Incidence rates of Guillain Barré (GBS), chronic fatigue/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS) prior to introduction of human papilloma virus (HPV) vaccination among adolescent girls in Finland, 2002-2012. — CFSMEATLAS
Incidence rates of Guillain Barré (GBS), chronic fatigue/systemic exertion intolerance disease (CFS/SEID) and postural orthostatic tachycardia syndrome (POTS) prior to introduction of human papilloma virus (HPV) vaccination among adolescent girls in Finland, 2002-2012.
Skufca, J, Ollgren, J, Ruokokoski, E et al. · Papillomavirus research (Amsterdam, Netherlands) · 2017 · DOI
Quick Summary
This Finnish study looked at how often three conditions—ME/CFS, Guillain-Barré syndrome (GBS), and POTS—were diagnosed in teenage girls between 2002 and 2012, before the HPV vaccine program started. Researchers wanted to establish baseline numbers to help evaluate vaccine safety in the future. They found these conditions were relatively rare, though ME/CFS and POTS diagnoses increased over the decade studied.
Why It Matters
This study establishes pre-vaccination baseline incidence rates essential for future safety surveillance of HPV vaccination. For ME/CFS patients, it provides crucial context for evaluating whether vaccine introduction correlates with disease incidence changes, helping distinguish vaccine safety signals from background rates and diagnostic practice evolution.
Annual incidence increased 33% per year for CFS/SEID and 16.5% per year for POTS (p<0.05)
No significant annual increase observed for GBS incidence (5.4% per year, p=0.460)
Inferred Conclusions
Baseline incidence rates for these three conditions in Finnish adolescent girls prior to HPV vaccination introduction are now established for future comparative safety analyses.
The rising trend in CFS/SEID and POTS diagnoses before vaccine introduction suggests factors beyond vaccination (diagnostic awareness, coding changes, healthcare-seeking patterns) may influence reported incidence.
Registry-based incidence estimates require careful interpretation for poorly-standardized diagnostic entities where criteria and coding practices are evolving.
Remaining Questions
What drives the observed increases in CFS/SEID and POTS diagnoses between 2002-2012—true disease incidence, diagnostic recognition, or coding preference changes?
What This Study Does Not Prove
This study does not establish any causal relationship between HPV vaccination and these conditions—it only provides baseline data before vaccination began. The observed increases in CFS/SEID and POTS diagnoses may reflect improved awareness, changed diagnostic practices, or increased healthcare-seeking behavior rather than true disease increases. The study cannot determine whether the 2012 peak was clinically meaningful or an artifact of coding practices.
Tags
Symptom:Fatigue
Phenotype:Pediatric
Method Flag:Weak Case DefinitionNo ControlsSmall SampleExploratory Only
How do these Finnish baseline rates compare to other countries, and what explains any international variations?
What specific diagnostic criteria were clinicians using to assign these diagnoses in the register, and did criteria change during the study period?
Will post-vaccination incidence rates differ meaningfully from these pre-vaccination baselines, and how will confounding factors be controlled in such comparisons?