Pancreatitis after human papillomavirus vaccination: a matter of molecular mimicry

Abstract

A 20-year-old man developed severe abdominal pain 1 week after being vaccinated with the first dose of quadrivalent human papillomavirus (HPV) vaccine (Gardasil). Despite ongoing symptoms of nausea and pain, he received the second dose of the vaccine. Only 10 days later, laboratory results revealed significantly elevated pancreatic enzymes, and with concomitant abdominal pain and vomiting, he was diagnosed with acute pancreatitis. This case of acute pancreatitis after HPV vaccination is not a novel entity. Although confirming the relationship between pancreatitis and vaccine is challenging, some factors suggest a possible link, including the positive re-challenge upon repeated exposure to the vaccine, HPV vaccine as probable causal relationship to other autoimmune diseases and a probable mechanism of molecular mimicry. In conjunction with aluminum adjuvant, the induction of immunity through molecular mimicry may potentially culminate in production of cytotoxic autoantibodies with a particular affinity for pancreatic acinar cells.

Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine

“…described in 2 case reports. 31,32 Additionally, in a Vaccine Adverse Event Report System study, researchers reported 9 cases after 4vHPV vaccination, 33 although the postvaccination reporting rate was not greater than expected. In our analyses, the pancreatitis statistical signal was not confirmed after further investigation.…”

Acute Pancreatitis and Pancreatic Pseudocyst in a Toddler Following Mumps, Measles and Rubella Vaccine

“…The AP could be either a 'vaccine reaction' or purely 'coincidental' to the vaccination [7]. As suggest by Bijzak et al [5] The MMR vaccine, since its very inception, has been associated with many controversies relating to various adverse effects. A recent Cochrane database of systematic reviews [8] concluded that the vaccine is associated with aseptic meningitis, febrile seizure and possibly immune thrombocytopenic purpura but it did not seem to increase the risks of autism, asthma, leukemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, or bacterial or viral infections.…”

“…Among the infectious etiologies of AP, viral agents, namely, Mumps, HIV (Human immune deficiency virus), Coxsackie B, Hepatitis B and Varicella zoster predominate [1]. Acute pancreatitis has also been sparingly reported after various viral vaccines, including Mumps [2], Mumps-Measles-Rubella (MMR) [3], Hepatitis A and B [4], Human papilloma virus (HPV) [5] and also after bacterial (Cholera and Typhoid) vaccines [6]. Though various theories are proposed, the actual mechanism of pancreatitis following vaccination has been unclear.…”

Letter to the editor – HPV vaccine and autoimmunity Incidence of new‐onset autoimmune disease in girls and women with pre‐existing autoimmune disease after quadrivalent human papillomavirus vaccination: a cohort study

“…Since the licensure by the US Food and Drug Administration (FDA) and subsequent introduction on the market in 2009, the HPV vaccine has been linked to a variety of serious autoimmune manifestations. This includes vasculitis, thrombocytopenic purpura, autoimmune hepatitis, pancreatitis, postural orthostatic tachycardia syndrome (POTS), premature ovarian failure and systemic lupus erythematosus [2][3][4][5][6][7][8][9].…”