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Afrin LB, Dempsey TT, Weinstock LB. Post-HPV-Vaccination Mast Cell Activation Syndrome: Possible Vaccine-Triggered Escalation of Undiagnosed Pre-Existing Mast Cell Disease? Vaccines (Basel) 2022; 10:127. [PMID: 35062788 PMCID: PMC8779641 DOI: 10.3390/vaccines10010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 01/27/2023] Open
Abstract
For nearly a decade, case reports and series have emerged regarding dysautonomias-particularly postural orthostatic tachycardia syndrome (POTS)-presenting soon after vaccination against human papilloma virus (HPV). We too have observed a number of such cases (all following vaccination with the Gardasil product), and have found several to have detectable mast cell activation syndrome (MCAS) as well as histories suggesting that MCAS was likely present long before vaccination. We detail 11 such cases here, posing a hypothesis that HPV vaccination (at least with the Gardasil product) may have triggered or exacerbated MCAS in teenagers previously not recognized to have it. Only recently recognized, MCAS is being increasingly appreciated as a prevalent and chronic multisystem disorder, often emerging early in life and presenting with inflammatory ± allergic phenomena following from known mast cell (MC) mediator effects. There is rising recognition, too, of associations of MCAS with central and peripheral neuropathic disorders, including autonomic disorders such as POTS. Given the recognized potential for many antigens to trigger a major and permanent escalation of baseline MC misbehavior in a given MCAS patient, we hypothesize that in our patients described herein, vaccination with Gardasil may have caused pre-existing (but not yet clinically recognized) MCAS to worsen to a clinically significantly degree, with the emergence of POTS and other issues. The recognition and management of MCAS prior to vaccinations in general may be a strategy worth investigating for reducing adverse events following HPV vaccinations and perhaps even other types of vaccinations.
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Affiliation(s)
- Lawrence B. Afrin
- AIM Center for Personalized Medicine, Purchase, New York, NY 10577, USA;
| | - Tania T. Dempsey
- AIM Center for Personalized Medicine, Purchase, New York, NY 10577, USA;
| | - Leonard B. Weinstock
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA;
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Hviid A, Thorsen NM, Thomsen LN, Møller FT, Wiwe A, Frisch M, Valentiner-Branth P, Rytter D, Mølbak K. Human papillomavirus vaccination and all-cause morbidity in adolescent girls: a cohort study of absence from school due to illness. Int J Epidemiol 2021; 50:518-526. [PMID: 33547468 PMCID: PMC8128452 DOI: 10.1093/ije/dyab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background A growing body of evidence supports the safety of the human papillomavirus (HPV) vaccines. However, concerns about autonomic dysfunction syndromes and non-specific symptoms continue to linger. These conditions are not easily captured by traditional diagnostic classification schemes and call for innovative approaches to the study of vaccine safety which take more general measures of all-cause morbidity into account. Methods Taking advantage of the unique Danish registers, including regional registration of absence from school, we conducted a cohort study of 14 068 adolescent Danish girls attending 5th through 9th grade in public schools in the municipality of Copenhagen during 1 August 2013–23 January 2018. We obtained time-varying HPV vaccination status and demographic information from nationwide registers. Using Poisson regression with random effects, we estimated rate ratios (RRs) of absence due to illness, comparing HPV-vaccinated girls with unvaccinated girls with adjustment for grade, season, calendar period, demographic factors and random effects at the individual, class and school levels. Results Our study included 6 206 188 school days with 213 221 days of absence from school due to illness (absence rate, 3.4%). Comparing absence rates due to illness in HPV-vaccinated and unvaccinated girls yielded an adjusted RR of 1.00 (95% confidence interval [CI], 0.98–1.03). Conclusions Our study provides an important and novel contribution to HPV vaccine safety. Using absence from school records, we were able to address important safety concerns without relying on medical diagnoses. We conclude that HPV vaccination does not increase the risk of morbidity in any manner that manifests as absence from school due to illness.
