HPV vaccine: no link to primary ovarian insufficiency

  • Naleway AL & al.
  • Pediatrics
  • 21 Aug 2018

  • curated by Liz Scherer
  • Clinical Essentials
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  • 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.

Key results

  • 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.

Study design

  • 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.

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