title: Adverse events following HPV vaccination, Alberta 2006-2014.
abstract: BACKGROUND
  In Canada, private purchase of human papilloma virus (HPV) vaccines has been possible since 2006. In Alberta, Canada, a publicly funded quadrivalent HPV vaccine program began in the 2008/2009 school year. There have been concerns about adverse events, including venous thromboembolism (VTE) associated with HPV vaccines. We describe the frequencies of adverse events following HPV vaccination among Alberta females aged 9 years or older and look at VTE following HPV vaccination.
  
  
  METHODS
  We used the Alberta Immunization and Adverse Reaction to Immunization (Imm/ARI) repository (publicly funded vaccine), the population-based Pharmaceutical Information Network (PIN) information system (dispensing of a vaccine), and the Alberta Morbidity and Ambulatory Care Abstract reporting system (MACAR) for June 1, 2006-November 19, 2014. Deterministic data linkage used unique personal identifiers. We identified all reported adverse events following immunization (AEFI) and all emergency department (ED) utilization or hospitalizations within 42 days of immunization. We calculated the frequency of AEFI by type, rates per 100,000 doses of HPV vaccine administered and the frequencies of ICD-10-CA codes for hospitalizations and emergency department visits.
  
  
  RESULTS
  Over the period 195,270 females received 528,913 doses of HPV vaccine. Of those receiving at least one dose, 192 reported one or more AEFI events (198 AEFI events), i.e., 37.4/100,000 doses administered (95% CI 32.5-43.0). None were consistent with VTE. Of the women who received HPV vaccine 958 were hospitalized and 19,351 had an ED visit within 42 days of immunization. Four women who had an ED visit and hospitalization event were diagnosed with VTE. Three of these had other diagnoses known to be associated with VTE; the fourth woman had VTE among ED diagnoses but not among those for the hospitalization.
  
  
  CONCLUSIONS
  Rates of AEFI after HPV immunization in Alberta are low and consistent with types of events seen elsewhere.
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T2N 4Z6. Electronic address: xcliu@ucalgary.ca.
authors.forename: Xianfang C
authors.initials: XC
authors.lastname: Liu
authors.affiliation: Epidemiology and Surveillance Team, Alberta Ministry of Health, 23rd fl Telus Plaza NT, 10025 Jasper Avenue, Edmonton, AB, Canada AB T5J 1S6. Electronic address: chris.bell@gov.ab.ca.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Bell
authors.affiliation: Epidemiology and Surveillance Team, Alberta Ministry of Health, 23rd fl Telus Plaza NT, 10025 Jasper Avenue, Edmonton, AB, Canada AB T5J 1S6. Electronic address: kimberley.simmonds@gov.ab.ca.
authors.forename: Kimberley A
authors.initials: KA
authors.lastname: Simmonds
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T2N 4Z6; Epidemiology and Surveillance Team, Alberta Ministry of Health, 23rd fl Telus Plaza NT, 10025 Jasper Avenue, Edmonton, AB, Canada AB T5J 1S6; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 1C9. Electronic address: larry.svenson@gov.ab.ca.
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Svenson
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T2N 4Z6. Electronic address: mlrussel@ucalgary.ca.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000416:Alberta; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D053918:Papillomavirus Vaccines / Q000009:adverse effects*; D011358:Product Surveillance, Postmarketing; D014611:Vaccination / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: *Papillomavirus vaccines/ae [adverse effects]; *Product surveillance; *Vaccination/ae [adverse effects]; Alberta; Canada; HPV vaccination; Humans; Population surveillance; Postmarketing