This Cochrane review covers the ‘Effects of human papillomavirus (HPV) vaccination programmes on community rates of HPV-related disease and harms from vaccination'
Henschke et al, Cochrane Database of Systematic Reviews 2025
Summary from article
- reduces the incidence of cervical cancer by around 80% in people vaccinated at or before the age of 16 years;
- reduces the incidence of high-grade cervical pre-cancer lesions, as well as anogenital warts;
- is not associated with an increased risk of long-term side effects or infertility;
- is more effective when given at or before the age of 16 years, before onset of sexual activity.
Full Abstract (excerpt)
Objectives
We aimed to assess population-level effects of HPV vaccination programmes on HPV-related disease and harms from vaccination.
Data collection and analysis
We used methods recommended by Cochrane. Two review authors carried out data extraction independently using pretested data extraction forms. We assessed the risk of bias of all included effect estimates using different tools according to study design. We carried out quantitative and qualitative data synthesis separately by outcome and study design. We performed meta-analysis on studies that reported effect estimates adjusted for confounding, with a focus on those receiving HPV vaccination at or before the age of 16 years (the target age group for vaccination). We rated the certainty of the evidence with GRADE.
Main results
We included 225 studies from 347 records in this review, evaluating over 132 million people. We included 86 cohort studies, four case-control studies, 46 cross-sectional studies, 69 pre-post vaccine introduction studies, five RCT extensions and two self-controlled case series. Thirteen additional studies reported on more than one type of analysis. Of the included studies, 177 reported only on females, 11 only males and 37 a combination of males and females. Risk of bias ranged from overall moderate risk to critical risk.
Specific adverse events
Across a range of study designs, HPV vaccination was not associated with an increased risk of postural orthostatic tachycardia syndrome, chronic fatigue syndrome/myalgic encephalomyelitis, paralysis, complex regional pain syndrome, premature ovarian failure, infertility or sexual activity (all moderate-certainty evidence). There was evidence that suggests HPV vaccination was not associated with an increased risk of Guillain-Barré syndrome (low-certainty evidence).
MEA Comment
The human papilloma virus (HPV) vaccine provides protection against a virus that causes genital infections and a number of cancers including mouth, cervical, vaginal and vulval cancer. So it's a very important advance in the prevention of cancer.
The vaccine is normally given to children aged 12 to 13 as well as older age groups who are at increased risk of developing genital cancers.
The most common side effects are mild and don't normally last very long. These can include:
- swelling or pain where the injection was given
- headache
- high temperature
- dizziness
- feeling sick
- tiredness
Although there is sound evidence that a number of commonly used vaccines can occasionally trigger ME/CFS, and sometimes exacerbate ME/CFS symptoms, we have not received any recent feedback in relation to this vaccine either triggering ME/CFS, or causing a significant exacerbation of existing ME/CFS symptoms.
However, a small number of cases have been reported where HPV has been linked to the development of ME/CFS or a post viral fatigue syndrome. In this case, the 2012 MHRA (Medicines and Healthcare Regulatory Authority) review of HPV vaccine safety concluded that there was no causal link. See pages 18-19 in this report:
The new report from Cochrane concluded that there was no link to either ME/CFS and PoTS (Cochrane Review link above MEA comment).
In conclusion, HPV vaccine helps to prevent several types of cancer and has a good safety record. All the research and patient evidence indicates that vaccination is well worth considering if a young person has ME/CFS. However, as with any vaccine, it is best avoided if you are feeling more unwell than usual and have any infective or flu like symptoms.
NHS website information on HPV vaccine:
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
Further Information
- MEA Leaflet: Immunisations as Possible Triggers