The document discusses two syndromes - complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS) - that some young women reported developing after receiving HPV vaccines. The European Medicines Agency reviewed the evidence and found no causal relationship between the HPV vaccines and the syndromes. They determined the rates of the syndromes were not significantly different between vaccinated groups and the general population. The conclusion was that CRPS and POTS are not linked to HPV vaccinations, and that all HPV vaccines remain safe and effective.

1. Relationship between HPV
vaccines and the
development of CRPS and
POTS
Dien Vu
11/17/2015

2. Health reports of HPV vaccines1
 Young women given HPV vaccines reported the
development of two syndromes:
1. CRPS = complex regional pain syndrome.
 Chronic pain syndrome affecting a limb.
2. POTS = postural orthostatic tachycardia syndrome.
 Heart rate increases abnormally on sitting or standing up.
 Other symptoms: dizziness, fainting, weakness, headache,
pains, nausea, fatigue.
 Severely affect quality of life.

3. Where was the incidents?1
 80 millions girls and women over the world.
 In some European countries, up to 90% of
recommended age group received the vaccines.

4. The evidence1
 The European Medicines Agency’s Pharmacogivilance Risk
Assessment Committee (PRAC) reviewed the evidences of
these two syndromes.
 The evidences do not support a causal relationship
between HPV vaccines and the syndromes.
 Around 150 girls age 10-19 per million may develop CRPS
annually with or without the vaccines.
 Around 150 girls per million may develop POTS annually with or
without the vaccines.
 The overall rates were not significantly different between
vaccinated groups and general populations.

5. Conclusion of finding1
 CRPS and POTS are not linked to HPV vaccinations.
 All HPV vaccines remain safe and effective.
 HPV vaccine information remains the same.

6. HPV2
 HPV = Human Papillomavirus.
 “Papilloma” = warts
 HPV has more than 150 related viruses. Each virus is
given a number (type).
 Some HPV types can cause cancer (cervical cancer,
anogenital cancer).
 Some HPV types can infect genital areas and cause
warts in both males and females.

7. Health problem3
 Most HPV goes away on its own.
 If not, it can cause genital warts and cancer:
 Warts
 Mostly caused by type 6, 11.
 Appearance: small bumps, group of bumps, small or large, raised
or flat, or shaped like cauliflower.
 Cancer
 Mostly caused by type 16, 18
 Cervical cancer, cancer of the vulva/vagina, penis, or anus, and
oropharyngeal cancer.
Note: There is currently no method to know which HPV+ individual
will develop cancer, wart or other health problem.
 Proposed to depend on immune system.

8. Warts

9. HPV transmission2
 Skin-to-skin contact.
 Included: vaginal, anal, oral sex.
 Most common sexually transmitted disease.
 Any sexually active person can get HPV.
 Including monogamous.
 At some point in life, almost all sexually active men and women
will obtain HPV.
 Spread asymptomatically and develop symptoms years after
making it difficult to know when you are first infected.

10. HPV prevention4
 HPV vaccines
 Ceravix = HPV type 16,18
 Gardasil = HPV type 6,11,16,18
 Gardasil-9 = HPV type 6,11,16,18,31,33,45,52,58
 All HPV vaccines are given in 3-dose series over 6 months:
 Dose 1.
 Dose 2 given 1-2 months after Dose 1.
 Dose 3 given 6 months after Dose 1.
 HPV vaccines can be given regardless of history of anogential warts,
abnormal Pap/HPV test, or anogenital precancer.
66% cervical cancer
15% cervical cancer90% anogenital wart

11. Lower risk of getting HPV3,5
 Get vaccinated
 All boys and girls age > 11.
 Catch-up vaccines:
 Males through age 21, and females through age 26.
 Gay and bisexual men through age 26.
 Anyone with compromised immune system through age 26.
 For females: any HPV vaccine is recommended.
 For males: recommend Gardasil and Gardasil-9.
 Get screened for cervical cancer.
 Women age 21 to 65.
 Condoms may not give full protection as HPV infects the exposed skin.
 Monogamous relationship.
 Abstaining from sexual activity.

12. HPV vaccines miscellaneous3,6
 Men and Women age <11 or >26, and pregnant women should avoid
HPV vaccines.
 HPV vaccines does not require a prescription.
 HPV vaccines are given as 3 doses because the clinical trials
determine the number of doses.
 Complete all 3 doses to get the full benefit.
 Missed dose?
 Do not need to restart the series, even if years has passed.
 Should still complete series.
 Currently, there is no booster recommended.
 HPV from toilet seat?
 No case report from acquiring HPV through environmental surfaces.
 Possible from shared objects (toys) during sexual activity.

13. HPV status3
 No test to find out HPV status.
 HPV test to screen cervical cancer only for women age
30 or over.
 HPV vaccines do not rule out Pap test.
 Asymptomatic, people do not know until visible genital
wart, abnormal Pap smear test result, or cancer.

14. HPV treatment3,5
 There is no treatment for virus.
 Only treatment for health problems associated.
1. Genital warts:
 Subclinical genital infection typically clears
spontaneously.
 Antiviral not recommended.
2. Cervical precancer:
3. Cancer:
Cancer treatment guideline

15. HPV External Genital Wart Treatment7
 Patient-applied:
 Podofilox 0.5% solution or gel.
 Imiquimod 5% cream.
 Sinecatechins 15% ointment.
 Provider-applied:
 Cryotherapy (with liquid nitrogen).
 Podophyllin resin 10-25%.
 Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80-90%.
 Surgical removal.

16. Treatment for Hand or Plantar wart8,9
 OTC medications
 Salicyclic Acid
 Compound W.
 Duofilm.
 Occlusal HP.
 Cryotherapy
 Compound W Freeze Off.
 Dr. Scholl’s Freeze Away Wart Remover.
 Duct tape
 Cover the wart with duct tape for 6 days. Then remove tape and rub
surface of wart with emery board or pumice stone.
 Leave uncovered overnight. Apply a new piece of duct tape the next
morning. Repeat until wart is gone.

17. Reference
1. European Medicine Agency.
http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2015/11/news_detail_002429.jsp&mi
d=WC0b01ac058004d5c1. Last updated 11/5/2015. Accessed on 11/8/2015.
2. Centers for Disease Control and Prevention. http://www.cdc.gov/hpv/parents/whatishpv.html. Accessed on
11/8/2015.
3. Centers for Disease Control and Prevention. http://www.cdc.gov/std/HPV/STDFact-HPV.htm#a7. Accessed on
11/8/2015.
4. Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm.
Accessed on 11/8/2015.
5. Center For Disease Control and Prevention. http://www.cdc.gov/std/tg2015/hpv.htm. Accessed 11/17/2015.
6. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm. Accessed on
11/17/2015.
7. Centers for Disease Control and Prevention. http://www.cdc.gov/std/treatment/2010/genital-warts.htm. Accessed
on 11/17/2015
8. A Pharmacist’s Guide to OTC Therapy: OTC Treament for Warts.
http://www.pharmacytimes.com/publications/issue/2006/2006-07/2006-07-5674. Last updated: 7/1/2006. Accessed
11/17/2016
9. Wart Treatment with Duct Tape. http://www.mckinley.illinois.edu/handouts/wart_duct_tape.html. Accessed 11/18/2015

18. Question?
Thank you!