No association between HPV vaccine and reported post-vaccination symptoms in Japanese young women: Results of the Nagoya study

Lack of knowledge, not vaccine hesitancy, is the main cause of low human papilloma virus vaccination rate among systemic lupus erythematosus patients in Japan after suspension of proactive recommendation: Analysis of a patients' survey

OBJECTIVE

To identify the factors that inhibit human papilloma virus (HPV) vaccination to improve the high HPV infection rate and cervical cancer incidence among SLE patients.

METHODS

We conducted a questionnaire survey of female SLE patients aged 18-45 years attending our hospital to analyze factors related to HPV vaccination.

RESULTS

We obtained responses of 88 participants. Only 5 (5.7%) were received HPV vaccination, 15 (17.0%) were uncertain of their vaccine history, and 27 (30.7%) had never even heard of HPV vaccination. The reasons for unvaccinated against HPV were "don't know" with 24 participants, "missed opportunity" with 15, and "troublesome, somehow" with 8. The most trusted source of medical information for the unvaccinated was their physician (69, 60.2%). Among the unvaccinated, those who wished to be vaccinated in the future were positively correlated with "trust of vaccine benefit" (r = 0.561, p = 0.005) and "general knowledge about HPV vaccine" (r = 0.512, p = 0.013), and negatively correlated with "negative attitudes toward vaccination and vaccine policy" (r = -0.547, p = 0.007).

CONCLUSION

HPV vaccination rate among SLE patients in Japan was extremely low. The main reason was lack of knowledge. The most effective solution is considered to provide accurate information and adequate recommendations of HPV vaccination by attending physicians.

Cost-effectiveness analysis of 9-valent human papillomavirus vaccine combined with screening for cervical cancer in Japan

OBJECTIVE

In Japan, the current coverage rate of human papillomavirus (HPV) vaccination is only 30%, and the rate of biennial cervical screening is 40%. The Japanese Government has attempted to increase the coverage of HPV vaccination and cervical screening. We analyzed the cost-effectiveness of the 9-valent HPV vaccine and cervical screening in Japan.

METHODS

A yearly cycle Markov model with 15 health states was created to evaluate the cost-effectiveness of the 9-valent HPV vaccination and cervical screening in women aged 12-75 years. We considered four scenarios: 30% coverage of vaccination with 40% coverage of biennial screening (Scenario 1 representing the current Japanese situation), 70% (the highest proportion in 2013 in Japan) and 90% coverage of vaccination with 40% coverage of biennial screening (Scenarios 2 and 3, respectively), and 90% coverage of vaccination with 70% coverage of biennial screening (Scenarios 4). The incremental cost-effectiveness ratio (ICER) was calculated as costs per quality-adjusted life year (QALY) based on the perspective of the healthcare payer and compared with the benchmark for willingness to pay in Japan (41 700 USD per QALY). The cumulative morbidity and mortality in each scenario were analyzed using the Markov model.

RESULTS

Compared with Scenario 1, the ICERs of Scenarios 2, 3, and 4 were 5382, 5321, and 8524 USD/QALY, respectively, which were lower than the benchmark for willingness to pay. As the coverage of HPV vaccination and cervical screening increased, the cumulative morbidity and mortality decreased.

CONCLUSION

Increasing the coverage of the 9-valent HPV vaccination and cervical screening is cost-effective in Japan.

Menstrual Cycle Length Changes Following Vaccination Against Influenza Alone or With COVID-19

Importance

Multiple studies have identified an association between COVID-19 vaccination and menstrual disturbances. Data on whether menstrual health is impacted by other vaccines are needed to counsel individuals about what to expect and to address vaccine hesitancy.

Objective

To assess the association of changes in length of the menstrual cycle with influenza vaccination, with or without concurrent receipt of a COVID-19 vaccine.

Design, Setting, and Participants

This global retrospective cohort study prospectively collected menstrual cycle data from April 25, 2023, to February 27, 2024 (4-5 cycles per individual), among international English-speaking users of a digital birth control application. Participants included individuals aged 18 to 45 years, not using hormonal contraception, and with average cycle lengths of 24 to 38 days in 3 consecutive cycles before receipt of vaccines.

Exposure

Seasonal influenza vaccination with or without concurrent receipt of COVID-19 vaccine.

Main Outcome and Measure

The primary outcome consisted of adjusted mean within-individual changes of menstrual cycle length assessed by vaccination group. Secondary analysis evaluated the phase of menstrual cycle at time of vaccination.

