title: Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus.
abstract: BACKGROUND
  Infections with human papilloma virus (HPV) can result in cervical, oropharyngeal, anal, and penile cancer and vaccination programs have been launched in many countries as a preventive measure. We report the characteristics of a number of patients with a syndrome of orthostatic intolerance, headache, fatigue, cognitive dysfunction, and neuropathic pain starting in close relation to HPV vaccination.
  
  
  METHODS
  Patients were referred for orthostatic intolerance following HPV vaccination. Symptoms of autonomic dysfunction were quantified by standardised questionnaire. The diagnosis of postural orthostatic tachycardia syndrome (POTS) rested on finding a sustained heart rate increment of >30 min(-1) (>40 min(-1) in adolescents) or to levels >120 min(-1) during orthostatic challenge.
  
  
  RESULTS
  35 women aged 23.3 ± 7.1 years participated. Twenty-five had a high level of physical activity before vaccination and irregular periods were reported by all patients not on treatment with oral contraception. Serum bilirubin was below the lower detection limit in 17 patients. Twenty-one of the referred patients fulfilled the criteria for a diagnosis of POTS (60%, 95%CI 43-77%). All patients had orthostatic intolerance, 94% nausea, 82% chronic headache, 82% fatigue, 77% cognitive dysfunction, 72% segmental dystonia, 68% neuropathic pain.
  
  
  CONCLUSIONS
  In a population referred for symptoms of orthostatic intolerance and other symptoms consistent with autonomic dysfunction that began in close temporal association with a quadrivalent HPV vaccination, we identified a 60% prevalence of POTS. Further work is urgently needed to elucidate the potential for a causal link between the vaccine and circulatory abnormalities and to establish targeted treatment options for the affected patients.
authors.affiliation: Coordinating Research Centre, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
authors.forename: Louise S
authors.initials: LS
authors.lastname: Brinth
authors.affiliation: Coordinating Research Centre, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Pors
authors.affiliation: Coordinating Research Centre, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Theibel
authors.affiliation: Coordinating Research Centre, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark. Electronic address: jesper.mehlsen@regionh.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Mehlsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D002648:Child; D003072:Cognition Disorders / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006261:Headache / Q000209:etiology; D006339:Heart Rate; D006801:Humans; D009437:Neuralgia / Q000209:etiology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D054972:Postural Orthostatic Tachycardia Syndrome / Q000175:diagnosis / Q000209:etiology*; D011795:Surveys and Questionnaires; D014611:Vaccination; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines; D001663:Bilirubin
keywords: Autonomic nervous system; Human papilloma virus vaccination