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      Trends of Adverse Events Following Immunization (AEFI) Reports of Human Papillomavirus Vaccine in the Valencian Community—Spain (2008–2018)

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          Abstract

          Vaccine safety surveillance is essential in vaccination programs. We accomplished a descriptive study of surveillance AEFI-reporting rate in human papillomavirus (HPV) vaccine administered in the Valencian Community, Spain. Data were obtained from Spanish Pharmacovigilance Adverse Reactions Data (FEDRA). Reporting rates were calculated using local net doses distributed as the denominator. Trends were assessed using joinpoint regression with annual percent change (APC) reported. The AEFI-reports decreased between 2008 and 2018 in two periods, a fast decreasing rate from 2009 to 2011 (from 192.2 to 24.93 per 100000 doses; APC, −54.9%; 95%CI [−75.2; −17.7]), followed by a stable trend (−13% APC, 95%CI [−26.1; 2.4]). For the age group analysis, only the group aged 14–15 years old followed the same trend with -58.4% (95%CI [−73.9; −33.8]) APC during 2008–2011, and −8.8% (95%CI [−27.7; 15]) APC during 2011-2018. The majority of the reports (73.82%) were nonserious, involving reactions at or near the vaccination site, headache, and dizziness events. No death was reported. AEFI-reporting rates for HPV immunization in the Valencian Community have decreased considerably with two trend periods observed for girls aged 14–15 years old. Currently, the AEFI reporting rate shows a decreasing trend, perhaps following the Weber effect, and it could also be affected by media attention and coverage.

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          Most cited references54

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          Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine.

          In June 2006, the Food and Drug Administration licensed the quadrivalent human papillomavirus (types 6, 11, 16, and 18) recombinant vaccine (qHPV) in the United States for use in females aged 9 to 26 years; the Advisory Committee on Immunization Practices then recommended qHPV for routine vaccination of girls aged 11 to 12 years. To summarize reports to the Vaccine Adverse Event Reporting System (VAERS) following receipt of qHPV. Review and describe adverse events following immunization (AEFIs) reported to VAERS, a national, voluntary, passive surveillance system, from June 1, 2006, through December 31, 2008. Additional analyses were performed for some AEFIs in prelicensure trials, those of unusual severity, or those that had received public attention. Statistical data mining, including proportional reporting ratios (PRRs) and empirical Bayesian geometric mean methods, were used to detect disproportionality in reporting. Numbers of reported AEFIs, reporting rates (reports per 100,000 doses of distributed vaccine or per person-years at risk), and comparisons with expected background rates. VAERS received 12 424 reports of AEFIs following qHPV distribution, a rate of 53.9 reports per 100,000 doses distributed. A total of 772 reports (6.2% of all reports) described serious AEFIs, including 32 reports of death. The reporting rates per 100,000 qHPV doses distributed were 8.2 for syncope; 7.5 for local site reactions; 6.8 for dizziness; 5.0 for nausea; 4.1 for headache; 3.1 for hypersensitivity reactions; 2.6 for urticaria; 0.2 for venous thromboembolic events, autoimmune disorders, and Guillain-Barré syndrome; 0.1 for anaphylaxis and death; 0.04 for transverse myelitis and pancreatitis; and 0.009 for motor neuron disease. Disproportional reporting of syncope and venous thromboembolic events was noted with data mining methods. Most of the AEFI rates were not greater than the background rates compared with other vaccines, but there was disproportional reporting of syncope and venous thromboembolic events. The significance of these findings must be tempered with the limitations (possible underreporting) of a passive reporting system.
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            Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of randomized trials

            M Arbyn, L. Xu (2018)
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              Human papillomavirus vaccines: WHO position paper, October 2014.

              (2014)
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                Author and article information

                Journal
                Vaccines (Basel)
                Vaccines (Basel)
                vaccines
                Vaccines
                MDPI
                2076-393X
                02 March 2020
                March 2020
                : 8
                : 1
                : 117
                Affiliations
                [1 ]Hospital General Universitario de Alicante, Unit of Clinical Pharmacology, 03010 Alicante, Spain; mayaego1@ 123456gmail.com
                [2 ]Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, San Vicente del Raspeig, 03690 Alicante, Spain; pablo.caballero@ 123456ua.es (P.C.); nolasco@ 123456ua.es (A.N.)
                [3 ]Centro de Farmacovigilancia de la Comunidad Valenciana, Dirección General de Farmacia y Productos Sanitarios, Conselleria de Sanitat Universal i Salut Pública, 46010 Valencia, Spain; carreras_jua@ 123456gva.es
                [4 ]Hospital Universitario del Vinalopó, Elche, 03293 Alicante, Spain; emontagud@ 123456vinaloposalud.com
                [5 ]Dirección General de Salud Pública y Adicciones. Conselleria de Sanitat Universal i Salut Pública, 46021 Valencia, Spain; pastor_eli@ 123456gva.es
                Author notes
                [* ]Correspondence: tuells@ 123456ua.es
                Author information
                https://orcid.org/0000-0003-0166-4901
                https://orcid.org/0000-0003-1159-429X
                https://orcid.org/0000-0002-5725-8972
                https://orcid.org/0000-0002-5148-6472
                https://orcid.org/0000-0002-1234-2150
                https://orcid.org/0000-0001-6583-379X
                Article
                vaccines-08-00117
                10.3390/vaccines8010117
                7157534
                32131535
                7c751914-4c96-44f9-bc98-a3463dfea3b1
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 February 2020
                : 28 February 2020
                Categories
                Article

                adverse events following immunization (aefis),human papillomavirus vaccines,spanish pharmacovigilance system,vaccine safety,postlicensure surveillance

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