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Skufca et al: Incidence rates of GBS, CFS/SEID and POTS prior to HPV vaccination in Finland

Discussion in 'Latest ME/CFS Research' started by mango, Mar 21, 2017.

  1. mango

    mango Senior Member

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    Incidence rates of Guillain Barré (GBS), chronic fatigue/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS) prior to introduction of human papilloma virus (HPV) vaccination among adolescent girls in Finland, 2002–2012

    J. Skufca
    a, b, , , J. Ollgren a, , E. Ruokokoski c, , O. Lyytikäinen a, , H. Nohynek c,

    a Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
    b European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
    c Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland

    Papillomavirus Research Volume 3, June 2017, Pages 91–96
    Received 29 September 2016, Revised 9 March 2017, Accepted 9 March 2017, Available online 16 March 2017
    http://dx.doi.org/10.1016/j.pvr.2017.03.001

    Highlights
    • CFS/SEID, GBS and POTS can be found in all distinct age- and sex-related diagnostic entities.

    • Significant increase in CFS/SEID and POTS but not in GBS rates in years before HPV immunization.

    • Rates based on register data should be interpreted with caution, especially for non-specific diagnostic entities.

    • Factors contributing to clinicians setting the diagnoses and using different ICD-10 codes should be explored.
    Abstract
    Background

    In Finland a vaccination programme against human papillomavirus (HPV) was introduced in November 2013 for girls aged 11–12 years with a catchup for girls 13–15 years. Allegations that HPV vaccine is causing Guillain Barré syndrome (GBS) and non-specific diagnostic entities, such as chronic fatigue syndrome/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS), continue to surface. We examined population register-based incidence rates of CFS/SEID, GBS and POTS to provide baseline data for future HPV vaccine safety evaluations.

    Methods
    First diagnosis of CFS/SEID, GBS and POTS in girls aged 11–15 years were obtained from the National Hospital Discharge Register during 2002–2012. We considered the following ICD-10 codes: G93.3 for CFS; G61.0 for GBS and G90.9, G90.8, G93.3, I49.8 for POTS. We calculated incidence rates per 100,000 person-years with 95% confidence intervals (CI).

    Results
    In total, 9 CFS/SEID, 19 GBS and 72 POTS cases were identified. The overall incidence rate was 0.53/100,000 (95% CI; 0.27–1.01) for CFS/SEID, 1.11 (95% CI; 0.71–1.74) for GBS and 4.21 (95%CI; 3.34–5.30) for POTS. Significant relative increase in annual incidence rate with a peak in 2012 was observed in CFS/SEID (33% (95% CI; 3.0–70.3: p=0.029) and POTS (16.5% (95% CI; 7.8–25.9: p<0.05), but not in GBS (5.4% (95% CI; −8.4–21.3: p=0.460).

    Conclusions
    Our findings provide baseline estimates of CFS/SEID, GBS and POTS incidences in Finland. However, rates based on register data should be interpreted with caution, especially for non-specific diagnostic entities for which internationally and even nationally agreed criteria are still being discussed. To assess the associations with HPV vaccine, methods using register linkage for cohort and self-controlled case series should be explored in addition to factors contributing to patients seeking care, treating physicians setting the diagnoses, and their preference of using of codes for these clinical entities.

    Keywords
    Papillomavirus vaccines; Vaccination adverse effects; Incidence rates; Guillain Barré syndrome; Chronic fatigue syndrome/Systemic exertion intolerance disease; Postural orthostatic tachycardia syndrome; Finland

    http://www.sciencedirect.com/science/article/pii/S2405852116300696
     
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  2. RogerBlack

    RogerBlack Senior Member

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    "National Hospital Discharge Register" - if this not a bad translation or misleadingly named, it would seem to be a massive problem. I can't imagine a significant number of people will be hospitalised normally. 1 in 200000 person-years (if average length of disease is 20 years, 0.01% of the population) seems really, really low compared with other estimates.
     
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  3. Dolphin

    Dolphin Senior Member

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    Yes, they appeared to have missed a lot of individuals either through diagnoses occurring elsewhere, different codes being used and/or a lack of awareness in Finland.

     
  4. Dolphin

    Dolphin Senior Member

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    These are the figures for all ages. Extremely low.
     
  5. Dolphin

    Dolphin Senior Member

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  6. Dolphin

    Dolphin Senior Member

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  7. Dolphin

    Dolphin Senior Member

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    I am not convinced. I think a lot of severely affected people would avoid being inpatients: I know I have.
     
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  8. RogerBlack

    RogerBlack Senior Member

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    I think this is a different set of 'severe' patients - it's probably those who for one reason or another - suspected abuse, someone reported they aren't coping, accidents/fires/falls who get into hospital for some other reason than simply a static case of CFS.
    It's not people who are 'managing'.
    By this definition, they may be capturing 'severe' cases - but while this set of patients is interesting, it's a tiny, tiny fraction of those severely affected enough that CFS has a devastating impact on their lives.
     

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