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Exposure to HPV vaccines was not associated with an increased risk of ADs within the time period studied. Results were robust to case definitions and time windows of exposure. Continued active surveillance is needed to confirm this finding for individual ADs.

IntroductionImmune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts due to increased destruction and impaired platelet production, partially related to the presence of autoantibodies directed toward platelet-membrane antigens. 1 ITP manifestations include various degrees of cutaneous and/or mucosal purpura; life-threatening hemorrhages occur in less than 5% of adult patients. 2 Onset is frequently insidious and low platelet counts often last beyond 6 months. 3 In adults, the incidence of ITP is approximately 3.3 per 100 000 person-years. 4,5 Studies have suggested that immunizations could be involved in the development of autoimmune disorders. 6 This could be because of molecular mimicry, in which antigens of the host are recognized as being similar to antigens of the immunization, thus provoking the development of autoantibodies. 7,8 Although several populationbased studies have described an association between the measlesmumps-rubella vaccine and ITP in children, 9-12 published evidence concerning the risk associated with other vaccines or with vaccination in adults is sparse and limited to a few case reports. [13][14][15][16][17] The risk of ITP associated with adult vaccines therefore remains controversial. The objective of this prospective case-control study was to explore the incidence of ITP in relation to all vaccination in adults, with a special emphasis on vaccines against influenza (the injectable/killed type only) and diphtheria-tetanus-pertussispoliomyelitis (DTPP). Methods PatientsThis case-control study prospectively recruited consecutive patients with newly diagnosed ITP at 22 internal medicine and hematology centers in continental France and compared them with controls recruited from general practice settings. Cases and controls were recruited from the same geographically diverse areas. All participants (cases and controls) provided informed written consent to participate in the study, were 18-79 years of age, could read French, and were capable of answering questions by a The online version of this article contains a data supplement.The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked ''advertisement'' in accordance with 18 USC section 1734. For personal use only. on May 11, 2018. by guest www.bloodjournal.org From qualified telephone interviewer. Cases and controls were excluded from the study if they had a history of thrombocytopenia.The study protocol was submitted to the ethical review committee of Paris-Ile de France III (Comité de Protection des Personnes Ile de France III) and was approved by the French Data Protection Authority (Commission Nationale de l'Informatique et des Libertés). All participants signed an informed consent form in accordance with the Declaration of Helsinki. Study populationCase subjects. We conducted this study using patient data retrieved from the Pharmacoepidemiological General Research on ITP (PGRx-ITP) registry, a French...

Objective. Studies have suggested that systemic lupus erythematosus (SLE) may be triggered by vaccinations. We undertook this study to investigate the relationship between vaccination and onset of SLE.Methods. This international case-control study was conducted between April 2008 and June 2012 in 36 specialist referral centers (34 in France and 2 in Quebec, Canada) and recruited patients <60 years old recently diagnosed as having either definite SLE (meeting >4 American College of Rheumatology [ACR] criteria including at least 1 immunologic criterion) or probable SLE (meeting 3 ACR criteria including at least 1 immunologic criterion). Controls were recruited from general practice settings through a closely monitored protocol and matched to patients by age, sex, region of residence, and date of recruitment. Vaccinations and other potential risk factors for SLE were assessed using a standardized telephone interview. We compared proportions of patients and controls who were vaccinated 12 and 24 months before the index date (date of first clinical symptom presented by the patient) using odds ratios (ORs) from conditional logistic regression.Results. We assessed 105 patients (89 with definite SLE and 16 with probable SLE) and 712 controls. Twenty-two of the 105 patients (21.0%) and 181 of the 712 controls (25.4%) had received at least 1 vaccination within 24 months before the index date (adjusted OR 0.9 [95% confidence interval 0.5-1.5]). The proportions of patients and controls vaccinated within the previous 12 months were also similar.Conclusion. Our study showed no association between exposure to vaccination and risk of developing SLE.Supported by LA-SER. Dr. Grimaldi-Bensouda was recipient of an INSERM research fellowship during this study.