1887
Research Open Access
Like 0

Abstract

Background

Suspected 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.

Aim

We 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.

Methods

We 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.

Results

Four 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%).

Conclusions

Non-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.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.19.1800380
2019-05-09
2024-11-05
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.19.1800380
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/19/eurosurv-24-19-2.html?itemId=/content/10.2807/1560-7917.ES.2019.24.19.1800380&mimeType=html&fmt=ahah

References

  1. Statens Serum Institut (SSI). Gratis HPV-vaccination til kvinder født i 1993-1997 ophører ultimo 2015. [Free HPV-vaccination for women born 1993-1997 ceases at the end of 2015.] Copenhagen: SSI; 2015. Danish. Available from: https://www.ssi.dk/aktuelt/nyheder/2015/2015-12-epinyt-50-hpv-vaccination
  2. Statens Serum Institut. EPI-NYT Uge 47 – 2014. [EPI-NEWS Week 47 – 2014]. Copenhagen, Statens Serum Institut; 2014. Danish. Available from: https://www.ssi.dk/aktuelt/nyhedsbreve/epi-nyt/2014/uge-47---2014.
  3. Danish Medicines Agency (DMA). HPV vaccination protects against cervical cancer [Internet]. Copenhagen: DMA; 2017. Available from: http://laegemiddelstyrelsen.dk/en/sideeffects/side-effects-from-medicines/childhood-vaccines/hpv-vaccination/~/media/4DCEFB530117489AB2AE35A871DE3805.ashx
  4. Statens Serum Institut. EPI-NYT Uge 39 - 2017. [EPI-NEWS Week 39 - 2017]. Copenhagen, Statens Serum Institut; 2017. Danish. Available from: https://www.ssi.dk/aktuelt/nyhedsbreve/epi-nyt/2017/uge-39---2017
  5. World Health Organization (WHO). Human papillomavirus vaccines: WHO position paper, May 2017. Wkly Epidemiol Rec. 2017;92(19):241-68. PMID: 28530369 
  6. Gilmour S, Kanda M, Kusumi E, Tanimoto T, Kami M, Shibuya K. HPV vaccination programme in Japan. Lancet. 2013;382(9894):768.  https://doi.org/10.1016/S0140-6736(13)61831-0  PMID: 23993189 
  7. Statens Serum Institut (SSI). EPI-NYT Uge 41 - 2017. [EPI-NEWS Week 41 - 2017]. Copenhagen, SSI; 2017. Available from: https://www.ssi.dk/aktuelt/nyhedsbreve/epi-nyt/2017/uge-41---2017
  8. Blitshteyn S. Postural tachycardia syndrome following human papillomavirus vaccination. Eur J Neurol. 2014;21(1):135-9.  https://doi.org/10.1111/ene.12272  PMID: 24102827 
  9. Brinth L, Theibel AC, Pors K, Mehlsen J. Suspected side effects to the quadrivalent human papilloma vaccine. Dan Med J. 2015;62(4):A5064. PMID: 25872549 
  10. Brinth L. Is Chronic Fatigue Syndrome/Myalgic Encephalomyelitis a Relevant Diagnosis in Patients with Suspected Side Effects to Human Papilloma Virus Vaccine? Int J Vaccines Vaccin.2015;1(1):00003.  https://doi.org/10.15406/ijvv.2015.01.00003 
  11. Lewis I, Pairman J, Spickett G, Newton JL. Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome. J Intern Med. 2013;273(5):501-10.  https://doi.org/10.1111/joim.12022  PMID: 23206180 
  12. Hoad A, Spickett G, Elliott J, Newton J. Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. QJM. 2008;101(12):961-5.  https://doi.org/10.1093/qjmed/hcn123  PMID: 18805903 
  13. Kinoshita T, Abe RT, Hineno A, Tsunekawa K, Nakane S, Ikeda S. Peripheral sympathetic nerve dysfunction in adolescent Japanese girls following immunization with the human papillomavirus vaccine. Intern Med. 2014;53(19):2185-200.  https://doi.org/10.2169/internalmedicine.53.3133  PMID: 25274229 
  14. Feiring B, Laake I, Bakken IJ, Greve-Isdahl M, Wyller VB, Håberg SE, et al. HPV vaccination and risk of chronic fatigue syndrome/myalgic encephalomyelitis: A nationwide register-based study from Norway. Vaccine. 2017;35(33):4203-12.  https://doi.org/10.1016/j.vaccine.2017.06.031  PMID: 28648542 
  15. Donegan K, Beau-Lejdstrom R, King B, Seabroke S, Thomson A, Bryan P. Bivalent human papillomavirus vaccine and the risk of fatigue syndromes in girls in the UK. Vaccine. 2013;31(43):4961-7.  https://doi.org/10.1016/j.vaccine.2013.08.024  PMID: 24001935 
  16. Arana J, Mba-Jonas A, Jankosky C, Lewis P, Moro PL, Shimabukuro TT, et al. Reports of Postural Orthostatic Tachycardia Syndrome After Human Papillomavirus Vaccination in the Vaccine Adverse Event Reporting System. J Adolesc Health. 2017;61(5):577-82.  https://doi.org/10.1016/j.jadohealth.2017.08.004  PMID: 29061232 
