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Human papillomavirus (HPV) vaccine and autonomic disorders: a position statement from the American Autonomic Society



Human papillomavirus (HPV) vaccination has been anecdotally connected to the development of dysautonomia, chronic fatigue, complex regional pain syndrome and postural tachycardia syndrome.


To critically evaluate a potential connection between HPV vaccination and the above-noted conditions.


We reviewed the literature containing the biology of the virus, pathophysiology of infection, epidemiology of associated cancers, indications of HPV vaccination, safety surveillance data and published reports linking HPV vaccination to autonomic disorders.


At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia.


Certain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.

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Author information

Correspondence to Alexandru Barboi.

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Conflict of interest

AB—none. CHG—CHG has received research support at Beth Israel Deaconess Medical Center from Grifols Inc. CHG has served as a scientific consult for Lundbeck. CHG has served as a consultant for the United States Department of Justice (Vaccine Court). CHG has received compensation for editorial activities (Associate Editor) with Autonomic Neuroscience–basic and clinical. FA—none. EEB—none. IB—none related to this topic. IB is a consultant for and recipient of research grants from Lundbeck Pharmaceuticals and Theravance Biopharma for the development of treatments for orthostatic hypotension. MWC—none. GC—co-owner of PainStakers LLC, a company dedicated to teaching primary care physicians effective pain management. TC—co-owner of PainStakers LLC, a company dedicated to teaching primary care physicians effective pain management. WPC—none. VEC—research grants from the Heart and Stroke Foundation of Canada, Craig H Nielsen Foundation, and International Collaboration On Repair Discoveries. RF—RF received personal compensation and/or stock options for serving on scientific advisory boards of Abide, Applied Therapeutics, Astellas, Aptinyx, Biogen, Chromacel, Cutaneous NeuroDiagnostics, Ironwood, Lundbeck, MundiPharma, NeuroBo, Novartis, Pfizer, Regenacy, Spinifex, Toray and Theravance. RF received personal compensation for editorial activities (Editor) with Autonomic Neuroscience—basic and clinical. DSG—none. MJJ—none. HK—HK has served as an expert witness for the US Department of Justice in a case alleging that POTS was caused by HPV vaccination. PAL—PAL has served as an expert witness for the US Department of Justice in Vaccine Court. LNK—LNK has served as a consultant for PTC Therapeutics. DR—none. CAS—CAS received grant support from Office of Orphan Products Development. Food and Drug Administration, Grant #FD-R-04778-01-A3. CAS has received speaker honorarium from Lundbeck Pharmaceuticals. CAS received consulting honoraria from Lundbeck. CAS has received research support from the CDC, Clinical Immunization and Safety Assessment Program at Vanderbilt University Medical Center. WS—none. HS—none. SV—SV receives research support from Dysautonomia International, Genentech, Grifols, Rex Griswold Foundation, and Athena/Quest Diagnostics and personal compensation for consulting for Argenx, Alexion, and Lundbeck. SV has provided medicolegal consultation related to HPV vaccination. SRR—SRR has grant support from the Canadian Institutes of Health Research (Ottawa, Canada), Cardiac Arrhythmia Network of Canada (London, ON, Canada), and Dysautonomia International (East Moriches, NY, USA). SRR is a consultant for GE Healthcare and Lundbeck LLC, and has performed medicolegal consulting on diagnosis and causation of POTS. SRR has received compensation for editorial activities (Associate Editor) with Autonomic Neuroscience—basic and clinical.

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This article is co-published in the journals “Clinical Autonomic Research” and “Autonomic Neuroscience”. or

These articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style.

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Barboi, A., Gibbons, C.H., Axelrod, F. et al. Human papillomavirus (HPV) vaccine and autonomic disorders: a position statement from the American Autonomic Society. Clin Auton Res 30, 13–18 (2020).

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  • Consensus statement
  • Postural tachycardia syndrome
  • HPV
  • Vaccine
  • Autonomic dysfunction