Results

A total of 1501 individuals met the inclusion criteria, of whom 791 were vaccinated for influenza only and 710 were concurrently vaccinated for influenza and COVID-19. By race and ethnicity, 1 participant (0.1%) was American Indian or Alaska Native; 10 (0.7%), Asian; 3 (0.2%), Black; 15 (1.0%), Hispanic or Latina; 1 (0.1%), Middle Eastern or North African; 368 (24.5%), White; and 19 (1.3%), other; and 1084 (72.2%), missing. Most of the cohort was younger than 35 years (1230 [82.0%]), had at least a college degree (1122 [74.8%]), and was located in the US or Canada (938 [62.5%]). Individuals vaccinated for influenza alone experienced an adjusted mean increase of 0.40 (95% CI, 0.08-0.72) days, while those vaccinated concurrently for influenza and COVID-19 experienced a mean increase of 0.49 (95% CI, 0.16-0.83) days (P = .69 for difference between vaccine groups). A total of 37 individuals (4.7%) experienced a change in cycle length of at least 8 days with influenza vaccine only and 42 (5.9%) with concurrent receipt of both vaccines (P = .28). In the postvaccination cycle, both vaccination groups returned to their prevaccination cycle lengths. Menstrual cycle changes occurred with vaccination in the follicular phase but not the luteal phase.

Conclusions and Relevance

In this cohort study of individuals with regular menstrual cycles, influenza vaccine given alone or in combination with a COVID-19 vaccine was associated with a small but temporary change in menstrual cycle length. These findings may help clinicians confirm the utility of vaccination for patients with concerns about menstrual adverse effects of vaccination.

Evaluating the understandability and actionability of Japanese human papillomavirus vaccination educational materials on cervical cancer

Educational materials about human papillomavirus (HPV) vaccination must be easy to understand and must support recommended behaviors regardless of readers' health literacy levels. The purpose of this study was to evaluate the understandability, actionability, and comprehensiveness of HPV vaccination educational materials in Japan. From August to September 2023, we obtained HPV vaccination educational materials from the central government, local governments, and websites. We assessed the understandability and actionability of the materials using the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P), Japanese version. We also evaluated the comprehensiveness of the content. Ratings of understandability, actionability, and comprehensiveness were compared by material type and source. We evaluated 164 eligible materials. The mean understandability and actionability of all materials were 60.5% (standard deviation [SD] = 12.5) and 42.0% (SD = 20.5), respectively. Many materials lacked definitions of medical terms, clear explanations of numbers, content summaries, explicit steps of action, and the use of visual aids to improve understanding and actionability. The mean comprehensiveness score was 73.5% (SD = 14.7%). A few materials included all the necessary information content. The highest understandability score and actionability score were for local government mailings, and the highest comprehensiveness score was for academic materials. Most Japanese HPV vaccination educational materials were insufficiently understandable and actionable. Such materials need to be improved, especially regarding the use of numbers, medical terms, and visual aids. In terms of content, the importance of vaccination before sexual debut and the benefits of vaccination for men should be emphasized.

Coronavirus disease 2019 vaccination and menstrual cycle changes: A cross-sectional study on females of reproductive age in Saudi Arabia

Data supporting the evidence of changes in the menstrual cycle and premenstrual symptoms associated with coronavirus disease (COVID-19) is quite scarce. To determine the association between COVID-19 vaccination and menstrual cycle changes and its relationship with different types of vaccines among women of reproductive age in Abha City, Saudi Arabia. A cross-sectional study was conducted from January 2022 to June 2022, among participants from Asser region of Saudi Arabia by using a self-administered questionnaire through an electronic survey. Data analysis was performed using SPSS version 16.0. Among 1208 study subjects, majority (66.9%) of females had menarche at the age of <13 years, 17.2% had irregular periods, and 24.8% reported an average regularity of periods (23-35 days). A statistically significant association was found among females who experienced a change in their menstrual cycle after receiving COVID-19 vaccine. Mood swings and lower back pain were common symptoms of premenstrual syndrome symptoms. Only 15% females reported a delay in conception. Out of 176 females, 40% showed 6 month delay in conception after receiving vaccine. Multivariate logistic regression analysis showed that age, regularity of periods, and usual volume of bleeding were significantly associated with changes in the menstrual cycle after vaccination. The relationship between COVID-19 vaccine and associated changes on the menstrual cycle and premenstrual syndrome was established in our study. Further research is needed to produce concrete evidence regarding its relationship to eliminate vaccine hesitancy among women.

