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MS research update - Can the HPV vaccination cause MS? - 12 January 2015

Summary

The human papillomavirus (HPV) vaccine (called Gardasil) protects against cervical cancer. It was licensed for use in Europe in 2006 and since then teenage girls in many countries have been vaccinated with it. Since these vaccination programmes started there have been some reports that some people have developed MS after they had been vaccinated. However it is not clear whether this was a coincidence and they would have developed MS anyway or if the MS was as a result of the HPV vaccination.

This study looked at information about nearly four million women in Sweden and Denmark aged between 10 and 44 years old, to see if developing MS was linked to the HPV vaccination. Anyone who already had a diagnosis of MS at the time of vaccination was excluded from the study.

The study found that of the four million women studied, 789,082 had been vaccinated against HPV. When the researchers compared the information on vaccinated and unvaccinated women there was no difference in the number of women diagnosed with MS.

The researchers suggest that as they have studied a very large number of people, from a variety of backgrounds it is likely that the results can also be applied to women from other countries too. The researchers conclude that their results provide good quality evidence for the safety of the HPV vaccine and that it does not cause MS.

Background

The human papillomavirus (HPV) is a family of viruses, some types can cause verrucas and warts, however some other types can cause cervical cancer. The viruses are very common and infection may not cause any symptoms but can lead to cancer later in life. Therefore several vaccines have been developed to protect people from the HPV viruses and help prevent certain types of cervical cancer developing. One of these HPV vaccines called Gardasil protects against four different types of HPV virus, it was licensed in Europe in 2006 and since then teenage girls in many countries have been vaccinated with it. In the UK, the HPV vaccine is offered to girls aged 12 to 13 as part of the national vaccination programme. Since these vaccination programmes started there have been some reports that some people have developed MS after they had been vaccinated. However it is not clear whether this was a coincidence and they would have developed MS anyway or if the MS was as a result of the HPV vaccination. This study aimed to look at if developing MS was linked to the HPV vaccination.

How this study was carried out

National registers were used to identify all the women aged between 10 and 44 years old in Sweden and Denmark. In total there were nearly four million females identified. The researchers used data from the period 2006 to 2013 in these registers to identify those who had received the HPV vaccination and also those women who been diagnosed with MS. The researchers then excluded anyone who already had a diagnosis of MS at the time of vaccination. They considered the two years after vaccination to be the risk period where it was most likely to see any side effects as a result of the vaccination.

They analysed this information to see if there was any link between having a HPV vaccination and developing MS.

What was found

The study found that of the four million women studied, 789,082 had been vaccinated against HPV. They found that between 2006 and 2013 there were 4,322 diagnoses of MS, of these 73 were diagnosed within the two year risk period after women had been vaccinated. When they compared the information of vaccinated and unvaccinated women there was no difference in the number of women diagnosed with MS. The researchers looked at the information in several different ways, including looking at the information by each country individually and no matter how they looked at the data the result was the same, there was no link between the vaccination and developing MS.

What does it mean?

The study found no evidence of a link between HPV vaccination and a subsequent diagnosis of MS. This was the largest study carried out so far that has looked at this relationship and this study used information from the populations of two countries. The researchers suggest that as they have studied a very large number of people, from a variety of backgrounds it is likely that the results can also be applied to women from other countries too. The researchers conclude that their results provide good quality evidence for the safety of the HPV vaccine and that it does not cause MS.

Scheller NM, Svanström H, Pasternak B, et al.
Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system.
JAMA. 2015 Jan 6;313(1):54-61.
abstract

More about vaccinations

The cause of MS remains unknown, but a link between vaccination and the onset of MS has been suggested for many years. However many studies have failed to find evidence to support these concerns. For example in 2011, Argentinian researchers found that the risk of developing MS remained unchanged after vaccinations for hepatitis B, influenza, MMR, polio and typhoid fever and the BCG vaccination for tuberculosis. Their results suggested that diphtheria and tetanus vaccination may be associated with a decreased risk of MS. This current study also suggests that the HPV vaccine is safe and does not increase the risk of developing MS.

In the past there has also been concern over the potential effect of vaccination on people already diagnosed with MS, but research has failed to find evidence to support these concerns. However it is known that infections can trigger relapses in people with MS. Therefore it is recommended that people with MS should have all the vaccinations that are required both for use in the UK and when travelling abroad. For most people with MS it's preferable to be protected than run the risk of contracting the diseases, many of which are serious and life threatening or can have a major impact on their MS. There are certain exceptions and situations where people should not receive vaccinations. If the person is currently unwell vaccination is usually delayed to a time when the person is better again. If someone is taking a drug that suppresses the immune system, such as chemotherapy or steroids, then they should not receive 'live' vaccines as they may be at greater risk for developing the disease.

You can read more about vaccination and MS in the A to Z of MS.

You can read more about the HPV vaccination that is offered to teenage girls on the NHS, on the NHS Choices website.

Research by topic areas...

Assessment tools

Greene BR, Healy M, Rutledge S, et al.
Quantitative assessment of multiple sclerosis using inertial sensors and the TUG test.
Conf Proc IEEE Eng Med Biol Soc. 2014 Aug;2014:2977-2980.
abstract

Causes of MS

Bagheri M, Maghsoudi Z, Fayazi S, et al.
Several food items and multiple sclerosis: a case-control study in Ahvaz (Iran).
Iran J Nurs Midwifery Res. 2014 Nov;19(6):659-65.
abstract
Read the full text of this paper

Disease modifying treatments

Kappos L, Giovannoni G, Gold R, et al.
Time course of clinical and neuroradiological effects of delayed-release dimethyl fumarate in multiple sclerosis.
Eur J Neurol. 2015 Jan 2. [Epub ahead of print]
abstract
Read the full text of this paper

Falls

Wajda DA, Moon Y, Motl RW, et al.
Preliminary investigation of gait initiation and falls in multiple sclerosis.
Arch Phys Med Rehabil. 2015 Jan 2. [Epub ahead of print]
abstract

Other treatments

Kantor D, Chancellor MB, Snell CW, et al.
Assessment of confirmed urinary tract infection in patients treated with dalfampridine for multiple sclerosis.
Postgrad Med. 2015 Jan 6:1-5. [Epub ahead of print]
abstract

Naghashpour M, Majdinasab N, Shakerinejad G, et al.
Riboflavin supplementation to patients with multiple sclerosis does not improve disability status nor is riboflavin supplementation correlated to homocysteine.
Int J Vitam Nutr Res. 2013;83(5):281-90.
abstract

Saiote C, Goldschmidt T, Timäus C, et al.
Impact of transcranial direct current stimulation on fatigue in multiple sclerosis.
Restor Neurol Neurosci. 2014;32(3):423-36.
abstract

Prognosis

Kontschieder P, Dorn JF, Morrison C, et al.
Quantifying progression of multiple sclerosis via classification of depth videos.
Med Image Comput Comput Assist Interv. 2014;17(Pt 2):429-37.
abstract

Provision of care

Strickland K, Baguley F.
The role of the community nurse in care provision for people with multiple sclerosis.
Br J Community Nurs. 2015 Jan 2;20(1):6-10.
abstract

Quality of life

Baumstarck K, Pelletier J, Boucekine M, et al.
Predictors of quality of life in patients with relapsing-remitting multiple sclerosis: a 2-year longitudinal study.
Rev Neurol (Paris). 2015 Jan 2. [Epub ahead of print]
abstract

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