- There is no evidence for significantly elevated risk for primary ovarian insufficiency (POI) after HPV vaccination or other routine adolescent vaccine exposures in young women aged 11-34 years.
Why this matters
- Findings should help lessen parent hesitation around HPV vaccination, especially concerns about fertility effects.
- 199,078 female patients: 119,078 received tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap); 84,783 inactivated influenza (II); 58,871 HPV; 46,231 meningococcal conjugate (MenACWY) vaccines.
- 120 outpatients with premature menopause, ovarian failure, or ovarian dysfunction; 46 confirmed idiopathic POI cases (33 probable, 13 possible); only 9 cases met American College of Obstetricians and Gynecologists diagnostic POI criteria.
- POI incidence increased with age, from 0.87/1,000,000 person-months (age, 11-14 years) to 12.85/1,000,000 person-months (age, 30-34 years).
- 1 confirmed POI had HPV vaccination (2-40 months presymptom onset [PSO]), 11 II (2-91 months PSO), 3 MenACWY (2-27 months PSO).
- Age-adjusted HR for POI: 0.88 (95% CI, 0.37-2.10) with Tdap, 1.42 (95% CI, 0.59-3.41) with II, 0.94 (95% CI, 0.27-3.23) with MenACWY.
- Population-based, retrospective Kaiser Permanente Northwest cohort analysis of risk for POI in females aged 11-34 years, after HPV vaccination.
- Funding: CDC.
- Misclassification bias.
- Case definition biases.
- Inability to capture contraceptive use data.
- Long exposure window.