Effects of different educational interventions on cervical cancer knowledge and human papillomavirus vaccination uptake among young women in Japan: Preliminary results of a cluster randomized controlled trial

The incidence and mortality rates of cervical cancer are increasing among young Japanese women. In November 2021, the Japanese Ministry of Health, Labour, and Welfare reinstated the active recommendation of the human papillomavirus (HPV) vaccine, after it had been suspended in June 2013 due to reports of adverse reactions. However, vaccine hesitancy is prevalent in the younger generation in Japan. To identify obstacles to vaccine uptake, we conducted a randomized study using different methods to provide educational content to improve health literacy regarding cervical cancer and HPV vaccination among Japanese female students. We surveyed 188 Japanese female students, divided into three groups according to the intervention: no intervention, print-based intervention, and social networking service-based intervention. Twenty questionnaires and the Communicative and Critical Health Literacy scales were used as health literacy scales. Participants' knowledge and health literacy improved regardless of the method of education. In fact, participants acquired proper knowledge when given the opportunity to learn about the importance of the disease and its prevention. Therefore, medical professionals in Japan must provide accurate scientific knowledge regarding routine HPV vaccination and the risk of cervical cancer in young women to improve their health literacy and subsequently increase HPV vaccination rates in Japan, which may lead to cervical cancer elimination. Trial registration number: UMIN000036636.

Effect of information awareness on attitudes toward human papillomavirus vaccination intentions in Japan

Background

The Human Papillomavirus (HPV) vaccination rate among Japanese high school girls remains critically low, reflecting ongoing public apprehension and misinformation. This study explores the relationship between information presentation and attitudes toward HPV vaccination in Japan.

Methods

We conducted a web-based survey of female high school students aged 15 to 16 and mothers of daughters of similar age across Japan. The first screening questionnaire investigated the vaccine uptake among eligible students. The detailed questions assessing awareness of HPV vaccination information, including vaccine eligibility and its cost, effectiveness, lifetime prevalence of HPV infection, and vaccine safety, were asked to the respondents. After presenting each piece of information, we investigated how the information influenced the vaccination attitudes of unvaccinated students and mothers of unvaccinated girls.

Results

Data collection occurred from August 20 to August 24, 2021. Of 473 students, 68 (14.4 %) had already been vaccinated before the study. Over half of the 245 participating students were aware of vaccine eligibility and cost (68.7 %) and effectiveness (63.6 %), but fewer understood lifetime prevalence (28.7 %) and safety (45.3 %). In contrast, awareness of the same questions in 245 mothers was higher than that in the students: 90.2 %, 92.5 %, 55.4 %, and 61.1 %, respectively. Among unvaccinated students and mothers of unvaccinated girls, the intention to get vaccinated increased the most after being informed about the lifetime risks of HPV infection; 50.5 % of students and 38.8 % of mothers showed a positive attitude toward the HPV vaccination.

Conclusions

Bridging the awareness gap between students and mothers is crucial for improving HPV vaccination rates. The findings underscore the potential of specific, targeted information to influence vaccination intentions, particularly regarding the HPV infection rate.

Association between the COVID-19 vaccination campaign and fertility trends: a population-level time series analysis for 22 countries

Introduction

At the turn of 2021-2022, monthly birth rates declined in many higher-income countries. We explore how the rollout of COVID-19 vaccination was associated with this decline.

Methods

Using an interrupted time series design, we evaluate the impact of the onset of the COVID-19 pandemic and the start of COVID-19 vaccination on seasonally adjusted monthly total fertility rates in 22 high-income countries. We study the associations between COVID-19 vaccination and fertility by additionally controlling for youth unemployment, stringency index and vaccination coverage. Fertility data come from the Short-Term Fertility Fluctuations data series under the Human Fertility Database. Indicators used as control variables originate from Eurostat and OECD databases, Oxford COVID-19 Government Response Tracker and Our World in Data.

Results

The start of the pandemic had an immediate effect on fertility in most countries, although the size and direction of level changes considerably varied across them. The impact of COVID-19 vaccination was likewise extensive. While a relatively pronounced negative association between the COVID-19 vaccine rollout and fertility 9 months later was found only for 10 out of 22 countries, indications of a negative fertility response were detected in the vast majority of countries. For several countries, the decline was preceded by fertility increase that took place after the onset of the pandemic. Only 4 out of 22 countries had post-vaccination fertility declines that resulted in fertility being on lower level than what the pre-pandemic trend predicted. Additional control variables changed the associations only a little.

Conclusions

The COVID-19 vaccination campaign contributed to the variation in short-term fertility trends. Several countries experienced declines following the campaign, which often returned fertility closer to the pre-pandemic trend. Fertility appears to have responded in short run to vaccination, but only in few cases such that the long-term trajectory is below the pre-pandemic trend.

