I really do think that the latest proposed “HPV vaccination syndrome” is an extraordinary claim that requires some evidence proportionate to its absurdity. Actually some evidence would be a start. However a piece in the journal Clinical Rheumatology appears to have escaped what normally passes as scientific peer review and got received, revised and accepted in less than a month to be published just a couple of weeks later. The reason I say this is that the piece is devoid of science. Let me explain.
The claims in question (both here and in other articles) centre on reports of vague syndromes involving fatigue and pain manifesting in varying temporal association with administration of HPV vaccine. The bottom dwelling scientific literature is becoming littered with case reports of young women exhibiting vague symptoms with variable temporal onset to a vaccination event that are ambiguously characteristic of ill-defined autoimmune conditions that lack clear diagnostic tests. Inexplicit enough?
It is enormously frustrating to see case reports and anecdotes without any controls masquerading as scientific data. They are what they are and nothing more. It is even more frustrating when they get more attention than the genuine scientific data. I have previously grumped about hypotheses put forward in attempts to explain anecdotes and here is another one.
The latest hypothesis proposes that small fibre neuropathy (SFN) and dysautonomia could be the common underlying pathogenesis to the group of rare, but severe reactions that follow HPV vaccination. However the author does not seem terribly convinced of his own convictions.
Here is the title of the paper: Hypothesis: Human papillomavirus vaccination syndrome—small fiber neuropathy and dysautonomia could be its underlying pathogenesis and it is very vague.
-from the very brief hypothesis section
At this stage of knowledge in which a possible association between HPV vaccine and clinical syndromes is being explored, it seems risky to propose any potential pathogenetic mechanism. Yet, some speculations may be put forward:…
Nor does he seem committed to any particular idea:
The rareness of HPV vaccine-related events described so far suggests that there is a personal susceptibility to develop adverse reactions. Gender may play a role. HPV vaccine has been given (so far) mostly to women who are much more vulnerable to develop painful dysautonomic syndromes such as POTS, CRPS, and fibromyalgia.
OR perhaps this one
The vaccine adjuvant aluminium remains a culprit. An altered process of inactivated HPV virus and aluminum adjuvant that damage dorsal root ganglia could be suggested as a preliminary pathogenetic speculation for the development of small fiber neuropathy.
I have read the paper in utter awe as I tried to comprehend how it got published in a journal that does not appear predatory. Emotive language and adage’s aside the authors have demonstrated their gross lack of knowledge about vaccines, epidemiology, scientific method, cancer and so on. In fact according to the author’s wisdom smallpox is “practically eliminated” and the reason for keeping people for fifteen minutes after vaccination is to observe for syncope (fainting). Meanwhile the rest of the world has considered smallpox eradicated since 1980 and the reason for hanging around after a vaccination is to ensure you are handy to the adrenaline and oxygen for the one in a million anaphylactic reaction. However rather than dwell on the extensive list of shortcomings in this article, which are too many too enumerate, I would really just like to consider how this proposed mechanism involving aluminium in some undefined way could trigger these nebulous symptoms.
So what is small fibre neuropathy? It is a result of damage to small peripheral nerve fibres (called C fibres). It is relatively common in that it affects 15-20 million people in the US and the most common cause is diabetes. Autoimmune conditions such as SLE and sarcoidosis have also been postulated however no cause is determined in around 40% of cases. Some studies have suggested an association between SFN and another syndrome called postural orthostatic tachycardia syndrome (POTS)
Definitive diagnosis of SFN appears challenging however a recent study listed the following diagnostic approaches:
- Clinical examination (54.6% diagnostic efficiency) – pinprick, thermal and autonomic dysfunction
- Quantitative sensory testing (QST) that assesses psychophysical thresholds for cold/warm sensations (46.9% diagnostic efficiency)
- Skin biopsy with quantification of somatic intraepidermal nerve fibres to assess damage (88.4% diagnostic efficiency)
Where cases involving SFN following HPV vaccine are reported in the literature it would seem prudent that some consistent detailed medical examinations have occurred however this is not often the case.
What is dysautonomia – it is an umbrella term for autonomic nervous system conditions and the symptoms include pretty much all of those appearing in the case studies (for example fatigue, blood pressure fluctuations, dizziness…)
So how about the capacity of HPV vaccine to cause SFN and dysautonomia
The hypothesis paper (Clin Rheum 2015 34:1165-1169) does not actually propose how this may occur but tentatively suggests “the vaccine adjuvant aluminium remains a culprit” and “An altered process of inactivated HPV virus and aluminium adjuvant that damage dorsal root ganglia could be suggested as a preliminary pathogenic speculation for the development of small fibre neuropathy.”
So let me get this straight…dorsal root ganglion (DRG) are in the spine are they not? So how on earth can HPV Viral-Like Particles and aluminium adjuvant injected into the deltoid muscle find their way to the dorsal root ganglia? Because you see vaccine antigen and adjuvant are by and large taken up locally at the injection site and actively transported to the local lymph node. (By the way the author does not know the antigen he speaks of is not an inactivated virus but a viral like particle, you would think he would be very well acquainted with this fact given his claims.)
Let’s play this out. Vaccine formulation injected into muscle and the contents goes into the extracellular space. Local inflammatory response ensues. Antigen presenting cells take up Aluminium-adjuvant complex, and unbound antigen. Let’s imagine that not all of this is taken up at the injection site and a small amount of vaccine antigen-adjuvant finds its way into the blood. This amount would have to be tiny as it only started off as 225 micrograms in the first place. I assume this hypothetical aluminium gets to the DRG through the blood. So now the aluminium is in the blood, where does it go? Well it is going to have to be the kidneys where the glomeruli filter about 5-10 milligrams of aluminium every day from food. Only if the person has kidney failure will aluminium then accumulate in the blood where it binds to proteins such as albumin and is then distributed throughout the body. This pretty much only happens when someone hooks up ordinary tap water to the dialysis machine. Once a toxic overload occurs it will accumulate in brain and bone, not DRG. This pretty much only happens when someone hooks up ordinary tap water to the dialysis machine.
So the idea that aluminium has something vague to do with the dorsal root ganglia is really quite outrageous – given the amount of aluminium we put into our bodies every day according to this hypothesis we should surely all be dead.
Extraordinary claims demand extraordinary proof. (Carl Sagan)
- Claims that HPV vaccine causes a range of vague conditions involving fatigue and pain are circulating
- A paper proposing a hypothesis is published
- The paper does not actually provide a hypothesis* or any evidence
- Large scientific studies continue to support the safety of HPV vaccination and have consistently found vaccinated girls to be at NO greater risk of neurological or autoimmune disorders.
*Hypothesis needs to be testable
Part 2 of ‘HPV vaccination syndrome’ can be found here.
Featured image credit: Judy Schmidt – Public Health Image Library