Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus
Section snippets
Patients and methods
We included 35 patients consecutively referred to our syncope unit for head-up tilt test under the diagnosis of orthostatic intolerance as a suspected adverse event following vaccination with the quadrivalent HPV vaccine (Gardasil®). Informed consent was obtained from all patients. Due to the retrospective nature of the study, approval by the authorities was not required.
The patients were interviewed with special focus on symptoms from the central and peripheral nervous system, exercise habits,
Statistics
Data are given as mean values and standard deviations. Comparisons between groups were made with the Student's t-test for unpaired data and calculations were made in IBM SPSS statistics version 19. A two sided significance level of 0.05 was used.
Results
The study included 35 females aged 23.3 ± 7.1 years (mean ± sd) (range 13–39). Seventeen per cent were aged between 12 and 15 years, 21% between 15 and 19 years, 37% between 19 and 27 years, and 25% were 27 years or older. Body weight and height were (mean + sd) 62.4 ± 15.7 kg and 168 ± 7.2 cm, respectively resulting in a BMI of 22.1 ± 4.7 kg/m2. The mean delay between vaccination and onset of symptoms was 9.3 days (range: 0–30). The mean age at onset of symptoms was 22.0 years (range: 12–39). Mean time
Discussion
The present study is a case review of patients referred to our unit for orthostatic intolerance and other symptoms consistent with autonomic dysfunction as suspected side effects to a quadrivalent vaccination against human papilloma virus. Patients stories were consistent as were the reported symptoms and hemodynamic response to tilt with a 60% prevalence of POTS. These patients are in many ways “typical” POTS-patients—both with regard to gender, age of symptom-onset and the presence of
Conclusions
The present study has reported on symptoms and signs in patients referred for orthostatic intolerance suspected to be secondary to vaccination against human papilloma virus. The patients were generally older than the current target population for HPV vaccination programs. We found remarkable consistency in the reported symptoms and in the hemodynamic responses to the upright posture. The patients were characterised by a high level of physical activity prior to vaccination and by signs of
Funding
None.
Conflict of interest statement
Jesper Mehlsen has received fees for speaking and for consulting from Merck, Sharpe & Dohme. Jesper Mehlsen has received fees for speaking from Sanofi Pasteur. The other authors have no competing interests related to the contents of this manuscript or part thereof.
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2022, HeliyonCitation Excerpt :The association between the HPV vaccination and syndromes with autonomic dysfunction has been evaluated in many studies [69, 70, 71, 72]. For example, Brinth et al. reported the characteristics of 35 women aged 23.3 ± 7.1 of years with the postural orthostatic tachycardia syndrome (POTS) starting in close relation to the Gardasil vaccination [69]. The POST and chronic fatigue syndrome (CFS) were identified in our study that have a temporal relation to the HPV vaccination, especially POTS performed stronger statistically significant with all the three HPV vaccines in GPS model with gender stratification comparing with all others in VAERS (Figure 2a).
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