No increased risk of chronic fatigue syndrome after HPV vaccination

[Snow Leopard]

"No increased risk" doesn't make any sense as a study can't prove that. Studies are limited by their statistical power - so the increased risk could be anywhere between zero to a low incidence limited by the statistical power of the study.

A study like this cannot rule out very rare reactions, similar to Guillain-Barré Syndrome. So the decision to vaccinate is based on reduced risk of cancer vs very low risk of reactions.

 

[Londinium]

I must say I'm sceptical of the inevitability theory anyway, because this disease seems to have been rare at one time, and never had this prevalence amongst teenage girls even in the days when I first came down with it.

This study does support the assertion of increased prevalence amongst teenage girls. However, a similar increase is seen amongst teenage boys and no statistical significance is seen between the trends. That would suggest that it is some other factor driving this increase - better awareness/willingness of doctors to code as ME/CFS perhaps, or environmental factors causing more cases (similar to the ever-increasing rates of allergies). My personal view is it is probably the latter and I think the hygiene hypothesis has a part to play.

As for the HPV vaccine, the only conclusions that can be drawn from this specific study are:

- either the HPV vaccine does not trigger ME/CFS in people who would never have developed it had they not had the vaccine;
- or the HPV vaccine does trigger ME/CFS in some recipients, but they would have developed it due to another trigger at around the same time even if they hadn't had the vaccine;
- or the vaccine causes people to get ME/CFS who otherwise wouldn't, but prevents others from getting ME/CFS who would have gotten it had they not had the vaccine.

What this study cannot conclude upon - and isn't designed to - is whether vaccination causes somebody who already meets the diagnostic criteria for ME/CFS to get worse.

I cannot speak to the other studies on vaccination, but for this specific Norwegian study all I can say is it looks well designed and I can't spot any immediate flaws that would indicate that its conclusions are unreasonable.

 

[Deepwater]

It's actually very odd that although Hep A is the holiday hepatitis vaccine, and that is what I am down on my notes as having had, all I knew when I went along for it is that I needed hepatitis vaccination, and I came away completely and utterly convinced the nurse told me what she was giving me was Hepatitis B (and before ME I did have a phenomenally accurate memory). I probably had it wrong, but it is an odd coincidence given what I've later learnt about the link between Hep B vaccination and ME.

 

[Chrisb]

It's actually very odd that although Hep A is the holiday hepatitis vaccine, and that is what I am down on my notes as having had, all I knew when I went along for it is that I needed hepatitis vaccination, and I came away completely and utterly convinced the nurse told me what she was giving me was Hepatitis B (and before ME I did have a phenomenally accurate memory). I probably had it wrong, but it is an odd coincidence given what I've later learnt about the link between Hep B vaccination and ME.

Many years ago, following reporting of a vaccine damage case, I read an article by a lawyer for the plaintiff saying that whenever you have a vaccination you should ask for and record details of the vaccine, manufacturer and batch number.

 

[RogerBlack]

• • Polio (2%, 10 Votes)

The above survey at the least has problems.

In the UK, for example, polio vaccine is never (unless you are going to a polio endemic country) given alone, but along with other vaccines at 0-4 years old, with a boost at 14yo. But the boost at 14yo is always with Tetanus and Diptheria. (Diptheria is however not mentioned above)

There is no way you could know which vaccine triggered if in a combination.
'Combination' - the most common combination given in the age range typical of ME onset would be the above 14yo boost, which is given to at the least a hundred times the number of people getting voluntary polio innoculations.

At the very least the above needs to take into account multiple vaccine innoculations,
Those saying MMR, if they got the jab at the typical time would be saying they got it at 3yo..

It's a pity the above questionaire diddn't give a time between onset and vaccination. 14yo is a peak onset of CFS, so it would not be unreasonable that some got it around the same time.

If it was 'in the days after' - that would be a lot more significant than if it was months.

Does CFS from infancy exist?

I am not saying vaccines never cause CFS, just that the evidence (as in many cases with CFS) is bad, and some CFS occuring just after vaccine is expected randomly. Are we seeing more than that, ...
It's certainly going to vary by vaccine, and in some cases, the vaccine may protect.

