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No evidence found for an increased risk of long-term fatigue following human papillomavirus vaccination of adolescent girls

Schurink-van't Klooster, T.M., Kemmeren, J.M., van der Maas, N.A.T., van de Putte, E.M., ter Wolbeek, M., Nijhof, S.L., Vanrolleghem, A.M., van Vliet, J.A., Sturkenboom, M., de Melker, H.E.
Vaccine 2018 v.36 no.45 pp. 6796-6802
Papillomaviridae, adolescents, cohort studies, databases, girls, patients, public health, risk, vaccination, vaccines, Netherlands
In 2013, the Netherlands Pharmacovigilance Center Lareb published an overview of reports of long-lasting fatigue following bivalent HPV-vaccination (2vHPV). After an update of this overview in 2015, concerns regarding the safety of 2vHPV was picked up by the media, which led to further reports of long-lasting fatigue. Therefore, the Dutch National Institute for Public Health and the Environment (RIVM) investigated a possible association between HPV-vaccination and long-term fatigue.In this retrospective cohort study conducted in the Integrated Primary Care Information database, we investigated the occurrence of chronic fatigue syndrome (CFS), fatigue ≥6 months and 3–6 months in all girls born in 1991–2000 during the follow-up period January 1st 2007-December 31st 2014 (2007–2008 pre-vaccination and 2009–2014 post-vaccination). Patients with certain fatigue ≥6 m were asked for consent to link their primary care information with vaccination data. Incidence rates per 10,000 person years (PY) for 12–16-year-old girls were compared between pre- and post-HPV-vaccine era. A self-controlled case series (SCCS) analysis was performed using consenting vaccinated cases. A primary high-risk period of 12 months after each dose was defined.The cohort consisted of 69,429 12–16-year-old girls accounting for 2758 PY pre-vaccination and 57,214 PY post-vaccination. Differences between pre- and post-vaccination incidences (CFS: 3.6 (95% CI 0.5–25.7)/10,000 PY and 0.9 (0.4–2.1); certain fatigue ≥6 m: 7.3 (1.8–29.0) and 19.4 (16.1–23.4); certain fatigue 3–6 m: 0.0 and 16.6 (13.6–20.3), respectively) were not statistically significant. SCCS analyses in 16 consenting vaccinated cases resulted in an age-adjusted RR of 0.62 (95%CI 0.07–5.49).Fatigue ≥6 m and 3–6 m was frequently found among adolescent girls, but CFS was rarely diagnosed. No statistically significant increased incidence rates were found post-vaccination compared to similar age groups of girls pre-vaccination. The SCCS analysis included a low number of cases but revealed no elevated risk of certain fatigue ≥6 m in the high-risk period.