Vaccination in patients with multiple sclerosis (MS) is generally considered to be safe. However, anecdotal reports of acute disseminated encephalomyelitis (ADEM) or MS exacerbation following the use of a variety of vaccines exist in the literature. The recombinant human papilloma virus (HPV) vaccine has recently been introduced for females aged between 9 and 26 years, a cohort of patients who are demographically at risk for demyelinating syndromes.

We describe four patients aged 16 to 25 years with acute demyelinating syndromes that developed 1 to 21 days after the second or third dose of the recombinant HPV vaccine. In two of these cases, there was no prior neurological history and the clinical and magnetic resonance imaging (MRI) findings were most consistent with ADEM. The remaining two patients had experienced one previous episode of symptomatic inflammatory demyelination and in both cases, MRI was typical of MS.

While anecdotal, the present report raises the possibility of a temporal relationship between the use of the recombinant HPV vaccine and symptom onset in patients with acute demyelinating syndromes. In Australia, a nationwide voluntary vaccination program for schoolgirls in Years 10, 11 and 12 commenced in 2007. As this demographic cohort is also at higher risk of demyelinating disease, a prospective longitudinal study examining the potential effects of vaccination is warranted.