Epub: Menge et al. Neuromyelitis Optica Following Human Papillomavirus Vaccination. Neurology. 2012 Jun 20.
The quadrivalent human papillomavirus (HPV) vaccine Gardasil (Merck & Co., Whitehouse Station, NJ) (qHPV-vac) was recently approved for immunization of adolescent girls to prevent cervical cancer. Recently, 5 cases of MS were reported following qHPV-vac vaccination. These investigators report a further 4 subjects who developed symptoms of neuromyelitis optica (NMO)(3) within months after qHPV-vac inoculation.
Papillomavirus has been associated with the development of cervical cancer.
“Surprised? I am not; without a formal population study any conclusions are impossible. Most adolescent girls receive the vaccine in Europe and as it stimulates the immune system it therefore may trigger MS attacks; not to dissimilar to infections in general. Did you know that a third of MS relapses occur within the at risk period of an infection, i.e. up to 6 weeks after a symptomatic infection? As MS is a relatively common condition several MSers will have their first attack soon after vaccination. This does not mean that the vaccine is necessarily causal.”
“The purpose of the HPV vaccine is a noble public health effort. If you have ever seen a woman die from cervical cancer you will know why. The governments of the world are, however, missing the point about the HPV vaccine; they need to immunise boys as well. Vaccination is about herd immunity you need to get the immunity rate above 90% in the population to break the cycle of transmission. Vaccinations are a public health initiative, they are done to reduce a disease in the population, and are not about an individual’s health. In other words you have to accept a low level of side effects in people who receive the vaccine so that the general population derive the benefit. Getting yourself vaccinated is therefore a very altruistic behaviour. Imagine if we could vaccinate the population against EBV to prevent people from getting MS? What level of side effects would the population prepared to accept from the vaccine programme to prevent MS? I suspect a lot. What do you think?”
I contracted MS 4 months after being vaccinated for Hepatitis B (in Soho, London).Coincidence?
As the parent of an adolescent girl with MS who hasn't got this vaccine yet, I'm quite confused. "5 cases of MS were reported following qHPV-vac vaccination" How significant is this and should it affect our decision about this vaccine? If not, what use is this paper?The last lot of vaccines was followed by a relapse a few months later, but she had been off-treatment for several months and the relapse may have happened anyway
The French experience is interesting:http://www.ncbi.nlm.nih.gov/pubmed/17725231
Gavin, you really should've been a public health doctor.Not too late to change. This MS stuff is obviously not proving worthwhile enough.
I am sure G will appreciate this comment….NotWhat is your point?We are not agony aunts, If you have something constructive/sensible to say we can listen.
Re: "Not too late to change. This MS stuff is obviously not proving worthwhile enough."You miss the point; public health is the field that will have the biggest impact on MS. In particular in relation to MS prevention.
Re: "How significant is this and should it affect our decision about this vaccine? If not, what use is this paper?"This paper is just an observation and needs to be confirmed by proper population based studies. The point I am making is that it may trigger MS, i.e. the first attack, but I will be surprised if it is the cause of the disease. I suspect MS is there long before the vaccine is given. Deja vu; we have been here before with hepatitis B vaccine.
"Did you know that a third of MS relapses occur within the at risk period of an infection, i.e. up to 6 weeks after a symptomatic infection?"This resonates with me because all my downward spirals seem to have been preceded by some illness or other. It's silly, but I sometimes think if I could figure out how to not get sick, it would prevent much of my progression.
Australia is going to be the first country to offer free access to Gardasil for boys aged 12-13, beginning next year. 900,000 boys are targeted and $21million dollars is allocated for the role out. Perhaps not surprising as the drug has a ringing endorsement here as it was developed and invented here. I wonder whether we might see NMO events in young males?
Gavin Giovannoni said… "I suspect MS is there long before the vaccine is given."When does MS start? At the time of the first relapse that leads to diagnosis? Some other time?
Re: "When does MS start? At the time of the first relapse that leads to diagnosis? Some other time?"I suspect in the majority of people MS starts years, may be decades, before the first attack. Most CISers have old inactive lesions on their scan when they present. Similarly, in identical twins pairs the unaffected twin often has MS lesions long before their clinical attack. There is also the radiological isolated syndrome data that you could read:http://multiple-sclerosis-research.blogspot.co.uk/2012/02/cognitive-impairment-in-asymptomatic-ms.html
Re: "I wonder whether we might see NMO events in young males?" Possibly, but that is the price society has to pay to reduce the incidence of cervical and anal cancer, and possibly oesophageal cancer. It is no use targeting girls and not boys who act as the reservoir. Rule number one I learnt in my public health course in medical school is the primary objective of national vaccination programmes is to induce her immunity – this comes at a price as no vaccine is safe.