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Affiliation(s)
- Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Nicklas M Thorsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Louise N Thomsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Frederik T Møller
- Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Andreas Wiwe
- Ledelsesinformation, data og analyser, Børne- og Ungdomsforvaltningen, City of Copenhagen, Denmark
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark
| | | | - Dorte Rytter
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kåre Mølbak
- Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark.,Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
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Conklin L, Hviid A, Orenstein WA, Pollard AJ, Wharton M, Zuber P. Vaccine safety issues at the turn of the 21st century. BMJ Glob Health 2021; 6:bmjgh-2020-004898. [PMID: 34011504 PMCID: PMC8137241 DOI: 10.1136/bmjgh-2020-004898] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022] Open
Abstract
Global gains in vaccination coverage during the early 21st century have been threatened by the emergence of antivaccination groups that have questioned the effectiveness of vaccines to generate public distrust of vaccines and immunisation programmes. This manuscript summarises six key topics that have been at the centre of global discussions on vaccine safety during the early 21st century: thiomersal in multi-dose non-live vaccines, aluminium adjuvants used with several non-live vaccines, autism and auto-immune conditions as possible consequences of vaccination, a risk of immune overload with increasing numbers of vaccinations, and detrimental non-specific effects (NSEs) of vaccination. For each topic, we describe the hypothesis behind the public concern, the evidence reviewed by the WHO’s Global Advisory Committee for Vaccine Safety (GACVS) during 1999–2019, and any significant new data that has emerged since GACVS conclusions were made. Although the scientific evidence on these issues overwhelmingly supports the safety of vaccines, communication messages to caregivers and providers need to condense and convey scientific information in an appropriate way to address concerns contributing to vaccine distrust. In addition, there is need for further studies specifically designed to address both positive and negative NSE of vaccination. The role of GACVS will be increasingly important in evaluating the evidence and engaging the global community in promoting and assuring the safety of vaccines in the decades to come as we move into an era in which we use new vaccination platforms, antigens and formulations.
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Affiliation(s)
- Laura Conklin
- Global Immunizations Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Melinda Wharton
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Zuber
- Essential Medicines and Health Products, Organisation mondiale de la Sante, Geneve, Switzerland
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Hviid A, Thorsen NM, Valentiner-Branth P, Frisch M, Mølbak K. Association between quadrivalent human papillomavirus vaccination and selected syndromes with autonomic dysfunction in Danish females: population based, self-controlled, case series analysis. BMJ 2020; 370:m2930. [PMID: 32878745 PMCID: PMC7463169 DOI: 10.1136/bmj.m2930] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the association between quadrivalent human papillomavirus vaccination and syndromes with autonomic dysfunction, such as chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome. DESIGN Population-based self-controlled case series. SETTING Information on human papillomavirus vaccinations and selected syndromes with autonomic dysfunction (chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome) identified using ICD-10 (international classification of diseases, revision 10) diagnostic codes from Danish nationwide registers. PARTICIPANTS 869 patients with autonomic dysfunction syndromes from a cohort of 1 375 737 Danish born female participants aged 10 to 44 years during 2007-16. MAIN OUTCOME MEASURES Self-controlled case series rate ratios (95% confidence intervals) of the composite outcome of chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome, adjusted for age and season, comparing female participants vaccinated and unvaccinated with the quadrivalent human papillomavirus vaccine. Chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome were also considered separately in secondary analyses. RESULTS During 10 581 902 person years of follow-up, 869 female participants with syndromes of autonomic dysfunction (136 with chronic fatigue syndrome, 535 with complex regional pain syndrome, and 198 with postural orthostatic tachycardia syndrome) were identified. Quadrivalent human papillomavirus vaccination did not statistically significantly increase the rate of a composite outcome of all syndromes with autonomic dysfunction in a 365 day risk period following vaccination (rate ratio 0.99, 95% confidence interval 0.74 to 1.32) or the rate of any individual syndrome in the risk period (chronic fatigue syndrome (0.38, 0.13 to 1.09), complex regional pain syndrome (1.31, 0.91 to 1.90), or postural orthostatic tachycardia syndrome (0.86, 0.48 to 1.54)). CONCLUSIONS When vaccination is introduced, adverse events could occur in close temporal relation to the vaccine purely by chance. These results do not support a causal association between quadrivalent human papillomavirus vaccination and chronic fatigue syndrome, complex regional pain syndrome, or postural orthostatic tachycardia syndrome, either individually or as a composite outcome. An increased risk of up to 32% cannot be formally excluded, but the statistical power of the study suggests that a larger increase in the rate of any syndrome associated with vaccination is unlikely.
