Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;142(3):e20180943.
doi: 10.1542/peds.2018-0943. Epub 2018 Aug 21.

Primary Ovarian Insufficiency and Adolescent Vaccination

Allison L Naleway  1 , Kathleen F Mittendorf  2 , Stephanie A Irving  2 , Michelle L Henninger  2 , Bradley Crane  2 , Ning Smith  2 , Matthew F Daley  3   4 , Julianne Gee  5
Affiliations

Primary Ovarian Insufficiency and Adolescent Vaccination

Allison L Naleway et al. Pediatrics. 2018 Sep.

Abstract

Background: Published case series have suggested a potential association between human papillomavirus (HPV) vaccination and primary ovarian insufficiency (POI). We describe POI incidence and estimate POI risk after HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap); inactivated influenza (II); and meningococcal conjugate (MenACWY) vaccination.

Methods: We searched Kaiser Permanente Northwest electronic health records for outpatient diagnoses suggestive of POI in female patients aged 11 to 34 years between 2006 and 2014. We reviewed and adjudicated the medical record to confirm diagnoses and estimate symptom onset dates. We excluded cases with known causes and calculated the incidence of idiopathic POI. We estimated risk by calculating hazard ratios and 95% confidence intervals (CIs).

Results: From a cohort of 199 078 female patients, we identified 120 with diagnoses suggestive of POI. After adjudication and exclusion of 26 POI cases with known causes, we confirmed 46 idiopathic POI cases. POI incidence was low in 11- to 14-year-olds (0.87 per 1 000 000 person-months) and increased with age. One confirmed case patient received the HPV vaccine 23 months before the first clinical evaluation for delayed menarche. The adjusted hazard ratio was 0.30 (95% CI: 0.07-1.36) after HPV, 0.88 (95% CI: 0.37-2.10) after Tdap, 1.42 (95% CI: 0.59-3.41) after II, and 0.94 (95% CI: 0.27-3.23) after MenACWY vaccination.

Conclusions: We did not find a statistically significant elevated risk of POI after HPV, Tdap, II, or MenACWY vaccination in this population-based retrospective cohort study. These findings should lessen concern about POI risk after adolescent vaccination.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Naleway has received research funding from Pfizer, MedImmune AstraZeneca, and Merck for unrelated studies. Ms Irving has received research support from MedImmune AstraZeneca for an unrelated study. Dr Henninger has received research funding from Pfizer for an unrelated study; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Ascertainment and adjudication of POI cases, KPNW, August 2006 to December 2014.
See this image and copyright information in PMC

References

    1. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–193 - PubMed
    1. Petrosky E, Bocchini JA Jr, Hariri S, et al. ; Centers for Disease Control and Prevention. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64(11):300–304 - PMC - PubMed
    1. Walker TY, Elam-Evans LD, Singleton JA, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years - United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(33):874–882 - PMC - PubMed
    1. Bingham A, Drake JK, LaMontagne DS. Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings. Arch Pediatr Adolesc Med. 2009;163(5):455–461 - PubMed
    1. Verhoeven V, Baay MF, Baay PE, Lardon F, Van Royen P, Vermorken JB. Everything you always wanted to know about HPV (but could not ask your doctor). Patient Educ Couns. 2010;81(1):101–105 - PubMed

Publication types

Substances