Menstrual cycle alterations in reproductive age women after anti COVID-19 vaccination. A survey in 419 Italian women and quality of life and sexual function evaluation

BACKGROUND

Pharmacovigilance agencies did not collect data regarding menstrual changes after COVID-19 vaccination even if many women experienced it. Our aim was to evaluate whether COVID-19 vaccination is associated with secondary changes in menstrual cycle and to assess both quality of life (QoL) and sexual function (SF).

METHODS

This study is a retrospective analysis referred to our Department from January 2021 to December 2021. The study cohort responded to same questionnaires before the second dose of vaccination (referring to previous 3 months) and 3 months after that (referring to three menstrual cycles after full-dose vaccination). The surveys administered were FSFI, FSDS, SF-36, MEDI-Q and the VAS-scale for dysmenorrhea.

RESULTS

Four-hundred-nineteen vaccinated women were included in the study. The survey did not show a significant change in menstrual cycle length before and after COVID-19 vaccine (5.88±3.67 vs. 4.97±2.89, P=0.21); the interval between periods was significantly higher after a full-cycle vaccination (28.32±7.34 vs. 32.38±7.45, P<0.02); 32 patients (7.6%) developed amenorrhea after the second dose; VAS Scale did not change significantly (median range 3 (3-5) vs. 4 (3-6), P=0.20). MEDI-Q did not show significant variations before and after the vaccination (43.21±11.65 vs. 40.28±9.88, P=0.35). QoL and SF did not change significantly (FSFI median 27 [24-29] vs. 28 [25-30], P=0.12, FSDS median 9 [5-11] vs. 8 [4-12], P=0.22), SF-36 median 81 [70-85] vs. 82 [72-86], P=0.43).

CONCLUSIONS

COVID-19 vaccination is associated with a significant change in intervals between menstrual cycles without other alterations in menstrual characteristics, in QoL or SF.

Risk of heavy menstrual bleeding following COVID-19 vaccination: A nationwide case-control study

BACKGROUND

COVID-19 vaccination has been inconsistently associated with an increased risk of heavy menstrual bleeding in previous studies. This study aimed to assess the risk of heavy menstrual bleeding requiring hospital care following COVID-19 vaccination according to the number of doses received and the time elapsed since vaccination.

METHODS

Using comprehensive data of the French National Health Data System, we carried out a case-control study. Non-pregnant 15-50 years old women who had a hospital discharge diagnosis of heavy menstrual bleeding between May 12, 2021, and August 31, 2022 (cases) were randomly matched to up to 30 controls of same age, place of residence, social deprivation index, and contraceptive use profile at the date of case hospital admission (index date). Conditional logistic regression models were used to estimate the risk of hospital care for heavy menstrual bleeding associated with primary or booster doses and delay since last COVID-19 vaccination at index date, adjusting for socio-demographic characteristics, comorbidities, healthcare use indicators, and recent SARS-CoV-2 infection.

RESULTS

A total of 4610 cases and 89,375 matched controls were included (median age, 42 years). Compared to unvaccinated women, the risk of hospital care for heavy menstrual bleeding was increased in those having received a last dose of primary vaccination in the preceding 1-3 months (Odds Ratio, 1.20 [95% confidence interval, 1.07-1.35]). This association was marked among women residing in the most deprived municipalities (1.28 [1.07-1.52]) and those who were not using hormonal contraception (1.28 [1.11-1.48]). Assuming a causal relationship, a total of 103 cases [54-196] were estimated to be attributable to primary vaccination in France.

CONCLUSION

These findings provide evidence of an increased risk of heavy menstrual bleeding during the three-month period following primary COVID-19 mRNA vaccination. No increased risk was found beyond 3 months after primary vaccination nor following booster doses.

Human papillomavirus (HPV) vaccination in Japan

AIM

To review the status of human papillomavirus (HPV) vaccination in Japan from inception to the present, focusing on past and current challenges.

METHODS

Published articles and website content related to HPV vaccination were reviewed.

RESULTS

The Ministry of Health, Labor and Welfare suspended proactive recommendations for HPV vaccination in June 2013 following repeated media reports of girls experiencing adverse events, including chronic pain and walking disturbances, after receiving the HPV vaccine. Despite later recognition of these symptoms as a functional somatic syndrome, HPV vaccine coverage of target girls aged 12 to 16 years in the National Immunization Program (NIP) rapidly decreased to near zero. This suspension of the proactive HPV vaccination recommendation ceased in fiscal year (f-year) 2022, initiating a 3-year catch-up free HPV vaccination period from April 2022 to March 2025 for women born from f-years 1997 to 2005. These drastic changes were driven by established evidence of the effectiveness and safety of HPV vaccines reported from both Japan and other countries, and a nine-valent HPV vaccine has been included in the NIP since f-year 2023. However, the estimated HPV vaccination rate in the NIP remains low at ≤30%.