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Affiliation(s)
- Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
| | - Nicklas M Thorsen
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | | | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
- Department of Clinical Medicine, Centre for Sexology Research, Aalborg University, Aalborg, Denmark
| | - Kåre Mølbak
- Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
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Ward D, Thorsen NM, Frisch M, Valentiner-Branth P, Mølbak K, Hviid A. A cluster analysis of serious adverse event reports after human papillomavirus (HPV) vaccination in Danish girls and young women, September 2009 to August 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31088598 PMCID: PMC6518966 DOI: 10.2807/1560-7917.es.2019.24.19.1800380] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BackgroundSuspected adverse events (AE) after human papillomavirus (HPV) vaccines include postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome (CFS), complex regional pain syndrome (CRPS) and symptoms including headache and orthostatic intolerance.AimWe aimed to identify phenotypes of AEs after HPV vaccination, defined as patterns of AE terms (signs, symptoms, diagnoses), and to evaluate if identified phenotypes reflected previously suspected symptomatology or heightened public concerns over HPV vaccine safety since 1 January 2015.MethodsWe conducted a retrospective observational study using latent class cluster analysis of all serious AE reports (n = 963) reported by females residing in Denmark between September 2009 and August 2017. Resulting clusters were characterised according to AE terms associated with POTS, CFS and CRPS before (September 2009-December 2014) and during (January 2015-August 2017) a time of heightened media activity regarding HPV vaccines.ResultsFour clusters of AE reports were distinguished. The most common symptoms were fatigue, dizziness and headache but their frequency varied among clusters. The majority of reports in one cluster were submitted during a period of heightened media activity, including an anomalous spike in submissions in December 2015; a high proportion of these reports included the symptoms cognitive disorder (78%), abdominal pain (77%), dysuria (60%) and sleep disorder (60%).ConclusionsNon-specific symptoms including headache, fatigue and dizziness feature prominently in serious AE reports from females in Denmark. Our analysis identified a cluster of reports, likely media stimulated, with a focus on symptoms of CFS and POTS.
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Affiliation(s)
- Daniel Ward
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Morten Frisch
- Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Aalborg, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Kåre Mølbak
- Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark.,Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Meggiolaro A, Migliara G, La Torre G. Association between Human Papilloma Virus (HPV) vaccination and risk of Multiple Sclerosis: A systematic review. Hum Vaccin Immunother 2018; 14:1266-1274. [PMID: 29333935 DOI: 10.1080/21645515.2017.1423155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The vaccination against Humanpapilloma Virus (HPV) is an effective strategy to prevent high-risk HPV infection and subsequent cervical carcinogenesis. Although the safety profile has been ascertained, the relation with the development of central nervous system (CNS) autoimmune disorders (AD) appears still controversial. Multiple Sclerosis (MS) is the most common cause of chronic neurological impairment in young people, typically striking females. The main purpose of this review was to assess the association between HPV vaccination and MS. METHODS The systematic review of the literature was carried out using 5 search engines: MEDLINE, SCOPUS, ISI WEB OF KNOWLEDGE, GOOGLE SCHOLAR and ClinicalTrial.gov. The web search was updated on January 2017. PRISMA checklist was adopted to address the content of the systematic review. The measures of outcome were reported as relative risk (RR) in cohort studies and odds ratio (OR) in case-control studies. RESULTS The systematic review identified 5 observational studies, 9 reviews, and 1 randomized clinical trials (RCT) pooled analysis. The RR of MS onset detected by cohort studies ranged from 1.54 (95%CI, 0.04-8.59) to 1.37 (95%CI, 0.74-3.20). Concerning case-control studies, the OR spanned from 0.3, (95%CI 0.1-0.9) to 1.60 (95%CI = 0.79-3.25) for the group exposed to HPV vaccination. No result was significant. CONCLUSION This review showed no significant association between HPV vaccination and MS. The low statistical power of the studies agreed with the low incidence of MS disease among general population. In order to overcome the shortcoming the research may be extended to the entire pattern of CNS ADs.
