Autonomic dysfunction syndromes with quadrivalent HPV vaccine
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Autonomic dysfunction syndromes with quadrivalent HPV vaccine There does not seem to be an association between receipt of a quadrivalent human papillomavirus (HPV) vaccine [Gardasil] and the development of syndromes with autonomic dysfunction, according to study results reported in the BMJ. The population-based study used nationwide registers in Denmark to identify 1375 737 female patients, 10–44 years of age, in 2007–2016. At least one dose of HPV vaccine was received by 529 547 patients. During 10 581 902 person-years (PY) of follow-up, 869 patients developed syndromes with autonomic dysfunction, or 8.21 per 100 000PY. This was comprised of complex regional pain syndrome (n=535), postural orthostatic tachycardia syndrome (n=198) and chronic fatigue syndrome (n=136). "The incidence rate of all syndromes increased throughout the study period", note the authors, and "the incidence rates were highest among adolescent girls". Most of the 433 patients with a syndrome diagnosis who were vaccinated during the study period received a diagnosis after vaccination. In a self-controlled case series analysis for these patients, 72 syndrome diagnoses occurred within the 1-year postvaccination risk period. Compared with unvaccinated patients, there was no significantly increased syndrome diagnosis rate in HPV vaccinated patients (rate ratio [RR] 0.99; 95% CI 0.74, 1.32). Similar results occurred for the individual components of complex regional pain syndrome (RR 1.31; 0.91, 1.90), postural orthostatic tachycardia syndrome (RR 0.86; 0.48, 1.54) and chronic fatigue syndrome (RR 0.38; 0.13, 1.09). "Our study does not support a causal association between quadrivalent human papillomavirus vaccination and chronic fatigue syndrome, complex regional pain syndrome, or postural orthostatic tachycardia syndrome", conclude the authors, "either individually or as a composite outcome". Hviid A, et al. Association between quadrivalent human papillomavirus vaccination and selected syndromes with autonomic dysfunction in Danish females: population based, 803501987 self-controlled, case series analysis. British Medical Journal : 2 Sep 2020. Available from: URL: https://doi.org/10.1136/bmj.m2930
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Reactions 19 Sep 2020 No. 1822
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