CONCLUSIONS

To regain high coverage of HPV vaccination in Japan, it is essential that government, industry, and academic society work together to raise awareness and educate Japanese people about cervical cancer prevention and HPV-related diseases.

Assessment of COVID-19 Vaccine Impact on Women's Menstrual Health within an 18-Month Follow-Up

Considering menstruation as a crucial factor in females' health and fertility, any factor that could change its cycle is important. This study was conducted from April 2021 to October 2022 on females who got 3 doses of vaccines against SARS-CoV-2 through different platforms. The participants were requested to provide the trained experts with any changes regarding menstrual cycles after each dose of the vaccine up to 6 months after the booster shots. The disturbances related to the vaccines were identified by the adverse events committee to find possible associations with the applied vaccines. Of 308 women who participated until the end of the study, 22 (7.1%) complained about at least one abnormality in their menstrual patterns. The most common disturbance was metrorrhagia as 10 (48%) incidences followed by menorrhagia as 6 events (24.2%). Notably, the identified complaints were persistent in 59% of the patients. In addition, 14 studied cases developed COVID-19 infection after menstrual disorders. In these cases, COVID-19 could also play a role in the persistence of postvaccine menstrual disturbances. COVID-19 vaccination could affect menstrual cycle in women with no remarkable previous medical history. More longitudinal studies are required regarding this issue.

Three-year questionnaire study on human papillomavirus vaccination targeting new female college school students: Follow-up to a 2021 report to reveal the impact of a policy change in Japan

AIM

The purpose of this study was to examine the trend in human papillomavirus (HPV) vaccination rates in Japan before and after a policy change in 2022, involving resumption of active recommendation and start of catch-up vaccination.

METHODS

From 2021 to 2023, a web-based questionnaire survey was administered to newly enrolled female college students in Yokohama, Japan. The questionnaire included items such as age, HPV vaccination status, HPV vaccine awareness, and awareness of catch-up vaccination. We compared knowledge about the HPV vaccine and cervical cancer in 2021 and 2023, before and after resumption of the national vaccination program.

RESULTS

The HPV vaccination rates were 5.4% in 2021, 7.5% in 2022, and 35.3% in 2023, with a significant upward trend (p < 0.001). A similar upward trend was observed for HPV vaccine awareness (p < 0.001). Comparing 2022 and 2023 after the start of catch-up vaccination, there was no significant difference in awareness of catch-up vaccination (p = 0.669), but there was a significant increase in awareness of free vaccination tickets (p < 0.001). After resumption of the national vaccination program with adoption of the catch-up vaccination program, there was no difference in knowledge of cervical cancer, but there was a difference in knowledge of the HPV vaccine.

CONCLUSIONS

Although the HPV vaccination rate has increased after the policy change, it has not recovered to the level before the suspension of active recommendation. It is important for healthcare providers and school educators to actively communicate the safety and effectiveness of the HPV vaccine.

Effect of Coronavirus Disease 2019 Pandemic and Vaccination on Menstrual Cycle Among King Saud University Students in Riyadh: A Retrospective Online Survey

Objectives We aimed to evaluate the prevalence of menstrual cycle changes following the COVID-19 pandemic and the COVID-19 vaccination among female students at King Saud University in Riyadh, Saudi Arabia. Methods A cross-sectional retrospective study using an online questionnaire was conducted between October 2022 and December 2022. Data were collected concerning demographic variables, clinical conditions, menstrual cycle characteristics, COVID-19 infection status, and vaccination history. Results Of the 525 female students who participated in the study (mean age, 21.5 ± 3.9 years; mean body mass index, 22.7 ± 4.7 kg/m2), 246 (46.9%) had tested positive for COVID-19, 15 (2.9%) had visited the emergency room, and eight (1.5%) had been hospitalized. The average duration between menstrual cycles increased significantly among the study sample (pre-pandemic, 25.9 ± 5.3 days; post-pandemic, 26.8 ± 6.7 days; p = 0.016). Pre-pandemic, 221 (42.1%) participants reported less than two days of variance between their shortest and longest cycles, as compared with 175 (33.3%) post-pandemic (p < 0.001). Regarding vaccination, 393 (74.9%) participants had received three vaccinations, and 110 (21%) had received two vaccinations. Post-vaccination, 184 (35%) participants reported no changes to their menstrual cycle, 154 (29.3%) reported less disruption, and 44 (8.4%) experienced more disrupted menstrual cycles. Conclusion This study highlights potential associations between the COVID-19 pandemic, subsequent vaccinations, and changes in menstrual patterns, which can help to elucidate the physiological and psychological effects of pandemics and vaccination campaigns on women's health. Future studies must consider biological and psychosocial factors to elucidate underlying mechanisms and causal relationships.