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Affiliation(s)
- Angela Meggiolaro
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Giuseppe Migliara
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Giuseppe La Torre
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
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Skufca J, Ollgren J, Ruokokoski E, Lyytikäinen O, Nohynek H. Incidence rates of Guillain Barré (GBS), chronic fatigue/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS) prior to introduction of human papilloma virus (HPV) vaccination among adolescent girls in Finland, 2002-2012. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:91-96. [PMID: 28720463 PMCID: PMC5883192 DOI: 10.1016/j.pvr.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Finland a vaccination programme against human papillomavirus (HPV) was introduced in November 2013 for girls aged 11-12 years with a catchup for girls 13-15 years. Allegations that HPV vaccine is causing Guillain Barré syndrome (GBS) and non-specific diagnostic entities, such as chronic fatigue syndrome/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS), continue to surface. We examined population register-based incidence rates of CFS/SEID, GBS and POTS to provide baseline data for future HPV vaccine safety evaluations. METHODS First diagnosis of CFS/SEID, GBS and POTS in girls aged 11-15 years were obtained from the National Hospital Discharge Register during 2002-2012. We considered the following ICD-10 codes: G93.3 for CFS; G61.0 for GBS and G90.9, G90.8, G93.3, I49.8 for POTS. We calculated incidence rates per 100,000 person-years with 95% confidence intervals (CI). RESULTS In total, 9 CFS/SEID, 19 GBS and 72 POTS cases were identified. The overall incidence rate was 0.53/100,000 (95% CI; 0.27-1.01) for CFS/SEID, 1.11 (95% CI; 0.71-1.74) for GBS and 4.21 (95%CI; 3.34-5.30) for POTS. Significant relative increase in annual incidence rate with a peak in 2012 was observed in CFS/SEID (33% (95% CI; 3.0-70.3: p=0.029) and POTS (16.5% (95% CI; 7.8-25.9: p<0.05), but not in GBS (5.4% (95% CI; -8.4-21.3: p=0.460). CONCLUSIONS Our findings provide baseline estimates of CFS/SEID, GBS and POTS incidences in Finland. However, rates based on register data should be interpreted with caution, especially for non-specific diagnostic entities for which internationally and even nationally agreed criteria are still being discussed. To assess the associations with HPV vaccine, methods using register linkage for cohort and self-controlled case series should be explored in addition to factors contributing to patients seeking care, treating physicians setting the diagnoses, and their preference of using of codes for these clinical entities.
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Affiliation(s)
- J Skufca
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - J Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - E Ruokokoski
- Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - O Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - H Nohynek
- Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland.
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Mølbak K, Hansen ND, Valentiner-Branth P. Pre-Vaccination Care-Seeking in Females Reporting Severe Adverse Reactions to HPV Vaccine. A Registry Based Case-Control Study. PLoS One 2016; 11:e0162520. [PMID: 27611088 PMCID: PMC5017678 DOI: 10.1371/journal.pone.0162520] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/24/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2013 the number of suspected adverse reactions to the quadrivalent human papillomavirus (HPV) vaccine reported to the Danish Medicines Agency (DMA) has increased. Due to the resulting public concerns about vaccine safety, the coverage of HPV vaccinations in the childhood vaccination programme has declined. The aim of the present study was to determine health care-seeking prior to the first HPV vaccination among females who suspected adverse reactions to HPV vaccine. METHODS In this registry-based case-control study, we included as cases vaccinated females with reports to the DMA of suspected severe adverse reactions. We selected controls without reports of adverse reactions from the Danish vaccination registry and matched by year of vaccination, age of vaccination, and municipality, and obtained from the Danish National Patient Registry and The National Health Insurance Service Register the history of health care usage two years prior to the first vaccine. We analysed the data by logistic regression while adjusting for the matching variables. RESULTS The study included 316 cases who received first HPV vaccine between 2006 and 2014. Age range of cases was 11 to 52 years, with a peak at 12 years, corresponding to the recommended age at vaccination, and another peak at 19 to 28 years, corresponding to a catch-up programme targeting young women. Compared with 163,910 controls, cases had increased care-seeking in the two years before receiving the first HPV vaccine. A multivariable model showed higher use of telephone/email consultations (OR 1.9; 95% CI 1.2-3.2), physiotherapy (OR 2.1; 95% CI 1.6-2.8) and psychologist/psychiatrist (OR 1.9; 95% CI 1.3-2.7). Cases were more likely to have a diagnosis in the ICD-10 chapters of diseases of the digestive system (OR 1.6; 95% CI 1.0-2.4), of the musculoskeletal system (OR 1.6; 95% CI 1.1-2.2), symptoms or signs not classified elsewhere (OR 1.8; 95% CI 1.3-2.5) as well as injuries (OR 1.5; 95% CI 1.2-1.9). CONCLUSION Before receiving the first HPV vaccination, females who suspected adverse reactions has symptoms and a health care-seeking pattern that is different from the matched population. Pre-vaccination morbidity should be taken into account in the evaluation of vaccine safety signals.
