Clinical Rheumatology

, Volume 34, Issue 11, pp 1981–1983

HPV vaccination syndrome. A questionnaire-based study

  • Manuel Martínez-Lavín
  • Laura-Aline Martínez-Martínez
  • Paola Reyes-Loyola
Brief Report

Abstract

Isolated cases and small series have described the development of complex regional pain syndrome, postural orthostatic tachycardia, and fibromyalgia after human papillomavirus (HPV) vaccination. These illnesses are difficult to diagnose and have overlapping clinical features. Small fiber neuropathy and dysautonomia may play a major role in the pathogenesis of these entities. We used the following validated questionnaires to appraise the chronic illness that might appear after HPV vaccination: The 2010 American College of Rheumatology Fibromyalgia Diagnostic Criteria, COMPASS 31 dysautonomia questionnaire, and S-LANSS neuropathic pain form. These questionnaires and a “present illness” survey were e-mailed to persons who had the onset of a chronic ailment soon after HPV vaccination. Forty-five filled questionnaires from individuals living in 13 different countries were collected in a month’s period. Mean (±SD) age at vaccination time was 14 ± 5 years. Twenty-nine percent of the cases had immediate (within 24 h) post-vaccination illness onset. The most common presenting complaints were musculoskeletal pain (66 %), fatigue (57 %), headache (57 %), dizziness/vertigo (43 %), and paresthesias/allodynia (36 %). Fifty-three percent of affected individuals fulfill the fibromyalgia criteria. COMPASS-31 score was 43 ± 21, implying advanced autonomic dysfunction. Eighty-three percent of the patients who had ongoing pain displayed S-LANSS values >12, suggesting a neuropathic component in their pain experience. After a mean period of 4.2 ± 2.5 years post-vaccination, 93 % of patients continue to have incapacitating symptoms and remain unable to attend school or work. In conclusion, a disabling syndrome of chronic neuropathic pain, fatigue, and autonomic dysfunction may appear after HPV vaccination.

Keywords

Complex regional pain syndrome Dysautonomia Fibromyalgia Gulf War Illness HPV vaccine Myalgic encephalomyelitis Small fiber neuropathy 

References

  1. 1.
    Martínez-Lavin M (2015) Human papillomavirus vaccination syndrome. Small fiber neuropathy and dysautonomia could be its underlying pathogenesis. Clin Rheumatol 34:1165–1169CrossRefPubMedGoogle Scholar
  2. 2.
    Rodríguez-Galán MA, Pérez-Vilar S, Díez-Domingo J, Tuells J, Gomar-Fayos J, Morales-Olivas F, Pastor-Villalba E (2014) Adverse reactions to human papillomavirus vaccine in the Valencian Community (2007-2011)]. An Pediatr (Barc) 81:303–309CrossRefGoogle Scholar
  3. 3.
    Kinoshita T, Abe RT, Hineno A, Tsunekawa K, Nakane S, Ikeda S (2014) Peripheral sympathetic nerve dysfunction in adolescent Japanese girls following immunization with the human papillomavirus vaccine. Intern Med 53:2185–2200CrossRefPubMedGoogle Scholar
  4. 4.
    Blitshteyn S (2014) Postural tachycardia syndrome following human papillomavirus vaccination. Eur J Neurol 21:135–139CrossRefPubMedGoogle Scholar
  5. 5.
    Brinth L, Theibel AC, Pors K, Mehlsen J (2015) Suspected side effects to the quadrivalent human papilloma vaccine. Dan Med J 62:A5064PubMedGoogle Scholar
  6. 6.
    Martinez-Lavin M (2014) Fibromyalgia-like illness in 2 girls after human papillomavirus vaccination. J Clin Rheumatol 20:392–393PubMedGoogle Scholar
  7. 7.
    Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Katz RS, Mease P et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610CrossRefGoogle Scholar
  8. 8.
    Sletten DM, Suarez GA, Phillip A, Low PA, Mandrekar J, Singera W (2012) COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc 87:1196–1201PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Bennett MI, Smith BH, Torrance N, Potter J (2005) The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain 6:149–158CrossRefPubMedGoogle Scholar
  10. 10.
    Agmon-Levin N, Zafrir Y, Kivity S, Balofsky A, Amital H, Shoenfeld Y (2014) Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the ‘autoimmune (auto-inflammatory) syndrome induced by adjuvants’ (ASIA). Immunol Res 60:376–83CrossRefPubMedGoogle Scholar
  11. 11.
    Hotopf M, David A, Hull L, Ismail K, Unwin C, Wessely S (2000) Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study. BMJ 320:1363–1367PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Rigolet M, Aouizerate J, Couette M, Ragunathan-Thangarajah N, Aoun-Sebaiti M, Gherardi RK, Cadusseau J, Authier FJ (2014) Clinical features in patients with long-lasting macrophagic myofasciitis. Front Neurol 28:230Google Scholar
  13. 13.
    Vargas-Alarcon G, Alvarez-Leon E, Fragoso JM, Vargas A, Martinez A, Vallejo M, Martinez-Lavin M (2012) A SCN9A gene-encoded dorsal root ganglia sodium channel polymorphism associated with severe fibromyalgia. BMC Musculoskelet Dis 13:23CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2015

Authors and Affiliations

  • Manuel Martínez-Lavín
    • 1
  • Laura-Aline Martínez-Martínez
    • 1
  • Paola Reyes-Loyola
    • 1
  1. 1.Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio ChávezMexico CityMexico

Personalised recommendations