The association of COVID-19 vaccination and menstrual health: A period-tracking app-based cohort study

Background

In initial COVID-19 clinical trials, menstrual health was not formally monitored, yet anecdotal reports of menstruation changes surfaced on social media. This study aims to assess the association between COVID-19 vaccines and menstruation using Clue, a period-tracking application.

Study design

A survey assessing demographics, menstrual health, stress levels, and COVID-19 vaccination was sent to Clue users between 12/7/2021 and 2/9/2022. Inclusion criteria were (1) 18 years or older (2) currently menstruating (3) not pregnant or breastfeeding since 1/2020. Menstrual data was collected for each participant. Users with cycle lengths more than 90 days were excluded. Cycle lengths were calculated for the 6-month average pre-vaccination (PRIOR), the cycle during which vaccination was administered (DURING), the cycle following DURING (AFTER1), and the cycle following AFTER1 (AFTER2). For periods, individuals were stratified based on whether vaccination was received during their menstrual period (DURING). Period lengths were additionally calculated for the 6-month average pre-vaccination (PRIOR), the first period following vaccination (AFTER1), and the period following AFTER1 (AFTER2). For unvaccinated participants, an index date (4/1/2022) was used to similarly designate menstrual cycles and periods. For each participant, cycle length changes for DURING, AFTER1, and AFTER2 compared to PRIOR were determined. Student's t-test compared the mean of these changes between vaccinated and unvaccinated groups.

Results

Of 7,559 participants, 6,897 (91 %) were vaccinated. Compared to PRIOR, individuals vaccinated during their menstrual period demonstrated a statistically significant increase in the DURING period length, but not AFTER1 (p = 0.463) and AFTER2 (p = 0.692). No statistically significant changes were observed in period lengths of those vaccinated in between periods or in cycle lengths overall.

Conclusion

A small but statistically significant change in period length was observed only in individuals vaccinated for COVID-19 during their menstrual period. Providers can better counsel menstruating individuals to reduce vaccine misinformation.

Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial

BACKGROUND

Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine.

OBJECTIVE

This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases.

METHODS

In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination.

RESULTS

The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8% decrease in the duration of the menstrual phase following vaccination.

CONCLUSIONS

The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-021-05241-5.

Human Papillomavirus Vaccination by Birth Fiscal Year in Japan

Importance

The Ministry of Health, Labour, and Welfare (MHLW) of Japan aggregates human papillomavirus (HPV) vaccination data across Japan for each fiscal year (FY) by age at vaccination. Birth FY (BFY)-specific vaccination coverage remains unknown.

Objective

To calculate the BFY-specific vaccination coverage for each FY and the cumulative first-dose coverage for each BFY in Japan, to understand the generation-specific vaccination coverage, and to estimate the cumulative first-dose coverage of each BFY that would be achieved by FY 2028 vs World Health Organization (WHO) targets.

Design, Setting, and Participants

In this cross-sectional study, MHLW-published national age-specific HPV vaccination numbers and demographic data for female individuals were used to calculate the BFY-specific first-dose coverage for each FY and the BFY-specific cumulative first-dose coverage. It was assumed that the BFYs 2007 to 2012 vaccination coverage in FY 2023 to 2028 would remain the same as the vaccination coverage of the same grade in FY 2022 to estimate the cumulative first-dose coverage that would be achieved by FY 2028. Data analysis was performed from December 2023 to January 2024.

Exposure

Two MHLW policy changes were the government's suspension of proactive recommendation for HPV vaccination in June 2013 and the government's resumption of proactive recommendation for HPV vaccination in April 2022.

Main Outcomes and Measures

The primary outcome was generation-specific vaccination coverage among female individuals born in BFYs 1994 to 2010 in FYs 2010 to 2022, calculated using reconfigured published data.

Results

In this study of vaccination data for 9 414 620 female individuals, the generation-specific vaccination coverage was 71.96% for the vaccination generation (BFYs 1994-1999), 4.62% for the vaccine-suspension generation (BFYs 2000-2003), 16.16% for the generation that received information individually (BFYs 2004-2009), and 2.83% for the vaccine-resumed generation (BFY 2010). HPV routine vaccination coverage was extremely low in BFYs 2000 to 2010 (0.84%-25.21%) vs BFYs 1994 to 1999 (53.31%-79.47%). The cumulative first-dose coverage that was estimated to be achieved in the vaccine-resumed generation by FY 2028 plateaued at 43.16%.