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Affiliation(s)
- Kåre Mølbak
- Department of Infectious Diseases Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Dalum Hansen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
- IBM Denmark, Holte, Denmark
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10
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Arnheim-Dahlström L, Pasternak B, Svanström H, Sparén P, Hviid A. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ 2013; 347:f5906. [PMID: 24108159 PMCID: PMC3805482 DOI: 10.1136/bmj.f5906] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the risk of serious adverse events after vaccination of adolescent girls with quadrivalent human papillomavirus (qHPV) vaccine. DESIGN Register based cohort study. SETTING Denmark and Sweden, October 2006 to December 2010. PARTICIPANTS 997,585 girls aged 10-17, among whom 296,826 received a total of 696,420 qHPV vaccine doses. MAIN OUTCOME MEASURES Incident hospital diagnosed autoimmune, neurological, and venous thromboembolic events (53 different outcomes) up to 180 days after each qHPV vaccine dose. Only events with at least five vaccine exposed cases were considered for further assessment. Rate ratios adjusted for age, country, calendar year, and parental country of birth, education, and socioeconomic status were estimated, comparing vaccinated and unvaccinated person time. For outcomes where the rate ratio was significantly increased, we regarded three criteria as signal strengthening: analysis based on 20 or more vaccine exposed cases (reliability), rate ratio 3.0 or more (strength), and significantly increased rate ratio in country specific analyses (consistency). We additionally assessed clustering of events in time and estimated rate ratios for a risk period that started on day 181. RESULTS Among the 53 outcomes, at least five vaccine exposed cases occurred in 29 and these were analysed further. Whereas the rate ratios for 20 of 23 autoimmune events were not significantly increased, exposure to qHPV vaccine was significantly associated with Behcet's syndrome, Raynaud's disease, and type 1 diabetes. Each of these three outcomes fulfilled only one of three predefined signal strengthening criteria. Furthermore, the pattern of distribution in time after vaccination was random for all three and the rate ratios for these outcomes in the period from day 181 after vaccination were similar to the rate ratios in the primary risk period. The rate ratios for five neurological events were not significantly increased and there were inverse associations with epilepsy (rate ratio 0.66, 95% confidence interval 0.54 to 0.80) and paralysis (0.56, 0.35 to 0.90). There was no association between exposure to qHPV vaccine and venous thromboembolism (0.86, 0.55 to 1.36). CONCLUSIONS This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune, neurological, and venous thromboembolic adverse events. Although associations for three autoimmune events were initially observed, on further assessment these were weak and not temporally related to vaccine exposure. Furthermore, the findings need to be interpreted considering the multiple outcomes assessed.
