Reactions to HPV vaccination in schoolgirls
From April 2007, Australian girls and women aged 16–21 years have been offered immunization with a quadrivalent human papillomavirus (HPV) vaccine. Now a study in Australia has examined true hypersensitivity to the quadrivalent vaccine.
In 2007, after >380,000 doses of the quadrivalent HPV vaccine had been given to 12–18.9 year old schoolgirls in Victoria and South Australia, 35 of the schoolgirls had suspected hypersensitivity reactions, including urticaria, generalized rash, angio-oedema or anaphylaxis. Twenty-five of these girls were investigated further. Of these, 23 had reacted to the first vaccine dose. Thirteen of the 23 had urticaria or angio-oedema, and two of these had anaphylaxis. The median time from injection to reaction was 90 minutes. On skin testing of 19 subjects with the vaccine, none reacted to a skin prick test, and only one reacted to an intradermal test. A challenge test with the quadrivalent vaccine was performed on 18 girls: 17 did not react and one had limited urticaria after 4 hours. Probable hypersensitivity to the quadrivalent vaccine was diagnosed in three subjects: the two with anaphylaxis and the one who had a late reaction to vaccine challenge. One girl was considered to have had a possible hypersensitivity reaction.
Among 25 Australian schoolgirls investigated because of a suspected hypersensitivity reaction to quadrivalent HPV vaccine, three were considered to have had a probable hypersensitivity reaction, and one other was considered to have had a possible hypersensitivity reaction. It is concluded that all people with suspected hypersensitivity reactions should be investigated before being given a further dose, although most will tolerate further doses. Any further dose should be given under adequate supervision.
Kang LW, et al. Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study. BMJ 2008;337:1392–1396.