Conclusions and Relevance

Even after the resumption of MHLW's proactive recommendations, HPV vaccination coverage has only minimally recovered in Japan. The cumulative first-dose coverage that was estimated to be achieved in the vaccine-resumed generation by FY 2028 is below the WHO target. These findings reveal that stronger cervical cancer control measures are required, particularly for the vaccine-resumed generation, which will plateau at approximately one-half the WHO target values.

Association between receiving Covid-19 vaccine and menstrual cycle patterns among childbearing women: A cross-sectional study

Background and Aims

Many women reported experiencing abnormalities in their cycle after being vaccinated with Covid-19 vaccination. To understand this issue further, our study aimed to evaluate the menstrual cycle patterns among women of childbearing age after receiving COVID-19 vaccinations.

Methods

A cross-sectional study was conducted to investigate the impact of COVID-19 vaccine on women aged 18 years and above in Saudi Arabia. A self-administered online questionnaire was distributed among participants who had received at least one dose of COVID-19 vaccine. The questionnaire included questions about the participants' demographic characteristics, medical history, and vaccine-related adverse events.

Results

The study included 383 female participants with an average age of 30.8 ± 8.1 years. The majority of participants, 92.7%, were Saudi, and more than half, 51.4%, were single. Of the participants, 78.9% were disease-free, and a majority of 67.9% had no history of Coronavirus Disease 2019 infection. A significant proportion of participants reported postvaccination changes in the menstrual cycle. Specifically, 43.1% reported changes after the first dose, and 38.4% reported changes after the second dose (p = 0.044). The severity of premenstrual symptoms increased from 44 (11.5%) to 113 (29.5%) after the first dose. Reported pain on the (WONG-BAKER) scale was also significantly elevated from 34 (8.9%) to 87 (22.7%) (p < 0.001) after the first dose.

Conclusion

A relatively high prevalence of menstrual cycle irregularities was reported by Saudi vaccinated women, particularly young adults. These findings suggest the need to further research and explore the underlying causes of these irregularities and develop interventions that may help mitigate their impact on women's health. It is also recommended that women who observe long-term changes in their menstrual cycles seek follow-up and consultation with healthcare providers to ensure that any potential health concerns are addressed promptly.

The Evaluation of Menstrual Alterations in Mexican Women After Vaccination Against COVID-19

Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the vaccine. The evaluation of these alterations in women with the same and multiple vaccination schedules will provide valuable information. Methods An observational, cross-sectional study was carried out; data were collected through a survey of 164 vaccinated women at the American British Cowdray (ABC) Santa Fe Medical Center Hospital in Mexico City. The survey was validated by the Delphi method. Results The survey was applied from March 2023 to February 2024. Post-vaccination menstrual alterations occurred in 48.1%; the most frequent alteration was menorrhagia in 20.7% and pain accompanied by menstruation in 27.4%. Fifty-seven percent had a history of previous COVID-19 infection. There were no significant associations between changes in menstrual bleeding after vaccination, history of COVID-19 infection, and age group (p>0.9). However, women who received multiple doses of vaccines had a higher risk of suffering abnormalities in bleeding by 36.6%. Conclusion The incidence of menstrual disorders in this study post COVID-19 vaccination was 49%. Menstrual alterations in patients who received multiple doses and a single regimen were similar at 47% and 48%, where there is no statistical significance. The greatest number of menstrual alterations was seen in the first dose at 36%, probably due to the immunity they acquired after the different types of vaccination. Vaccination is a very effective way to prevent the severity of COVID-19 infection; it has an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving the first dose of the vaccine had changes in the amount of bleeding specifically the amount.

Questionnaire survey on the prevention and development of cervical cancer in patients with systemic lupus erythematosus in Japan

OBJECTIVES

The aim is to evaluate the prevention and development of cervical cancer in systemic lupus erythematosus (SLE) patients in Japan and its background based on a questionnaire survey.

METHODS

The questionnaire was handed to 460 adult female SLE patients at 12 medical institutions. The participants were grouped by age, and data related to their human papillomavirus vaccination status, age at first coitus, cervical cancer screening, and diagnosis of cervical cancer were analysed.

RESULTS

A total of 320 responses were received. Patients aged 35-54 years included a higher proportion of patients whose age at first coitus was <20 years. This group also showed a higher rate of cervical cancer/dysplasia. Only nine patients had a human papillomavirus vaccination history. Adequate frequency of cervical cancer screening was slightly higher (52.1%) among SLE patients than in the Japanese general population. However, 23% of the patients had never undergone examination, primarily because of a feeling of troublesome. The incidence of cervical cancer was significantly higher among SLE patients. One reason for this may be associated with the use of immunosuppressants, although the difference was not significant.

