaccinated participants and periods.
Scheller and colleagues report on the incidence of MS and other demyelinating diseases over a 7-year period in Denmark and Sweden in the context of implementation of qHPV vaccination. The study used national registries to identify vaccination status and disease outcomes. The incidence of MS and other demyelinating diseases was compared in vaccinated and unvaccinated patients within 2 years of vaccine exposure. All incident cases of MS or other demyelinating diseases were also identified, regardless of time since exposure; cases occurring within 2 years of vaccination were compared with those occurring after 2 years in a self-controlled case series. Neither approach showed an association between the vaccine and MS or other demyelinating diseases.
Setting: Denmark and Sweden. Patients: 3 978 271 girls and women 10 to 44 years of age (mean age at vaccination 19 y in Denmark and 15 y in Sweden) who did not have prevalent MS and 3 980 716 girls and women who did not have other prevalent demyelinating diseases. 789 082 girls and women (20%) were vaccinated during the study period. Risk factors: qHPV vaccine, which has a recommended schedule of second and third doses 2 and 6 months after the first dose. Analyses compared events in the 2-year risk periods after each dose with unvaccinated periods and were adjusted for calendar year, age, and country. Outcomes: Incident diagnoses of MS and a composite of other demyelinating diseases (optic neuritis, neuromyelitis optica, transverse myelitis, acute disseminated encephalomyelitis, or other central demyelinating diseases) identified through diagnostic codes in the national patient registers.
Main results qHPV vaccination was not associated with increased risk for MS or other demyelinating diseases (Table).
Conclusion Quadrivalent human papillomavirus vaccination was not associated with increased risk for multiple sclerosis or other demyelinating diseases.
Association between quadrivalent human papillomavirus (qHPV) vaccination and multiple sclerosis or other demyelinating diseases* Outcomes
Crude incidence rates / 100 000 person-y
Adjusted rate ratio
qHPV vaccine
No vaccine
Multiple sclerosis
6.12
21.54
0.90 (0.70 to 1.15)
Other demyelinating diseases†
7.54
16.14
1.00 (0.80 to 1.26)
*Abbreviations defined in Glossary. Rate ratio adjusted for calendar year, age, and country.
These findings from large, comprehensive, national cohorts should allay fears about an increased risk for MS or other demyelinating diseases associated with HPV vaccine. The study assessed the effect of qHPV vaccine, rather than the bivalent HPV vaccine, and men were not included because there was no recommendation at the time for men to receive the vaccine. It was offered to girls and women 10 to 44 years of age, which differs from the age range currently recommended in the USA (9 to 26 y) (1). Although this was not a randomized controlled trial, Denmark and Sweden have national registries that provide comprehensive validated data. A recent study failed to show longterm associations of any immunizations, including HPV, with MS or other demyelinating diseases (2). The benefit of HPV vaccine in reducing the incidence of HPV and HPV-related cancers has been established (3), whereas no evidence links HPV vaccine with MS or demyelinating disease. Bruno Granwehr, MD, MS, FACP University of Texas MD Anderson Cancer Center Houston, Texas, USA References 1. Markowitz LE, Dunne EF, Saraiya M, et al; Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63:1-30. 2. Langer-Gould A, Qian L, Tartof SY, et al. Vaccines and the risk of multiple sclerosis and other central nervous system demyelinating diseases. JAMA Neurol. 2014;71:1506-13. 3. Lu B, Kumar A, Castellsague´ X, Giuliano AR. Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review & meta-analysis. BMC Infect Dis. 2011;11:13.
†Composite of optic neuritis, neuromyelitis optica, transverse myelitis, acute disseminated encephalomyelitis, or other central demyelinating diseases.
21 April 2015
Annals of Internal Medicine
ACP Journal Club
JC13
姝 2015 American College of Physicians
Downloaded From: http://annals.org/pdfaccess.ashx?url=/data/journals/aim/933761/ by a University of California San Diego User on 06/09/2017
