title: Human papilloma virus vaccine and primary ovarian failure: another facet of the autoimmune/inflammatory syndrome induced by adjuvants.
abstract: OBJECTIVE
  Post-vaccination autoimmune phenomena are a major facet of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) and different vaccines, including HPV, have been identified as possible causes.
  
  
  METHODS
  The medical history of three young women who presented with secondary amenorrhea following HPV vaccination was collected. Data regarding type of vaccine, number of vaccination, personal, clinical and serological features, as well as response to treatments were analyzed.
  
  
  RESULTS
  All three patients developed secondary amenorrhea following HPV vaccinations, which did not resolve upon treatment with hormone replacement therapies. In all three cases sexual development was normal and genetic screen revealed no pertinent abnormalities (i.e., Turner's syndrome, Fragile X test were all negative). Serological evaluations showed low levels of estradiol and increased FSH and LH and in two cases, specific auto-antibodies were detected (antiovarian and anti thyroid), suggesting that the HPV vaccine triggered an autoimmune response. Pelvic ultrasound did not reveal any abnormalities in any of the three cases. All three patients experienced a range of common non-specific post-vaccine symptoms including nausea, headache, sleep disturbances, arthralgia and a range of cognitive and psychiatric disturbances. According to these clinical features, a diagnosis of primary ovarian failure (POF) was determined which also fulfilled the required criteria for the ASIA syndrome.
  
  
  CONCLUSIONS
  We documented here the evidence of the potential of the HPV vaccine to trigger a life-disabling autoimmune condition. The increasing number of similar reports of post HPV vaccine-linked autoimmunity and the uncertainty of long-term clinical benefits of HPV vaccination are a matter of public health that warrants further rigorous inquiry.
authors.affiliation: Zabludowicz Center for Autoimmune Diseases Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Colafrancesco
authors.forename: Carlo
authors.initials: C
authors.lastname: Perricone
authors.forename: Lucija
authors.initials: L
authors.lastname: Tomljenovic
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D001007:Anxiety / Q000209:etiology; D018771:Arthralgia / Q000209:etiology; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D015914:Estrogen Replacement Therapy; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D013577:Syndrome; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D012739:Gonadal Steroid Hormones; D053918:Papillomavirus Vaccines
keywords: Autoantibodies; autoimmune/inflammatory syndrome induced by adjuvants; autoimmunity; human papilloma virus; primary ovarian failure