scholarly journals Infections in temporal proximity to HPV vaccination and adverse effects following vaccination in Denmark: A nationwide register-based cohort study and case-crossover analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003768
Author(s):  
Lene Wulff Krogsgaard ◽  
Irene Petersen ◽  
Oleguer Plana-Ripoll ◽  
Bodil Hammer Bech ◽  
Tina Hovgaard Lützen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Effects ◽  
Hpv Vaccination ◽  
Hospital Setting ◽  
Chronic Fatigue ◽  
Temporal Proximity ◽  
Fatigue Syndrome ◽  
Case Crossover ◽  
Increased Risk ◽  
Crossover Analysis

Background Public trust in the human papilloma virus (HPV) vaccination programme has been challenged by reports of potential severe adverse effects. The reported adverse symptoms were heterogeneous and overlapping with those characterised as chronic fatigue syndrome (CFS) and have been described as CFS-like symptoms. Evidence suggests that CFS is often precipitated by an infection. The aim of the study was to examine if an infection in temporal proximity to HPV vaccination is a risk factor for suspected adverse effects following HPV vaccination. Methods and findings The study was a nationwide register-based cohort study and case-crossover analysis. The study population consisted of all HPV vaccinated females living in Denmark, born between 1974 and 2006, and vaccinated between January 1, 2006 and December 31, 2017. The exposure was any infection in the period ± 1 month around time of first HPV vaccination and was defined as (1) hospital-treated infection; (2) redemption of anti-infective medication; or (3) having a rapid streptococcal test done at the general practitioner. The outcome was referral to a specialised hospital setting (5 national HPV centres opened June 1, 2015) due to suspected adverse effects following HPV vaccination. Multivariable logistic regression was used to estimate the association between infection and later HPV centre referral. The participants were 600,400 HPV-vaccinated females aged 11 to 44 years. Of these, 48,361 (9.7%) females had a hospital-treated infection, redeemed anti-infective medication, or had a rapid streptococcal test ± 1 month around time of first HPV vaccination. A total of 1,755 (0.3%) females were referred to an HPV centre. Having a hospital-treated infection in temporal proximity to vaccination was associated with significantly elevated risk of later referral to an HPV centre (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.72 to 4.40; P < 0.001). Increased risk was also observed among females who redeemed anti-infective medication (OR 1.56, 95% CI 1.33 to 1.83; P < 0.001) or had a rapid streptococcal test (OR 1.45, 95% CI 1.10 to 1.93; P = 0.010). Results from a case-crossover analysis, which was performed to adjust for potential unmeasured confounding, supported the findings. A key limitation of the study is that the HPV centres did not open until June 1, 2015, which may have led to an underestimation of the risk of suspected adverse effects, but stratified analyses by year of vaccination yielded similar results. Conclusions Treated infection in temporal proximity to HPV vaccination is associated with increased risk for later referral with suspected adverse vaccine effects. Thus, the infection could potentially be a trigger of the CFS-like symptoms in a subset of the referred females. To our knowledge, the study is the first to investigate the role of infection in the development of suspected adverse effects after HPV vaccination and replication of these findings are needed in other studies.

scholarly journals Increased risk of chronic fatigue syndrome following psoriasis: a nationwide population-based cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Shin-Yi Tsai ◽  
Hsuan-Ju Chen ◽  
Chi Chen ◽  
Chon-Fu Lio ◽  
Chien-Feng Kuo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Population Based ◽  
Fatigue Syndrome ◽  
Increased Risk

scholarly journals Rethinking childhood adversity in chronic fatigue syndrome

2015 ◽  
Author(s):  
James E Clark ◽  
Sean Davidson ◽  
Laura Maclachlan ◽  
Megan Lynn ◽  
Julia L Newton ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Childhood Trauma ◽  
Childhood Adversity ◽  
Chronic Fatigue ◽  
Childhood Trauma Questionnaire ◽  
History Of Childhood ◽  
Fatigue Syndrome ◽  
Increased Risk ◽  
Co Morbidity ◽  
History Of

Objectives: Previous studies have consistently shown increased rates of childhood adversity in chronic fatigue syndrome (CFS). However, such aetiopathogenic studies of CFS are potentially confounded by co-morbidity and misdiagnosis particularly with depression. We used a modelling approach with existing data and data generated in our examination of the rates of childhood adversity in a sample of CFS patients who had no lifetime history of depression. Methods: The childhood trauma questionnaire (CTQ) was completed by a sample of 52 participants and 19 controls with chronic fatigue syndrome who did not meet criteria for a psychiatric disorder (confirmed using the Structured Clinical Interview for DSM-IV). Subsequently, Mediation Analysis (Baye’s Rules) was used to establish the risk childhood adversity poses for CFS with and without depression. Results: In a cohort of CFS patients with depression robustly excluded, CTQ scores were markedly lower than in all previous studies and, in contrast to these previous studies, not increased compared with healthy controls. Post-hoc analysis showed that CTQ scores correlated with the number of depressive symptoms during the lifetime worst period of low mood. The probability of developing CFS given a history of childhood trauma was shown to be 4%, a two-fold increased risk compared to the general population. However, much of this risk is mediated by the concomitant development of major depression. Discussion: The data suggests that previous studies showing a relationship between childhood adversity and CFS may be mediated by depression

Two year follow-up of sleep diaries and polysomnography in chronic fatigue syndrome: a cohort study

2017 ◽  
Vol 5 (2) ◽  
pp. 103-113
Author(s):  
Sean L. Davidson ◽  
Zoe M. Gotts ◽  
Jason G. Ellis ◽  
Julia L. Newton
Keyword(s):  
Cohort Study ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Sleep Diaries ◽  
Fatigue Syndrome

