Human Papillomavirus Vaccination and Physical and Mental Health Complaints Among Female Students in Secondary Education

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National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark; 2Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, Belgrade, Serbia.

BACKGROUND: Previous studies have not explored the effect of HPV vaccination on health status at a longer time interval. Similarly, self-reported physical and mental health in recipients of the HPV vaccine has not been studied. OBJECTIVE: To evaluate whether HPV vaccination was associated with physical and mental health complaints among girls in secondary education institutions. DESIGN: Prospective cohort study. PARTICIPANTS: This study used data from girls aged 15– 20 years who participated in the Danish National Youth Study (DNYS) 2014. Data on HPV vaccination was retrieved from the Danish Vaccination Register. MAIN MEASURES: Participants were asked whether they had experienced headaches, stomachache, neck pain, menstrual cramps, sore throat, sadness, irritation, nervousness and sleep problems in the past 6 months. KEY RESULTS: Of 41,333 girls, 39,145 (94.7%) received at least one dose of HPV vaccine. The most prevalent health complaint among the vaccinated and not vaccinated females was “been irritable” (88.2% and 88.4%, respectively). The lowest proportion of health complaints was stomachache (49.6% in vaccinated and in 50.4% in unvaccinated girls). Regression model, adjusted for sociodemographic characteristics and health behavior, showed that HPV vaccination was associated with a lower likelihood of reporting sore throat (odd ratio [OR] 0.86, 95% confidence interval [CI] 0.78–0.95) and being sad (OR 0.86, 95%CI 0.76–0.97). Similar results were observed when HPV vaccination status was analyzed according to the number of doses received. CONCLUSION: We conclude that HPV vaccination was not associated with physical and mental health complaints among girls in secondary education institutions in Denmark after a median of 5.3 years since HPV vaccination. KEY WORDS: HPV vaccination; girls; secondary education institutions; health status.

Prior Presentations The results of this study are presented in a poster session of the 9th Nordic Conference of Epidemiology and Register-Based Health Research, 18–20 September 2019, Tampere, Finland. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-05845-8) contains supplementary material, which is available to authorized users. Received November 29, 2019 Accepted April 7, 2020

J Gen Intern Med DOI: 10.1007/s11606-020-05845-8 © Society of General Internal Medicine 2020

INTRODUCTION

Bivalent and quadrivalent human papillomavirus (HPV) vaccines were approved for use in Denmark in October 2006 and since 2009 HPV immunization has been a part of the national immunization program.1 Girls aged 12 years were targeted for HPV vaccination, while a catch-up program was also established for girls and women until the age of 26.1 The HPV vaccine initiation coverage rates were initially above 80% following the introduction of the program; ho