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An unmasking phenomenon in an observational post-licensure safety study of adolescent girls and young women
Authors:Jacobsen Steven J  Sy Lina S  Ackerson Bradley K  Chao Chun R  Slezak Jeff M  Cheetham T Craig  Takhar Harpreet S  Velicer Christine M  Hansen John  Klein Nicola P
Affiliation:Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101 USA. Steven.J.Jacobsen@kp.org
Abstract:Our recent experience in a post-licensure safety study of autoimmune conditions following the quadrivalent human papillomavirus vaccine in 189,629 girls and young women ages 9-26 years led us to question the adequacy of the exclusion of Day 0 events to prevent the erroneous association of prevalent conditions with vaccination. Of the 18 confirmed cases of Graves' disease diagnosed in days 1-60 following vaccination, only 6 cases appeared to be truly new onset. Among the remaining 12 cases, 2 cases had abnormal thyroid stimulating hormone or thyroxine labs drawn prior to or on Day 0 but had no documented pre-existing symptoms. The other 10 cases had mention of symptoms of hyperthyroidism referencing a period prior to first HPV-4 dose. This 'unmasking' phenomenon, due to health care visits that include vaccination and new workups of preexisting symptoms, may not be adequately controlled through the exclusion of Day 0 events.
Keywords:HPV-4, quadrivalent human papillomavirus vaccine   TSH, thyroid stimulating hormone   T4, thyroxine
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