Chronic fatigue syndrome and related disorders in UK veterans of the Gulf War 1990–1991: results from a two-phase cohort study

2007 ◽  
Vol 38 (7) ◽  
pp. 953-961 ◽  
Author(s):  
K. Ismail ◽  
K. Kent ◽  
R. Sherwood ◽  
L. Hull ◽  
P. Seed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Chronic Fatigue Syndrome ◽  
Military Personnel ◽  
Physical Disability ◽  
Chronic Fatigue ◽  
Gulf War ◽  
Two Phase ◽  
Fatigue Syndrome ◽  
Glutamyl Transferase ◽  
Symptomatic Distress

BackgroundThe aim was to determine the prevalence of chronic fatigue syndrome (CFS), chronic fatigue and fibromyalgia in UK military personnel after the Gulf War 1990–1991.MethodA two-phase cohort study was used. Three randomly selected subsamples identified from a population-based cross-sectional postal survey of over 10 000 current and ex-service UK military personnel (Gulf veterans were those deployed to the Gulf War 1990–1991; non-Gulf veterans were Bosnia peacekeepers 1992–1997 and those on active duty during the Gulf War 1990–1991 but not deployed) were recruited. Their disability status was assessed using the Short Form 36 physical functioning scale; Gulf veterans who reported physical disability (n=111) were compared with non-Gulf (n=133) veterans who reported similar levels of physical disability. Screening for known medical and psychiatric conditions was conducted to exclude medical explanations for disability and symptomatic distress. Standardised criteria for CFS, chronic fatigue and fibromyalgia were used.ResultsDisabled Gulf veterans were more likely to be overweight, have elevated γ-glutamyl transferase levels and screen positive for hypertension. There were no other clinically significant differences in clinical markers for medically explainable conditions. Disabled Gulf veterans were more likely than similarly disabled Bosnia and Era veterans (adjusted odds ratio 7.8, 95% confidence interval 2.5–24.5) to meet the criteria for CFS. Rates for other medically unexplained conditions were not significantly increased.ConclusionsSymptoms in keeping with CFS account for a significant part of the symptomatic distress in Gulf veterans.

scholarly journals Air pollution exposure and risk of spontaneous abortion in the Nurses’ Health Study II

2019 ◽  
Vol 34 (9) ◽  
pp. 1809-1817 ◽  
Author(s):  
Audrey J Gaskins ◽  
Jaime E Hart ◽  
Jorge E Chavarro ◽  
Stacey A Missmer ◽  
Janet W Rich-Edwards ◽  
...  
Keyword(s):  
Air Pollution ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Health Study ◽  
Case Crossover ◽  
Increased Risk ◽  
Crossover Analysis

Abstract STUDY QUESTION Is there an association between air pollution exposures and the risk of spontaneous abortion (SAB)? SUMMARY ANSWER Higher exposure to particulate matter (PM) air pollution above and beyond a woman’s average exposure may be associated with greater risk of SAB, particularly among women experiencing at least one SAB during follow-up. WHAT IS KNOWN ALREADY There is sufficient biologic plausibility to suggest that air pollution adversely affects early pregnancy outcomes, particularly pregnancy loss; however, the evidence is limited. STUDY DESIGN, SIZE, DURATION Our prospective cohort study included 19 309 women in the Nurses’ Health Study II who contributed a total of 35 025 pregnancies between 1990 and 2008. We also conducted a case-crossover analysis among 3585 women (11 212 pregnancies) with at least one SAB and one live birth during follow-up. PARTICIPANTS/MATERIALS, SETTING, METHODS Proximity to major roadways and exposure to PM <10 microns (PM10), 2.5–10 microns (PM2.5–10) and <2.5 microns (PM2.5) were determined for residential addresses between 1989 and 2007. Pregnancy outcomes were self-reported biannually throughout follow-up and comprehensively in 2009. Multivariable log-binomial regression models with generalized estimating equations were used to estimate the risk ratios and 95% CIs of SAB. Conditional logistic regression was used for the case-crossover analysis. MAIN RESULTS AND THE ROLE OF CHANCE During the 19 years of follow-up, 6599 SABs (18.8% of pregnancies) were reported. In the main analysis, living closer to a major roadway and average exposure to PM10, PM10–2.5 or PM2.5 in the 1 or 2 years prior to pregnancy were not associated with an increased risk of SAB. However, small positive associations between PM exposures and SAB were observed when restricting the analysis to women experiencing at least one SAB during follow-up. In the case-crossover analysis, an increase in PM10 (per 3.9 μg/m3), PM2.5–10 (per 2.3 μg/m3) and PM2.5 (per 2.0 μg/m3) in the year prior to pregnancy was associated with 1.12 (95% CI 1.06, 1.19), 1.09 (95% CI 1.03, 1.14) and 1.10 (95% CI 1.04, 1.17) higher odds of SAB, respectively. LIMITATIONS, REASONS FOR CAUTION We did not have information on the month or day of SAB, which precluded our ability to examine specific windows of susceptibility or acute exposures. We also used ambient air pollution exposures as a proxy for personal exposure, potentially leading to exposure misclassification. WIDER IMPLICATIONS OF THE FINDINGS In our case-crossover analysis (but not in the entire cohort) we observed positive associations between exposure to all size fractions of PM exposure and risk of SAB. This may suggest that changes in PM exposure confer greater risk of SAB or that women with a history of SAB are a particularly vulnerable subgroup. STUDY FUNDING/COMPETING INTEREST(S) The authors are supported by the following NIH grants UM1CA176726, R00ES026648 and P30ES000002. The authors have no actual or potential competing financial interests to disclose.

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