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Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data

Huygen, Frank; Verschueren, Kristin; McCabe, Candida; Stegmann, Jens Ulrich; Zima, Julia; Mahaux, Olivia; Van Holle, Lionel; Angelo, Maria-Genalin


Frank Huygen

Kristin Verschueren

Candy McCabe
Florence Nightingale Foundation Chair

Jens Ulrich Stegmann

Julia Zima

Olivia Mahaux

Lionel Van Holle

Maria-Genalin Angelo


© 2015. Complex regional pain syndrome (CRPS) is a chronic pain disorder that typically follows trauma or surgery. Suspected CRPS reported after vaccination with human papillomavirus (HPV) vaccines led to temporary suspension of proactive recommendation of HPV vaccination in Japan. We investigated the potential CRPS signal in relation to HPV-16/18-adjuvanted vaccine (Cervarix®) by database review of CRPS cases with independent expert confirmation; a disproportionality analysis and analyses of temporality; an observed versus expected analysis using published background incidence rates; systematic reviews of aggregate safety data, and a literature review.The analysis included 17 case reports of CRPS: 10 from Japan (0.14/100,000 doses distributed) and seven from the United Kingdom (0.08/100,000). Five cases were considered by independent experts to be confirmed CRPS. Quantitative analyses did not suggest an association between CRPS and HPV-16/18-adjuvanted vaccine. Observed CRPS incidence after HPV-16/18 vaccination was statistically significantly below expected rates. Systematic database reviews using search terms varying in specificity and sensitivity did not identify new cases. No CRPS was reported during clinical development and no unexpected results found in the literature.There is not sufficient evidence to suggest an increased risk of developing CRPS following vaccination with HPV-16/18-adjuvanted vaccine. Post-licensure safety surveillance confirms the acceptable benefit-risk of HPV-16/18 vaccination.

Journal Article Type Article
Publication Date Sep 1, 2015
Journal EBioMedicine
Electronic ISSN 2352-3964
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 2
Issue 9
Pages 1114-1121
APA6 Citation McCabe, C., Huygen, F., Verschueren, K., McCabe, C., Stegmann, J. U., Zima, J., …Angelo, M. G. (2015). Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data. EBioMedicine, 2(9), 1114-1121.
Keywords complex regional pain syndrome, human papillomavirus vaccine, safety, chronic pain
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