Beruflich Dokumente
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Julianne Gee, MPH Immunization Safety Office Centers for Disease Control and Prevention
Presentation Outline
Describe sources of HPV4 safety data Review of HPV4 pre-licensure data Review of US surveillance HPV4 safety data Review post-licensure commitments Review findings from 2011 Institute of Medicines report of adverse events and vaccines
Active:
Vaccine Safety Datalink (VSD) Rapid Cycle Analysis
* Bonani P, et al. A summary of the post-licensure surveillance initiatives for GARDASIL/SILGARD. Vaccine 2010
0.04% SSAEs considered to be vaccine-related 40 deaths: events reported consistent with events in healthy adolescent and adult populations
Limitations
Reporting biases Incomplete data Lack of availability of denominator data Not designed to assess for causality
Assessment
17 yrs (0-82) 109 (0.5) 289 (1.4) 2158 (10.7) 8774 (43.7) 5061 (25.2) 427 (2.1) 3278 (16.3)
17 yrs (0-82) 77 (0.4) 270 (1.4) 1994 (10.4) 8443 (44.3) 4997 (26.2) 401 (2.1) 2893 (15.2)
14 yrs (0-77) 27 (4.7) 16 (2.8) 149 (26.2) 285 (50.1) 40 (7.0) 23 (4.0) 29 (5.1)
* Unknown gender= 452 (2.2%) ** Serious defined as an event resulting in Death, Life-threatening illness, Hospitalization, Prolongation of existing hospitalization, Persistent or significant disability Day 0 = Day of vaccination
Most Frequently Reported Terms for Non-serious and Serious Reports Following HPV4 in VAERS
Non-serious (N=18,569)
MedDRA Preferred Terms* Syncope Dizziness Nausea Headache Injection site pain Drug exposure during pregnancy Pyrexia Loss of consciousness Urticaria Pain in extremity % 14.5 13.7 9.3 8.3 7.0 6.8 6.3 5.9 4.9 4.9
Serious (N=1,527)
MedDRA Preferred Terms* Headache Nausea Fatigue Dizziness Vomiting Pyrexia Computerized tomogram normal Syncope Asthenia Pain % 25.0 18.6 17.4 16.8 14.7 13.7 13.0 12.6 11.7 11.6
* As coded using the MedDRA preferred terms, more than one code may be assigned to a single event
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Median age (range): 17 years (11-27) Median onset from vaccination to event: 0 days (0-10) Confirmed anaphylaxis: 12
All treated and recovered
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Verified* N= 34
Unconfirmed N= 37
Female N= 32
Male N=2
Hearsay** N=28
Other** N=9
*Deaths verified by autopsy, death certificate, or provider confirmation ** Hearsay: Reports with no identifying information for follow-up. Other: Under investigation
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Pulmonary embolism: 4
14.5 days (13-181)
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Serious Reports: 33 (5.8%) HPV4 given alone: 44% Median age (range) 14 yrs (0-77) Median onset interval from vaccination to event (range): 0 days (0-433)
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Most Frequently Reported Terms for Non-serious and Serious Reports Among Males Following HPV4 in VAERS
Non-serious (N=536)
MedDRA Preferred Terms* %
Serious (N=33)
MedDRA Preferred Terms* %
Dizziness Syncope Injection site erythema Pallor Nausea Pyrexia Headache Wrong drug administered Injection site swelling Fall
18.8 15.3 10.0 9.0 8.4 7.7 7.6 7.4 7.2 6.3
Pyrexia White blood cell count increased Nausea Pain in extremity Blood glucose increased Dyspnea Cough Muscular weakness Abdominal pain Chest pain
27.3 24.2 24.2 21.2 21.2 18.2 18.2 18.2 18.2 18.2
* As coded using the MedDRA preferred terms (PT), More than one code may be assigned to a single event
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Cardiac: 2 (myocarditis; pericarditis) Gastrointestinal: 4 (acute pancreatitis [2]; appendicitis; colon cancer) Infectious: 2 (cellulitis; diarrhea) Other: 8 (syncope/presyncope [3]; pulmonary embolism; osteitis pubis;
DM type 1; sickle cell disease; spontaneous pneumothorax)
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Marshfield Clinic
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Post-Vaccination Syncope
VAERS :
Majority of syncope occurs within 15 min of vaccination
VSD: Rates of syncope on day 0 following Td, Tdap, varicella, meningococcal or HPV vaccination among Rate per 10,000 9-26 yrs:*
Gender vaccinations 12.5 17.9 15.3 Male Female Both
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Summary
Monitoring and evaluation are ongoing for HPV4 VAERS continues reviewing reports following HPV4
No new adverse event concerns or clinical patterns identified
VSD rapid cycle analysis confirmed no significant risk for any of the pre-specified adverse events after vaccination for two age groups (9-17yrs and 18-26 yrs)
Further evaluation of VTE and HPV4 is ongoing
Acknowledgements
Immunization Safety Office Jorge Arana Karen Broder Jonathan Duffy Theresa Harrington Zanie Leroy Paige Lewis Pedro Moro Claudia Vellozzi Eric Weintraub DSTDP Eileen Dunne Lauri Markowitz FDA Thomas Buttolph David Martin Michael Nguyen Andrea Sutherland
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