Beijing is putting forward maternity health expert Song Li for the top position at the World Health Organization. If elected, she will be the second Chinese national to lead the WHO after Margaret Chan, who headed the organisation between 2007 and 2017.
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Agreement: I Agree Body: Dear Editor, Zhang and colleagues report that HPV vaccination before pregnancy was associated with lower odds of preterm birth. The adjusted odds ratio was 0.95 (95% CI 0.91 to 0.99) in 624,713 singleton births.[1] The association was stronger among women vaccinated before age 17 (0.90, 0.85 to 0.95), where the authors expect the least residual confounding. Treating the odds ratios as approximations to risk ratios, the E-values are 1.3 overall and 1.5 for that subgroup, with upper confidence limits of 1.1 and 1.3.[2] An unmeasured confounder linked to both vaccination and preterm birth by a risk ratio of at least 1.3 each could move the estimate to the null. Laake and colleagues tested whether HPV vaccination increases infectious disease hospitalisation in 754,458 Nordic girls and found decreased risk instead. In the Swedish school programme, which offered vaccination at about age 11 and reached 80% uptake, the adjusted hazard ratio was 0.59 (0.49 to 0.71). The authors judged healthy vaccinee bias the probable main explanation, while not excluding beneficial non-specific effects.[3] Lyth and colleagues used all-cause mortality as a negative control outcome for COVID-19 vaccination in 245,696 older Swedish adults, hazard ratio 0.43 (0.40 to 0.45).[4] Healthy vaccinee bias can be substantial in Swedish registers, although its magnitude for pregnancy outcomes is unknown. A negative control outcome is an endpoint the vaccine should not affect and which shares the confounding structure of the outcome.[5-7] The healthy vaccinee component of a modest protective association cannot be fully removed by adjustment for measured covariates. Neither the case-control nor the cohort analysis reports one in the main text. Sibling comparison, where feasible, addresses familial confounding, and in Swedish registers it reduced a maternal infection association with autism from 1.16 to 0.94.[8] None of this calls into question the cancer prevention value of HPV vaccination. References 1. Zhang Z, Ploner A, Sengpiel V, et al. Quadrivalent human papillomavirus vaccination before pregnancy and pregnancy outcomes: nationwide, population based case-control study. BMJ 2026;395:e100739. 2. VanderWeele TJ, Ding P. Sensitivity Analysis in Observational Research: Introducing the E-Value. Ann Intern Med. 2017;167(4):268-274. 3. Laake I, Feiring B, Gehrt L, et al. Infectious disease hospitalization after receipt of human papillomavirus vaccine: a nationwide register-based cohort study among Danish, Finnish, Norwegian, and Swedish girls. Eur J Epidemiol 2025;40(1):81-93. 4. Lyth J, Spreco A, Hinkula J, et al. Healthy vaccinee effect in the evaluation of updated COVID-19 vaccines in elderly populations. Nat Commun. 2026;17(1):8014. 5. Obel N, Fox MP, Tetens MM, et al. Confounding and Negative Control Methods in Observational Study of SARS-CoV-2 Vaccine Effectiveness: A Nationwide, Population-Based Danish Health Registry Study. Clin Epidemiol. 2024;16:501-512. 6. Ashby E, Janes H, Follmann D, et al. Validating and leveraging non-SARS-CoV-2 respiratory infection as a negative control outcome in a phase 3 COVID-19 vaccine trial with extended observational follow-up. Am J Epidemiol. 2026;195(1):168-177. 7. Lipsitch M, Tchetgen Tchetgen E, Cohen T. Negative controls: a tool for detecting confounding and bias in observational studies. Epidemiology. 2010;21(3):383-8. 8. Brynge M, Sjöqvist H, Gardner RM, et al. Maternal infection during pregnancy and likelihood of autism and intellectual disability in children in Sweden: a negative control and sibling comparison cohort study. Lancet Psychiatry. 2022;9(10):782-791. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Thursday, October 8, 2026 - 06:27 AI use: No, I have not used AI Highwire Comment Subject: Quadrivalent human papillomavirus vaccination before pregnancy and pregnancy outcomes: nationwide, population based case-control study Workflow State: Released Full Title: A negative control outcome would strengthen the evidence for a pregnancy benefit of HPV vaccination Highwire Comment Response to: Quadrivalent human papillomavirus vaccination before pregnancy and pregnancy outcomes: nationwide, population based case-control study Check this box if you would like your letter to appear anonymously:: Last Name: Zhang First name and middle initial: Jiawen Email: zhangjiawen@tongji.edu.cn Address: No. 301 Yan Chang Zhong Road, Shanghai, P.R.C. Occupation: Doctor Affiliation: Shanghai Tenth People's Hospital BMJ: Additional Article Info: Rapid response
Mr Ong, who is Minister for Health and Coordinating Minister for Social Policies, was speaking about women's health in a dialogue with former first lady of the United States Jill Biden at a forum in Singapore.
Gauteng has recorded more than 25,000 diabetes-related foot consultations since April as health authorities intensify efforts to prevent avoidable amputations and permanent disabilities through early screening and specialised treatment.
Summer Warne has shared details of her struggle with Obsessive Compulsive Disorder (OCD).
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