I rarely see patient reported onset time mentioned in papers.
I'd love to see an investigation of a cohort of CFS sufferers for onset time, diagnostic delay, which checked their medical records to see which if any vaccine or other treatment they'd gotten.

For example, a prescription of antibiotics may in some places be given 'on request' for probably viral chest infections. Given the large microbiome changes when you take antibiotics, what this does is a fun question.

For some vaccinations, in principle their discontinuation would let you get a signal in national stats if they were causative (BCG in the UK went away in ~2005). But the data is probably not good enough.

 

[Snow Leopard]

The above survey at the least has problems.

In the UK, for example, polio vaccine is never (unless you are going to a polio endemic country) given alone, but along with other vaccines at 0-4 years old, with a boost at 14yo. But the boost at 14yo is always with Tetanus and Diptheria. (Diptheria is however not mentioned above)

There is no way you could know which vaccine triggered if in a combination.
'Combination' - the most common combination given in the age range typical of ME onset would be the above 14yo boost, which is given to at the least a hundred times the number of people getting voluntary polio innoculations.

This is a good point. My onset was a GBS like reaction (acute flaccid paralysis) within 3 weeks of the OPV & Diptheria/Tetanus immunisations, when I was 15. There is some published evidence that the Diphteria/Tetanus vaccines can trigger GBS, but little to no evidence for the OPV. There is also a plausible mechanism - the bacterial toxins are known to complex to gangliosides (evidence over decades), so the possibility of a B-Cell making a mistake is right there (and consistent with Johnathan Edwards' hypothetical model). I have not managed to work out how HPV vaccines could trigger GBS (or other autoimmune syndromes) in a similar manner (based on existing evidence).

Also, it is a myth that most people with GBS recovery without symptoms - over 50% report long term chronic fatigue...

 

[RogerBlack]

little to no evidence for the OPV.

Small nit - The UK does not use OPV, but IPV.
Inactivated polio virus is the killed virus, OPV is the live virus which creates a long lasting immunity - but you run the risk of vaccinated people infecting others with vaccine derived polio.

The eradication campaign for polio has been _enormously_ successful.

http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
In 2014, 359 cases of wild poliovirus, 2015 74, 2016 37. So far this year 6.

(it was hundreds of thousands in the 1980s).

OPV is cheaper and easier to administer, but can cause the person (especially if they have a compromised immune system) to poop infectious virus.

This vaccine derived polio was also trending down, but there was a blip in Syria, as vaccination levels have dropped during the recent conflict.

It seems plausible that wild poliovirus may be wiped out by 2020. Vaccine derived may take a few years more, if nothing goes badly wrong.
At that point, we will have eradicated both smallpox and polio. Smallpox killed ~400 million, scarred billions. Polio paralysed or killed tens of millions.

This year, about 2.5 million people did not die due to measles, and it's at ~5% of the level it was in 1980.

This does not of course address the real side-effects of some vaccines, and questions around best vaccination strategy to reduce total risk from all diseases and side effects.

Routine vaccination for smallpox ended in the UK shortly before the disease was eradicated, and routine immunisation for TB stopped in ~2005, and has been concentrated on most at risk groups.

The smallpox vaccine had some serious rare side-effects. It might be worth revisiting if IPV should still be in routine vaccinations, from a precautionary perspective.
Though perhaps it's appropriate to leave it a couple more years, when the numbers are very close to zero.

http://www.microbe.tv/twiv/twiv-special-henderson/ Is a fascinating interview on the eradication campaign for smallpox, from the person who lead the effort.

Diptheria is still killing well over 10K (likely) annually, and has the potential for really quite large outbreaks if vaccination level wanes.
Tetanus will always need immunised against in some form, as it's largely a soil-borne organism, and is not spread human-human, so can't be eradicated.

 

[Snow Leopard]

Small nit - The UK does not use OPV, but IPV.

Yes, and I'm from Australia and we did use the OPV when I was a youth.