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!