{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:59:20Z","timestamp":1782197960782,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,18]],"date-time":"2017-10-18T00:00:00Z","timestamp":1508284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000329","name":"Novo Nordisk UK Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008392","name":"Sundhed og Sygdom, Det Frie Forskningsr\u00e5d","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since 2006, human papillomavirus (<jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>) vaccines have been introduced in many countries worldwide. Whilst safety studies have been reassuring, focus has been on the primary target group, the young adolescent girls. However, it is also important to evaluate safety in adult women where background disease rates and safety issues could differ significantly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We took advantage of the unique Danish and Swedish nationwide healthcare registers to conduct a cohort study comparing incidence rate ratios (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>s) of 45 preselected serious chronic diseases in quadrivalent <jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content>)\u2010vaccinated and <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content>\u2010unvaccinated adult women 18\u201344\u00a0years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used Poisson regression to estimate <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>s according to <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content> vaccination status with two\u2010sided 95% confidence intervals (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study cohort comprised 3\u00a0126\u00a0790 women (1\u00a0195\u00a0865 [38%] Danish and 1\u00a0930\u00a0925 [62%] Swedish) followed for 16\u00a0386\u00a0459 person\u2010years. Vaccine uptake of at least one dose of <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content> vaccine was 8% in the cohort: 18% amongst Danish women and 2% amongst Swedish. We identified seven adverse events with statistically significant increased risks following vaccination\u2014Hashimoto's thyroiditis, coeliac disease, localized lupus erythematosus, pemphigus vulgaris, Addison's disease, Raynaud's disease and other encephalitis, myelitis or encephalomyelitis. After taking multiple testing into account and conducting self\u2010controlled case series analyses, coeliac disease (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.56 [95% confidence interval 1.29\u20131.89]) was the only remaining association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Unmasking of conditions at vaccination visits is a plausible explanation for the increased risk associated with <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content> in this study because coeliac disease is underdiagnosed in Scandinavian populations. In conclusion, our study of serious adverse event rates in <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content>\u2010vaccinated and <jats:styled-content style=\"fixed-case\">qHPV<\/jats:styled-content>\u2010unvaccinated adult women 18\u201344\u00a0years of age did not raise any safety issues of concern.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12694","type":"journal-article","created":{"date-parts":[[2017,10,18]],"date-time":"2017-10-18T05:02:45Z","timestamp":1508302965000},"page":"154-165","source":"Crossref","is-referenced-by-count":55,"title":["Human papillomavirus vaccination of adult women and risk of autoimmune and neurological diseases"],"prefix":"10.1111","volume":"283","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7509-9127","authenticated-orcid":false,"given":"A.","family":"Hviid","sequence":"first","affiliation":[{"name":"Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-7215","authenticated-orcid":false,"given":"H.","family":"Svanstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. M.","family":"Scheller","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Gr\u00f6nlund","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Pasternak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark"},{"name":"Department of Medicine Solna Clinical Epidemiology Unit Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Arnheim\u2010Dahlstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.05.039"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2015.1013532"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6501a1"},{"issue":"05","key":"e_1_2_9_5_1","first-page":"1","article-title":"Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"63","author":"Markowitz LE","year":"2014","journal-title":"MMWR Recomm Rep"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-013-0039-5"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60920-X"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2011.185"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.071134"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60678-8"},{"key":"e_1_2_9_11_1","first-page":"441","article-title":"The Danish civil registration system. 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