LETTER TO THE EDITOR
Is HPV vaccination of pregnant women really safe?
More than 72 million girls and women have been vaccinated with
human papillomavirus (HPV) vaccines worldwide but data on safety of
vaccination during pregnancy are limited. HPV vaccination is not recom-
mended during pregnancy, but inadvertent vaccination of women with
unrecognized pregnancies was still of concern (Scheller, Pasternak,
om, & Hviid, 2017; Lawton et al., 2018). To
this end, Scheller et al. conducted an analysis to demonstrate that
administration of the Quadrivalent HPV vaccine (QHPVV) during preg-
nancy is not associated with a significant risk of adverse birthing out-
comes (Scheller et al., 2017). However, active HPV infection was not
determined in either cohort, which may have led to confounding results.
Ambuhl showed that HPV infection, alone, is significantly associ-
ated with, and may cause, spontaneous abortions and preterm deliv-
eries (Ambuhl, 2016); these findings are supported by Niyibizi, Zanr
Mayrand, & Trottier (2017) and Cho . Mosbah, Barakat, Nabiel,
& Barakat (2018) found an association between active HPV infection
and spontaneous preterm labor, and showed a direct correlation
between viral load and preterm labor.
Presumably, QHPVV decreases the prevalence of the most com-
monly encountered high-risk HPV infections in the vaccinated cohort
and, therefore, decreases the risk of HPV-associated adverse birthing
outcomes. Given the strong association of HPV infection with adverse
birthing outcomes, to appropriately measure the risk of QHPVV on
birthing outcomes, one should correct and test for active HPV infection
between the cohorts.
CONFLICT OF INTEREST
The authors have no conflicts of interest to disclose.
, Torello Lotti
, Christopher S. Lange
, Marigdalia K. Ramirez-Fort
Skin and Stem Cell Research Center, Tehran University of Medical
Sciences, Tehran, Iran
Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Universit
degli Studi “Guglielmo Marconi”, Rome, Italy
Radiation Oncology, State University of New York Downstate Medical
Center, Brooklyn, NY
Radiation Oncology, Medical University of South Carolina,
Urology, Weill Cornell Medical College, New York, NY
Amir Feily, Skin and Stem Cell Research Center,
Tehran University of Medical Sciences, Tehran, Iran.
Ambuhl, L. M. (2016). Human papillomavirus infection as a
possible cause of spontaneous abortion and spontaneous preterm
delivery. Infectious Diseases in Obstetrics and Gynecology, 2016,
Cho, G. (2013). High-risk human papillomavirus infection is associated
with premature rupture of membranes. BMC Pregnancy Childbirth,
Lawton, B., Howe, A. S., Turner, N., Filoche, S., Slatter, T., Devenish, C., &
Hung, N. A. (2018). Association of prior HPV vaccination with reduced
preterm birth: A population based study. Vaccine, 36(1), 134–140.
Mosbah, A., Barakat, R., Nabiel, Y., & Barakat, G. (2018). High-risk and
low-risk human papilloma virus in association to spontaneous pre-
term labor: A case-–control study in a tertiary center, Egypt. Journal
of Maternal Fetal Neonatal Medicine, 31, 720–725.
Niyibizi, J., Zanr
e, N., Mayrand, M.-H., & Trottier, H. (2017). The associa-
tion between adverse pregnancy outcomes and maternal human pap-
illomavirus infection: A systematic review protocol. Systematic
Reviews, 6(1), 53.
Scheller, N. M., Pasternak, B., Mølgaard-Nielsen, D., Svanstr
om, H., &
Hviid, A. (2017). Quadrivalent HPV vaccination and the risk of
adverse pregnancy outcomes. New England Journal Medicine, 376(13),
Dermatologic Therapy. 2018;31:e12593.
2018 Wiley Periodicals, Inc.
Received: 9 January 2018
Accepted: 12 January 2018