Objective
To evaluate the association between human
papillomavirus (HPV) vaccination and serious
adverse events in adolescent girls in South
Korea.
Design
Cohort study.
Setting
A large linked database created by linking the
Korea Immunization Registry Information System and
the National Health Information Database, between
January 2017 and December 2019.
Participants
441 399 girls aged 11-14 years who had been
vaccinated in 2017: 382 020 had been vaccinated
against HPV and 59 379 had not been vaccinated
against HPV.
Main outcome measures
Outcomes were 33 serious adverse events,
including endocrine, gastrointestinal,
cardiovascular, musculoskeletal, haematological,
dermatological, and neurological diseases. A
cohort design was used for the primary analysis
and a self-controlled risk interval design for the
secondary analysis; both analyses used a risk
period of one year after HPV vaccination for each
outcome. Incidence rate and adjusted rate ratios
were estimated using Poisson regression in the
primary analysis, comparing the HPV vaccinated
group with the HPV unvaccinated group, and
adjusted relative risks were estimated using
conditional logistic regression in the secondary
analysis.
Results
Among the 33 predefined serious adverse events,
no associations were found with HPV vaccination in
the cohort analysis, including Hashimoto’s
thyroiditis (incidence rate per 100 000 person
years: 52.7
v
36.3 for the
vaccinated and unvaccinated groups; adjusted rate
ratio 1.24, 95% confidence interval 0.78 to 1.94)
and rheumatoid arthritis (incidence rate per
100 000 person years: 168.1
v
145.4 for the vaccinated and unvaccinated groups;
0.99, 0.79 to 1.25), with the exception of an
increased risk observed for migraine (incidence
rate per 100 000 person years: 1235.0
v
920.9 for the vaccinated and
unvaccinated groups; 1.11, 1.02 to 1.22).
Secondary analysis using self-controlled risk
intervals confirmed no associations between HPV
vaccination and serious adverse events, including
migraine (adjusted relative risk 0.67, 95%
confidence interval 0.58 to 0.78). Results were
robust to varying follow-up periods and for
vaccine subtypes.
Conclusions
In this nationwide cohort study, with more than
500 000 doses of HPV vaccines, no evidence was
found to support an association between HPV
vaccination and serious adverse events using both
cohort analysis and self-controlled risk interval
analysis. Inconsistent findings for migraine
should be interpreted with caution considering its
pathophysiology and the population of
interest.