Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort
Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been l...
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| description | Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been limited by statistical power, and concerns about infertility after vaccination are associated with lower levels of uptake of the cancer-preventing vaccine in many countries.
To evaluate the risk of primary ovarian insufficiency after quadrivalent human papillomavirus (4HPV) vaccination.
This retrospective cohort study with follow-up from 2007 to 2016 used nationwide data for 996 300 Danish-born girls and women aged 11 to 34 years. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of primary ovarian insufficiency diagnoses by 4HPV vaccination status with adjustment for age, calendar period, and a propensity score summarizing health care use. Data were analyzed from October 2020 to January 2021.
Receiving 4HPV vaccination compared with receiving no vaccination.
The main outcome was hospital contacts for primary ovarian insufficiency, and the main outcome measures were HRs comparing rates of primary ovarian insufficiency among vaccinated and unvaccinated individuals.
During 6 781 166 person-years of follow-up among 996 300 girls and women aged 11 to 34 years (505 829 vaccinated individuals [50.8%] and 490 471 unvaccinated individuals [49.2%]), 144 individuals were diagnosed with primary ovarian insufficiency, including 54 individuals diagnosed after 4HPV vaccination. The median (interquartile range) age of primary ovarian insufficiency diagnosis was 26.94 (12.68) years. The adjusted HR of primary ovarian insufficiency comparing 4HPV vaccination to no vaccination was 0.96 (95% CI, 0.55-1.68).
This study found no association between HPV vaccination and primary ovarian insufficiency. However, given the rarity of the outcome in this study, the presence of a clinically relevant increase in rate of diagnosis cannot be excluded. |
| doi_str_mv | 10.1001/jamanetworkopen.2021.20391 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8391101</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667804319</sourcerecordid><originalsourceid>FETCH-LOGICAL-a473t-f25193bfec82580916fd848f51df1cf794382c874bde82bdabc0ade46acee8bb3</originalsourceid><addsrcrecordid>eNpdkU9P3DAQxS3UqqCFr1BZ9NLLUv-L4_SARFelICHgQHu1HGcMXhJ7sZNFfHsMC4hysS35N29m3kNon5IDSgj9sTSDCTDex3QbVxAOGGG0HLyhW2iHVbWYc0WqT-_e22gv5yUhhBHKG1l9QdtcCC4lZTtoOMo5Wm9GHwP-VXQBAj6ZSg98aVa-7-Ng1j5NGf8z1vqwAU3o8GXyg0kP-GJtki_4aciTc956CPYB-wLh82f63neAF_EmpnEXfXamz7D3cs_Q3-PfV4uT-dnFn9PF0dnciJqPc8cq2vDWgVWsUqSh0nVKKFfRzlHr6kZwxayqRduBYm1nWktMB0IaC6Dals_Q4UZ3NbUDdBbCmEyvV5uRdTRe__8T_I2-jmutio-02DRD318EUrybII968NlC3xfv45Q1q6RohCRCFfTbB3QZpxTKeppJWSsieFlmhn5uKJtizgnc2zCU6Kdg9Ydg9VOw-jnYUvz1_Tpvpa8x8keXQKej</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667804319</pqid></control><display><type>article</type><title>Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Hviid, Anders ; Myrup Thiesson, Emilia</creator><creatorcontrib>Hviid, Anders ; Myrup Thiesson, Emilia</creatorcontrib><description>Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been limited by statistical power, and concerns about infertility after vaccination are associated with lower levels of uptake of the cancer-preventing vaccine in many countries.
To evaluate the risk of primary ovarian insufficiency after quadrivalent human papillomavirus (4HPV) vaccination.
This retrospective cohort study with follow-up from 2007 to 2016 used nationwide data for 996 300 Danish-born girls and women aged 11 to 34 years. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of primary ovarian insufficiency diagnoses by 4HPV vaccination status with adjustment for age, calendar period, and a propensity score summarizing health care use. Data were analyzed from October 2020 to January 2021.
Receiving 4HPV vaccination compared with receiving no vaccination.
The main outcome was hospital contacts for primary ovarian insufficiency, and the main outcome measures were HRs comparing rates of primary ovarian insufficiency among vaccinated and unvaccinated individuals.
