HPV vaccination syndrome. A questionnaire based study
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.
Clinical Rheumatology