I read with great interest the article by Chao et al.  regarding the lack of autoimmune diseases in patients who were vaccinated against HPV. I would like to comment on this report and in particular on the validity of the results and conclusions.
First, the study was supported by companies that produce vaccines (i.e. Merck). Second, the authors were personally supported by these companies or were consultants with regard to the issue of vaccine safety. These two facts affect the validity of the results. I am reminded of the editorial comments in JAMA following the introduction to the market of the HPV vaccine Gardasil; it was noted that consultants to the regulatory authorities were also employed as consultants by the company producing the vaccine .
Third, the authors have looked for the presence of well-defined autoimmune diseases, most probably fulfilling the defined criteria for diagnosis  by the different following physicians. The clinical picture of autoimmune or autoinflammatory reaction to a vaccine or to its adjuvant, in particular aluminium, involves chronic stimulation of the immune system, which we recently summarized as ‘ASIA syndrome’ . This autoimmune (autoinflammatory) syndrome, which represents a reaction to vaccine adjuvants as well as to silicone rupture, may present as nonclassical clinical and laboratory manifestations characterizing a new syndrome and not necessarily a well-defined autoimmune condition. The authors failed to consider this.
Last but not least, a few studies have shown that the incubation time for induction of autoimmunity following vaccination can be more than 3 years (e.g. the development of multiple sclerosis 3 years after vaccination with either Gardasil or a hepatitis B vaccine) [1, 5–8].
Thus, all the above cast doubt on the results of this study reported in the paper.