During 6 781 166 person-years of follow-up among 996 300 girls and women aged 11 to 34 years (505 829 vaccinated individuals [50.8%] and 490 471 unvaccinated individuals [49.2%]), 144 individuals were diagnosed with primary ovarian insufficiency, including 54 individuals diagnosed after 4HPV vaccination. The median (interquartile range) age of primary ovarian insufficiency diagnosis was 26.94 (12.68) years. The adjusted HR of primary ovarian insufficiency comparing 4HPV vaccination to no vaccination was 0.96 (95% CI, 0.55-1.68).
This study found no association between HPV vaccination and primary ovarian insufficiency. However, given the rarity of the outcome in this study, the presence of a clinically relevant increase in rate of diagnosis cannot be excluded.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.20391</identifier><identifier>PMID: 34436612</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Adult ; Child ; Cohort Studies ; Denmark ; Drug-Related Side Effects and Adverse Reactions - etiology ; Female ; Human papillomavirus ; Humans ; Immunization ; Online Only ; Original Investigation ; Ovaries ; Papillomavirus Infections - prevention & control ; Papillomavirus Vaccines - administration & dosage ; Papillomavirus Vaccines - adverse effects ; Primary Ovarian Insufficiency - chemically induced ; Public Health ; Retrospective Studies ; Vaccination - adverse effects ; Vaccination - statistics & numerical data ; Vaccination Refusal - statistics & numerical data ; Young Adult</subject><ispartof>JAMA network open, 2021-08, Vol.4 (8), p.e2120391-e2120391</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 Hviid A et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-f25193bfec82580916fd848f51df1cf794382c874bde82bdabc0ade46acee8bb3</citedby><cites>FETCH-LOGICAL-a473t-f25193bfec82580916fd848f51df1cf794382c874bde82bdabc0ade46acee8bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34436612$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hviid, Anders</creatorcontrib><creatorcontrib>Myrup Thiesson, Emilia</creatorcontrib><title>Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been limited by statistical power, and concerns about infertility after vaccination are associated with lower levels of uptake of the cancer-preventing vaccine in many countries.
To evaluate the risk of primary ovarian insufficiency after quadrivalent human papillomavirus (4HPV) vaccination.
This retrospective cohort study with follow-up from 2007 to 2016 used nationwide data for 996 300 Danish-born girls and women aged 11 to 34 years. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of primary ovarian insufficiency diagnoses by 4HPV vaccination status with adjustment for age, calendar period, and a propensity score summarizing health care use. Data were analyzed from October 2020 to January 2021.
Receiving 4HPV vaccination compared with receiving no vaccination.
The main outcome was hospital contacts for primary ovarian insufficiency, and the main outcome measures were HRs comparing rates of primary ovarian insufficiency among vaccinated and unvaccinated individuals.
During 6 781 166 person-years of follow-up among 996 300 girls and women aged 11 to 34 years (505 829 vaccinated individuals [50.8%] and 490 471 unvaccinated individuals [49.2%]), 144 individuals were diagnosed with primary ovarian insufficiency, including 54 individuals diagnosed after 4HPV vaccination. The median (interquartile range) age of primary ovarian insufficiency diagnosis was 26.94 (12.68) years. The adjusted HR of primary ovarian insufficiency comparing 4HPV vaccination to no vaccination was 0.96 (95% CI, 0.55-1.68).
This study found no association between HPV vaccination and primary ovarian insufficiency. However, given the rarity of the outcome in this study, the presence of a clinically relevant increase in rate of diagnosis cannot be excluded.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Child</subject><subject>Cohort Studies</subject><subject>Denmark</subject><subject>Drug-Related Side Effects and Adverse Reactions - etiology</subject><subject>Female</subject><subject>Human papillomavirus</subject><subject>Humans</subject><subject>Immunization</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Ovaries</subject><subject>Papillomavirus Infections - prevention & control</subject><subject>Papillomavirus Vaccines - administration & dosage</subject><subject>Papillomavirus Vaccines - adverse effects</subject><subject>Primary Ovarian Insufficiency - chemically induced</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Vaccination - adverse effects</subject><subject>Vaccination - statistics & numerical data</subject><subject>Vaccination Refusal - statistics & numerical data</subject><subject>Young