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Hospital Records of Pain, Fatigue, or Circulatory Symptoms in Girls Exposed to Human Papillomavirus Vaccination: Cohort, Self-Controlled Case Series, and Population Time Trend Studies

Authors
  • Thomsen, Reimar Wernich1
  • Öztürk, Buket1
  • Pedersen, Lars1
  • Nicolaisen, Sia Kromann
  • Petersen, Irene1, 2
  • Olsen, Jørn1
  • Sørensen, Henrik Toft1
  • 1 Department of Clinical Epidemiology, Aarhus University Hospital, Denmark , (Denmark)
  • 2 Department of Primary Care and Population Health, Institute of Epidemiology and Health Care
Type
Published Article
Journal
American Journal of Epidemiology
Publisher
Oxford University Press
Publication Date
Jan 03, 2020
Volume
189
Issue
4
Pages
277–285
Identifiers
DOI: 10.1093/aje/kwz284
PMID: 31899791
PMCID: PMC7274189
Source
PubMed Central
Keywords
License
Unknown

Abstract

Human papillomavirus (HPV) vaccination has been associated with subsequent diffuse symptoms in girls, reducing public confidence in the vaccine. We examined whether girls have nonspecific outcomes of HPV vaccination, using triangulation from cohort, self-controlled case series (SCCS), and population time trend analyses carried out in Denmark between 2000 and 2014. The study population consisted of 314,017 HPV-vaccinated girls and 314,017 age-matched HPV-unvaccinated girls (cohort analyses); 11,817 girls with hospital records (SCCS analyses); and 1,465,049 girls and boys (population time trend analyses). The main outcome measures were hospital records of pain, fatigue, or circulatory symptoms. The cohort study revealed no increased risk among HPV vaccine-exposed girls, with incidence rate ratios close to 1.0 for abdominal pain, nonspecific pain, headache, hypotension/syncope, tachycardia (including postural orthostatic tachycardia syndrome), and malaise/fatigue (including chronic fatigue syndrome). In the SCCS analyses, we observed no association between HPV vaccination and subsequent symptoms. In time trend analyses, we observed a steady increase in these hospital records in both girls and (HPV-unvaccinated) boys, with no relationship to the 2009 introduction of HPV vaccine to Denmark’s vaccination program. This study, which had nationwide coverage, showed no evidence of a causal link between HPV vaccination and diffuse autonomic symptoms leading to hospital contact.

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