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. 2020 Jan;19(1):107-112.
doi: 10.1080/14740338.2020.1688299. Epub 2019 Nov 8.

Hazard of complex regional pain syndrome following human papillomavirus vaccination among adolescent girls in the United States: a case-cohort analysis of insurance claims data

Nadja A Vielot  1 , Sylvia Becker-Dreps  1   2
Affiliations

Hazard of complex regional pain syndrome following human papillomavirus vaccination among adolescent girls in the United States: a case-cohort analysis of insurance claims data

Nadja A Vielot et al. Expert Opin Drug Saf. 2020 Jan.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Expert Opin Drug Saf. 2021 Jun;20(6):i. doi: 10.1080/14740338.2021.1914939. Epub 2021 Apr 22. Expert Opin Drug Saf. 2021. PMID: 33886372 No abstract available.

Abstract

Objectives: Complex regional pain syndrome (CRPS) cases have followed human papillomavirus (HPV) vaccination, but no causal link has been established.Methods: Using insurance claims, the authors observed unvaccinated 11-year-old girls for CRPS diagnoses. The authors used time-dependent Cox regression to identify health-related CRPS predictors using diagnosis codes. Next, the authors identified HPV vaccinations using procedural codes. HPV vaccination and CRPS predictors were considered time-dependent covariates to estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for CRPS, 30, 90, and 180-days post-vaccination.Results: 1,232,572 girls received 563 unique CRPS diagnoses. In a 10% sub-cohort of 123,981 girls accounting for potential confounders and predisposing risk factors (i.e. injury, infection, mental illness, primary care use), CRPS hazard was not significantly elevated 30 days (HR: 0.90, 95% CI: 0.46, 1.73), 90 days (HR: 1.17, 95% CI: 0.83, 1.65), or 180-days post-vaccination (HR: 1.11, 95% CI: 0.83, 1.47).Conclusion: The results support the safety and continued administration of HPV vaccines to adolescents.

Keywords: Complex regional pain syndrome; girls; human papillomavirus; insurance claims; safety; vaccination.

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Conflict of interest statement

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure.
Figure.
Relative hazard of CRPS following common diagnoses in adolescent girls, 2006–2014 (n=1,232,572). The forest plot shows the hazard ratios and 95% confidence intervals for a diagnosis of complex regional pain syndrome (CRPS) following the most common diagnoses that were observed in the full cohort of adolescent girls.
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