Editorials

HPV vaccination and pregnancy

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4705 (Published 07 September 2015) Cite this as: BMJ 2015;351:h4705
  1. Karen Canfell, director1, adjunct professor2
  1. 1Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia
  2. 2School of Public Health, Sydney Medical School, University of Sydney, Australia
  1. Karen.Canfell{at}nswcc.org.au

After nine years of experience, the picture remains reassuring

Prophylactic vaccines against human papillomavirus (HPV) were first licensed for use in girls and young women in 2006, with more than 175 million doses distributed worldwide by 2013.1 Bivalent and quadrivalent vaccines protect against new infection with oncogenic HPV types 16 and 18, responsible for about 70% of cervical cancers. The quadrivalent vaccine also protects against HPV types 6 and 11, responsible for most anogenital warts. Although routine vaccination is recommended for preadolescent girls, catch-up to older ages was generally conducted in the first few years of implementation, with the upper age varying from 16-18 (United Kingdom, several European countries) to 23-26 years (France, Australia, United States). Although it is not recommended, many thousands of young women are thus likely to have been inadvertently vaccinated around the time of conception or in pregnancy.

In a linked paper, Panagiotou and colleagues (doi:10.1136/bmj.h4358) report on the long term follow-up for pregnancy outcomes in women enrolled in the Costa Rica HPV Vaccine Trial.2 An earlier pooled analysis from this trial and the PApilloma TRIal against Cancer In young Adults (PATRICIA) trial found no overall association between vaccination using the bivalent vaccine and spontaneous abortion, but a small increase in risk in the subgroup of pregnancies conceived within 90 days of vaccination could not be completely ruled out.3 In the Costa Rica trial, women …

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