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Affiliation(s)
- Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden
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11
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Clothier HJ, Lee KJ, Sundararajan V, Buttery JP, Crawford NW. Human papillomavirus vaccine in boys: background rates of potential adverse events. Med J Aust 2013; 198:554-8. [DOI: 10.5694/mja12.11751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/10/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Hazel J Clothier
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Childrens Research Institute, Melbourne, VIC
- School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, VIC
| | | | - Jim P Buttery
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Childrens Research Institute, Melbourne, VIC
- Department of Infectious Diseases and Department of Paediatrics, Monash University, Melbourne, VIC
| | - Nigel W Crawford
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Childrens Research Institute, Melbourne, VIC
- Department of General Medicine, Royal Children's Hospital, Melbourne, VIC
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12
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Macartney KK, Chiu C, Georgousakis M, Brotherton JML. Safety of Human Papillomavirus Vaccines: A Review. Drug Saf 2013; 36:393-412. [DOI: 10.1007/s40264-013-0039-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Van Ganse E, Letrilliart L, Borne H, Morand F, Robain M, Siegrist CA. Health problems most commonly diagnosed among young female patients during visits to general practitioners and gynecologists in France before the initiation of the human papillomavirus vaccination program. Pharmacoepidemiol Drug Saf 2011; 21:261-8. [PMID: 22052698 DOI: 10.1002/pds.2243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE Background rates for common health problems have seldom been estimated to facilitate interpretation of signals that may occur after a new public health intervention. Background rates of diagnoses from general practitioners (GPs) and gynecologists (GYNs) were assessed before the implementation of human papillomavirus (HPV) immunization program. METHODS This cross-sectional study used data collected in 2006 in France. All visits of women (aged 11-23 years) to a GP or a GYN participating in the longitudinal patient data (LPD) network were considered. Diagnoses and symptoms were retrieved and classified according to the International Classification of Primary Care. Only diagnoses made in ≥ 1% of visits were reported in primary analyses. Independent analyses were performed for visits to GPs and GYNs and for adolescents and young adults. Finally, the rates of pre-specified health problems of interest (e.g., because of their potential identification as signals after HPV immunization) were computed from processed diagnostic data, using time windows consistent with HPV vaccination scheme. RESULTS About 380,813 GP and 36,329 GYN visits were analyzed. Acute upper respiratory infections were the most frequently recorded diagnoses by GPs, accounting for 11,783 per 100,000 visits per year. Visits related to the respiratory system accounted for 10 of the 23 most frequent diagnoses by GPs. Genital candidiasis was the most frequent GYN diagnosis, accounting for 4746 per 100,000 visits per year. Most GYN visits were for pregnancy-related issues or menstrual problems. The main diagnoses were similar in adolescents compared with young adults in both GP and GYN settings. Pre-specified health problems occurred at high rates, as exemplified by acne that was diagnosed in 0.8% of patients during time windows consistent with HPV immunization. CONCLUSION Diagnostic data processed from electronic health records identified the rates of common health events experienced by young female patients routinely visiting their GP or GYN before HPV immunization. Such rates may prove useful in interpreting adverse events reported after the launch of new medical interventions.
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van der Maas NAT, Kramer MA, Jacobs BC, van Soest EM, Dieleman JP, Kemmeren JM, de Melker HE, Sturkenboom MCJM. Guillain-Barré syndrome: background incidence rates in The Netherlands. J Peripher Nerv Syst 2011; 16:243-9. [DOI: 10.1111/j.1529-8027.2011.00356.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marès Bermúdez J, van Esso Arbolave D, Arístegui Fernández J, Ruiz Contreras J, González Hachero J, Merino Moína M, Barrio Corrales F, Álvarez García F, Cilleruelo Ortega M, Ortigosa del Castillo L, Moreno Pérez D. Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010. An Pediatr (Barc) 2010; 72:433.e1-17. [DOI: 10.1016/j.anpedi.2010.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 02/15/2010] [Indexed: 11/29/2022] Open
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Abstract
UNLABELLED Given the serious consequences of low vaccine coverage, concerns and misconceptions need to be taken seriously and responded to appropriately to sustain accomplishments of immunization programmes. For parental decisions related to childhood vaccinations, it seems reasonable to assume that the cultural context of the immunization programme is of importance. This article is a short review of some recent studies of parental decision-making on vaccination in developed countries Kazaktstan, Uzbekistan and Northern Nigeria. Furthermore, an attempt is made to relate the findings in these studies to theoretical models of parental decision-making. CONCLUSION For the implementation of immunization programmes, it is important to develop an in-depth understanding of mechanisms underlying decisions to accept or reject the vaccination of a child. Theoretical models may aid in the understanding of these mechanisms.
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Affiliation(s)
- T Callréus
- Danish Medicines Agency, Consumer Safety Division, Copenhagen, Denmark.
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Rates of autoimmune diseases in Kaiser Permanente for use in vaccine adverse event safety studies. Vaccine 2010; 28:1062-8. [DOI: 10.1016/j.vaccine.2009.10.115] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/14/2009] [Accepted: 10/19/2009] [Indexed: 11/24/2022]
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