Immunogenicity of the Bivalent Human Papillomavirus Vaccine in Adolescents with Juvenile Systemic Lupus Erythematosus or Juvenile Dermatomyositis

To the Editor: In healthy females, human papillomavirus (HPV) vaccines are safe, immunogenic, and effective in inducing protection against HPV16/18 infections and their associated premalignant lesions, especially when administered to girls before they become sexually active1,2. Juvenile patients with rheumatic diseases such as systemic lupus erythematosus (SLE) or juvenile dermatomyositis (JDM) are at increased risk of infections due to the disease itself or its treatment3. This applies particularly to HPV infections in patients with SLE, because persistent HPV infections and cervical intraepithelial neoplasia (CIN) lesions are more prevalent in patients with SLE4. Interestingly, the immunogenicity of the quadrivalent HPV vaccine in adult SLE patients is lower than that in healthy controls5. However, the immunogenicity of the more immunogenic bivalent HPV16/18 vaccine in the target population, namely HPV-naive adolescent patients with rheumatic diseases, remains unknown. We describe the immunogenicity of the bivalent HPV16/18 vaccine in a small group of patients with juvenile SLE or JDM compared to healthy female adolescents. The bivalent HPV16/18 vaccine was introduced in the Dutch national immunization program in … Address correspondence to Dr. M.W. Heijstek, Department of Pediatric Immunology, Wilhelmina Children’s Hospital, KC 03.063.0, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands. E-mail: m.w.heijstek{at}umcutrecht.nl