Adult</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkU9P3DAQxS3UqqCFr1BZ9NLLUv-L4_SARFelICHgQHu1HGcMXhJ7sZNFfHsMC4hysS35N29m3kNon5IDSgj9sTSDCTDex3QbVxAOGGG0HLyhW2iHVbWYc0WqT-_e22gv5yUhhBHKG1l9QdtcCC4lZTtoOMo5Wm9GHwP-VXQBAj6ZSg98aVa-7-Ng1j5NGf8z1vqwAU3o8GXyg0kP-GJtki_4aciTc956CPYB-wLh82f63neAF_EmpnEXfXamz7D3cs_Q3-PfV4uT-dnFn9PF0dnciJqPc8cq2vDWgVWsUqSh0nVKKFfRzlHr6kZwxayqRduBYm1nWktMB0IaC6Dals_Q4UZ3NbUDdBbCmEyvV5uRdTRe__8T_I2-jmutio-02DRD318EUrybII968NlC3xfv45Q1q6RohCRCFfTbB3QZpxTKeppJWSsieFlmhn5uKJtizgnc2zCU6Kdg9Ydg9VOw-jnYUvz1_Tpvpa8x8keXQKej</recordid><startdate>20210802</startdate><enddate>20210802</enddate><creator>Hviid, Anders</creator><creator>Myrup Thiesson, Emilia</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210802</creationdate><title>Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort</title><author>Hviid, Anders ; Myrup Thiesson, Emilia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-f25193bfec82580916fd848f51df1cf794382c874bde82bdabc0ade46acee8bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Child</topic><topic>Cohort Studies</topic><topic>Denmark</topic><topic>Drug-Related Side Effects and Adverse Reactions - etiology</topic><topic>Female</topic><topic>Human papillomavirus</topic><topic>Humans</topic><topic>Immunization</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Ovaries</topic><topic>Papillomavirus Infections - prevention & control</topic><topic>Papillomavirus Vaccines - administration & dosage</topic><topic>Papillomavirus Vaccines - adverse effects</topic><topic>Primary Ovarian Insufficiency - chemically induced</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Vaccination - adverse effects</topic><topic>Vaccination - statistics & numerical data</topic><topic>Vaccination Refusal - statistics & numerical data</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hviid, Anders</creatorcontrib><creatorcontrib>Myrup Thiesson, Emilia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hviid, Anders</au><au>Myrup Thiesson, Emilia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2021-08-02</date><risdate>2021</risdate><volume>4</volume><issue>8</issue><spage>e2120391</spage><epage>e2120391</epage><pages>e2120391-e2120391</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Anecdotal case reports have suggested an association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency, but observational studies of HPV and primary ovarian insufficiency are rare, and their findings do not support an association. However, available studies have been limited by statistical power, and concerns about infertility after vaccination are associated with lower levels of uptake of the cancer-preventing vaccine in many countries.
To evaluate the risk of primary ovarian insufficiency after quadrivalent human papillomavirus (4HPV) vaccination.
This retrospective cohort study with follow-up from 2007 to 2016 used nationwide data for 996 300 Danish-born girls and women aged 11 to 34 years. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of primary ovarian insufficiency diagnoses by 4HPV vaccination status with adjustment for age, calendar period, and a propensity score summarizing health care use. Data were analyzed from October 2020 to January 2021.
Receiving 4HPV vaccination compared with receiving no vaccination.
The main outcome was hospital contacts for primary ovarian insufficiency, and the main outcome measures were HRs comparing rates of primary ovarian insufficiency among vaccinated and unvaccinated individuals.
During 6 781 166 person-years of follow-up among 996 300 girls and women aged 11 to 34 years (505 829 vaccinated individuals [50.8%] and 490 471 unvaccinated individuals [49.2%]), 144 individuals were diagnosed with primary ovarian insufficiency, including 54 individuals diagnosed after 4HPV vaccination. The median (interquartile range) age of primary ovarian insufficiency diagnosis was 26.94 (12.68) years. The adjusted HR of primary ovarian insufficiency comparing 4HPV vaccination to no vaccination was 0.96 (95% CI, 0.55-1.68).
This study found no association between HPV vaccination and primary ovarian insufficiency. However, given the rarity of the outcome in this study, the presence of a clinically relevant increase in rate of diagnosis cannot be excluded.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34436612</pmid><doi>10.1001/jamanetworkopen.2021.20391</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Child Cohort Studies Denmark Drug-Related Side Effects and Adverse Reactions - etiology Female Human papillomavirus Humans Immunization Online Only Original Investigation Ovaries Papillomavirus Infections - prevention & control Papillomavirus Vaccines - administration & dosage Papillomavirus Vaccines - adverse effects Primary Ovarian Insufficiency - chemically induced Public Health Retrospective Studies Vaccination - adverse effects Vaccination - statistics & numerical data Vaccination Refusal - statistics & numerical data Young Adult |
| title | Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort |
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