  17. European Medicines Agency (EMA), Pharmacovigilance Risk Assessment Committee (PRAC). HPV Vaccines - Assessment Report. 2015;44(726):1-40.
  18. Chandler RE, Juhlin K, Fransson J, Caster O, Edwards IR, Norén GN. Current Safety Concerns with Human Papillomavirus Vaccine: A Cluster Analysis of Reports in VigiBase®. Drug Saf. 2017;40(1):81-90.  https://doi.org/10.1007/s40264-016-0456-3  PMID: 27638661 
  19. Danish Medicines Agency. Report side effects in humans from medicines and vaccines. Copenhagen: Danish Medicines Agency; 2017. Available from: https://laegemiddelstyrelsen.dk/en/sideeffects/side-effects-from-medicines/report-a-side-effect/humans/
  20. Danish Health and Medicines Authority. Report from the Danish Health and Medicines Authority for consideration by EMA and rapporteurs in relation to the assessment of the safety profile of HPV-vaccines. Copenhagen: Danish Health and Medicines Authority; 2015. Available from: https://laegemiddelstyrelsen.dk/~/media/0A404AD71555435BB311CD59CB63071A.ashx
  21. Sundhedstyrelsen. Status på Sundhedsstyrelsens initiativer inden for overvågning, udredning og behandling af mulige bivirkninger ved HPV-vaccinen. [Status of the Health Agency’s initiatives on surveillance, investigation and treatment of possible adverse events following the HPV vaccine]. Copenhagen: Sundhedstyrelsen; 2015. Danish. Available from: http://www.ft.dk/samling/20142/almdel/suu/bilag/68/1548223.pdf
  22. Schmidt M, Pedersen L, Sørensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541-9.  https://doi.org/10.1007/s10654-014-9930-3  PMID: 24965263 
  23. Grove Krause T, Jakobsen S, Haarh M, Mølbak K. The Danish vaccination register. Euro Surveill. 2012;17(17):20155.  https://doi.org/10.2807/ese.17.17.20155-en  PMID: 22551494 
  24. Vermunt J, Magidson J. Latent class cluster analysis. In: Hagenaars J, McCutcheon A, editors. Applied latent class analysis. Cambridge: Cambridge University Press; 2002.
  25. Kincaid D, Ward Cheney E. Numerical Analysis: Mathematics of Scientific Computing. Third. Providence: American Mathematical Society; 2009.
  26. Dziak JJ, Coffman DL, Lanza ST, Li R, Jermiin LS. Sensitivity and specificity of information criteria. Brief Bioinform. 2019;bbz016. PMID: 30895308 
  27. Linzer DA, Lewis JB. poLCA: An R Package for Polytomous Variable Latent Class Analysis. J Stat Softw. 2011;42(10):1-29.  https://doi.org/10.18637/jss.v042.i10 
  28. Team RCR. A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017.
  29. Sheldon RS, Grubb BP 2nd, Olshansky B, Shen W-K, Calkins H, Brignole M, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12(6):e41-63.  https://doi.org/10.1016/j.hrthm.2015.03.029  PMID: 25980576 
  30. Harden RN, Bruehl S, Perez RSGM, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-74.  https://doi.org/10.1016/j.pain.2010.04.030  PMID: 20493633 
  31. Wright Clayton E, Alegría M, Bateman L, Chu L, Cleeland CS, Davis R, et al. Beyond Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: Redefining and Illness - Report Guide for Clinicians. Inst Med Natl Acad. 2015;4.
  32. Arana JE, Harrington T, Cano M, Lewis P, Mba-Jonas A, Rongxia L, et al. Post-licensure safety monitoring of quadrivalent human papillomavirus vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2009-2015. Vaccine. 2018;36(13):1781-8.  https://doi.org/10.1016/j.vaccine.2018.02.034  PMID: 29477308 
  33. Suppli CH, Hansen ND, Rasmussen M, Valentiner-Branth P, Krause TG, Mølbak K. Decline in HPV-vaccination uptake in Denmark - the association between HPV-related media coverage and HPV-vaccination. BMC Public Health. 2018;18(1):1360.  https://doi.org/10.1186/s12889-018-6268-x  PMID: 30526589 
  34. Callréus T, Svanström H, Nielsen NM, Poulsen S, Valentiner-Branth P, Hviid A. Human papillomavirus immunisation of adolescent girls and anticipated reporting of immune-mediated adverse events. Vaccine. 2009;27(22):2954-8.  https://doi.org/10.1016/j.vaccine.2009.02.106  PMID: 19428906 
  35. Rasmussen M, Pedersen T, Due P. Skolebørns-undersøgelsen 2014. [School children’s examination 2014]. Copenhagen: Statens Institut for Folkesundhed; 2015. Danish. Available from: http://www.hbsc.dk/downcount/HBSC-Rapport-2014.pdf
  36. 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 Res. 2017;3:91-6.  https://doi.org/10.1016/j.pvr.2017.03.001  PMID: 28720463 
/content/10.2807/1560-7917.ES.2019.24.19.1800380
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error