Multiple Sclerosis Development in Two Teens After HPV Vaccination

HPV vaccine
HPV vaccine
Authors describe 2 case reports of MS in the pediatric population after administration of HPV vaccination.
The following article is part of live conference coverage from the 2018 ACTRIMS Forum in San Diego, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from ACTRIMS 2018.

Researchers from the University of Miami presented 2 cases of multiple sclerosis (MS) developing in teens after receiving Gardasil, a human papillomavirus (HPV) vaccine.

Live, attenuated vaccines are not recommended for people with MS. Gardasil (quadrivalent human HPV types 6, 11, 16, and 18) is an inactivated recombinant vaccine approved in 2006 for the prevention of HPV infections and related cancers. Since then, several reports of central nervous system demyelinating disease (eg, acute disseminated encephalomyelitis, neuromyelitis optica, clinically isolated syndrome, MS) have been reported after administration of the vaccine.

At the 2018 ACTRIMS Forum in San Diego, California, study author Ye Hu reported on 2 teens who experienced MS symptoms 1 to 2 weeks after receiving the vaccination.

A 14-year-old male started to experience left retro-orbital pain and blurred vision in the left eye 2 weeks after receiving his third dose of Gardasil. He was diagnosed with left optic neuritis and reported a second occurrence 2 months after his initial symptoms.

A 17-year-old female started to experience blurred vision in the right eye 2 weeks after receiving her first dose of Gardasil. A right frontal enhancing lesion was seen on brain magnetic resonance imaging (MRI). She was diagnosed with right optic neuritis and did not receive further doses of Gardasil. One week after discharge, she experienced intermittent numbness and weakness in her lower extremities in addition to blurred vision in her right eye. A repeat brain MRI revealed a new left parieto-occipital enhancing lesion.

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Oligoclonal bands in the cerebrospinal fluid were detected for both patients, and white matter lesions with periventricular and corpus collosal involvement were seen in brain MRIs. “[The] rest of [the] workup was unremarkable including [neuromyelitis optica] antibody,” noted Hu.

Both patients received intravenous steroids for relapse and were started on interferon β-1a for relapsing-remitting MS after the second occurrence. Follow-up was 2 years.

A Scandinavian study published in JAMA2 found no increased risk for MS or demyelinating disease among 4 million females, of whom 800,000 received the HPV vaccination. These reported cases of MS point to a “temporal association” between HPV vaccination and MS onset, the authors concluded. It is still unknown whether Gardasil increases the risk for the first demyelinating event in at-risk patients or whether it triggers the onset of MS through an immune response.

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  1. Hu Y, Tornes L, Lopez-Alberola R. Two cases of pediatric multiple sclerosis after human papillomavirus vaccination. Presented at: ACTRIMS Forum 2018; February 1-3, 2018; San Diego, CA. Abstract #P088
  2. Scheller NM, Svanström H, Pasternak B, et al. Quadrivalent HPV vaccination and risk of multiple sclerosis and other demyelinating diseases of the central nervous system. JAMA. 2015;313(1):54-61.