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探讨丹麦 HPV 疫苗接种后疑似不良反应报告的决定因素。

Examining determinants for reporting suspected adverse events following HPV vaccination in Denmark.

机构信息

Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Evidence, Education & Emergency Services, Danish Health Authority, Islands Brygge 67, DK-2300 Copenhagen S, Denmark; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Gustav III:s Boulevard 40, 169 73 Solna, Sweden.

Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.

出版信息

Vaccine. 2018 Oct 1;36(41):6158-6162. doi: 10.1016/j.vaccine.2018.08.061. Epub 2018 Sep 7.

Abstract

HPV vaccination has been offered to 12-year-old girls as part of the Danish Childhood Vaccination Programme since 2009. From 2013, an increasing number of suspected severe adverse events (AE) without a documented causal link to the vaccine was observed, resulting in public concerns about vaccine safety and a decline in uptake. This study aimed at describing the group of females reporting AE and comparing them to vaccinated peers not reporting AE. A questionnaire focusing on demographics, lifestyle, and health-related issues was distributed to 251 female cases who had reported severe AE and 1,003 female controls randomly selected from the population-based Danish Vaccination Registry. All had been HPV-vaccinated. There were no significant differences on measures of self-reported psychiatric or somatic conditions before vaccination. More cases reported being physically very active prior to first HPV vaccination (OR 4.2) whereas fewer cases than controls sometimes (OR 0.31) or often/always (OR 0.36) felt sad. This is unexpected because two recent Danish registry-based case-control studies concluded that females reporting severe AE were more likely to consult a psychologist/psychiatrist and to have pre-existing psychiatric conditions before first HPV vaccination. One of these studies also showed that cases had increased health-care seeking regarding a number of somatic conditions prior to first vaccination. Our study adds value when seeking to understand the lifeworld of the affected females and their interpretations of their everyday lives pre- and post-HPV vaccination.

摘要

HPV 疫苗接种自 2009 年起已被纳入丹麦儿童免疫接种计划,作为 12 岁女孩的常规接种项目。自 2013 年以来,观察到越来越多的疑似严重不良事件(AE)与疫苗无明确因果关系,这引发了公众对疫苗安全性的担忧,并导致疫苗接种率下降。本研究旨在描述报告 AE 的女性群体,并将其与未报告 AE 的接种疫苗的同龄人进行比较。我们向 251 名报告严重 AE 的女性病例和从基于人群的丹麦疫苗接种登记处随机选择的 1003 名女性对照者分发了一份重点关注人口统计学、生活方式和健康相关问题的问卷。所有女性均已接种 HPV 疫苗。在接种疫苗之前,两组女性在自我报告的精神或躯体疾病方面没有显著差异。更多的病例在首次 HPV 疫苗接种前报告自己非常活跃(OR4.2),而较少的病例报告自己有时(OR0.31)或经常/总是(OR0.36)感到悲伤。这是出乎意料的,因为最近两项基于丹麦登记处的病例对照研究得出结论,报告严重 AE 的女性更有可能在首次 HPV 疫苗接种前咨询心理学家/精神科医生,并在首次 HPV 疫苗接种前存在先前存在的精神疾病。其中一项研究还表明,在首次接种疫苗之前,病例组在许多躯体疾病方面增加了寻求医疗保健的次数。当试图了解受影响女性的生活世界及其对 HPV 疫苗接种前后日常生活的解释时,我们的研究提供了更多价值。

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