CONCLUSIONS

SLE patients are at a higher risk of cervical cancer and dysplasia. Rheumatologists should proactively recommend vaccination and screening examinations for SLE female patients.

COVID-19 and abnormal uterine bleeding: potential associations and mechanisms

The impact of COVID-19 on menstruation has received a high level of public and media interest. Despite this, uncertainty exists about the advice that women and people who menstruate should receive in relation to the expected impact of SARS-CoV-2 infection, long COVID or COVID-19 vaccination on menstruation. Furthermore, the mechanisms leading to these reported menstrual changes are poorly understood. This review evaluates the published literature on COVID-19 and its impact on menstrual bleeding, discussing the strengths and limitations of these studies. We present evidence consistent with SARS-CoV-2 infection and long COVID having an association with changes in menstrual bleeding parameters and that the impact of COVID vaccination on menstruation appears less significant. An overview of menstrual physiology and known causes of abnormal uterine bleeding (AUB) is provided before discussing potential mechanisms which may underpin the menstrual disturbance reported with COVID-19, highlighting areas for future scientific study. Finally, consideration is given to the effect that menstruation may have on COVID-19, including the impact of the ovarian sex hormones on acute COVID-19 severity and susceptibility and reported variation in long COVID symptoms across the menstrual cycle. Understanding the current evidence and addressing gaps in our knowledge in this area are essential to inform public health policy, direct the treatment of menstrual disturbance and facilitate development of new therapies, which may reduce the severity of COVID-19 and improve quality of life for those experiencing long COVID.

The effect of iron supplementation on menstrual bleeding volume and hemoglobin level during menstrual bleeding : A randomized clinical trial

BACKGROUND

Many women around the world avoid taking iron supplements during their menstrual bleeding, thinking that menstrual bleeding will increase after taking these supplements. Due to the lack of relevant scientific evidence in this regard, this study was performed to determine the effect of iron supplementation on menstrual blood volume and hemoglobin level during menstrual bleeding.

MATERIALS AND METHODS

In this three-blind randomized clinical trial, 160 non-anemic female students of Rafsanjan University of Medical Sciences were selected through a public call and then they were randomly assigned to two intervention and control groups. The intervention group was given a ferrous sulfate tablet containsing 50 mg of elemental iron daily in the first four days of bleeding for three consecutive menstrual cycles, and the control group received a placebo simultaneously. Before and after the intervention, the level of hemoglobin was measured and the Higham chart was completed in each menstrual cycle by the participants of the two groups. The obtained data were analyzed using the SPSS software version 21 and Chi-square, independent t-test, paired t-test, analysis of variance with repeated measures, and nonparametric tests.

RESULTS

Before performing the intervention, the mean Higham score and hemoglobin level of the two groups were not statistically significant (P = 0.307, P = 0.670). The mean Higham score after each intervention was not statistically significant between the two groups over time or when considering the interaction of the time group (P = 0.77, P = 0.916). The hemoglobin level of these two groups did not change significantly after the intervention compared with that before the intervention (P = 0.444).

CONCLUSION

Compared with a placebo, taking iron supplements containing 50 mg of elemental iron during the first four days of menstrual bleeding in non-anemic women did not change the volume of menstrual bleeding and hemoglobin level.

Assessment of Female Hormonal Influence on COVID-19 Vaccine Response: A Prospective Cohort Study

INTRODUCTION

The diversity of oral epithelial cells offers potential viral infection sites. The lower level of ACE2 inhibitors in women's blood renders them more resistant to coronavirus disease 2019 (COVID-19). In order to determine the effect of COVID-19 vaccination on female hormones, salivary levels of total antibody, immunoglobulin G (IgG), and cortisol were measured in young and elderly women.

METHODS

Saliva samples from 88 participants were collected and subjected to ELISA for detecting total antibody, IgG, and cortisol.

RESULTS

Women who were infected with COVID-19 and who completed two doses of vaccination had more IgG antibodies when compared to the uninfected individuals/single-dose/non-vaccinated individuals. The cortisol levels in post-menopausal women were higher than those in women with normal menstrual cycles, and the difference was statistically significant (P-value 0.00). The increased cortisol levels were well correlated with increased levels of IgG antibodies which was statistically significant (Spearman rho P value 0.00) Conclusions: COVID variants will continue to mutate and evolve as long as the epidemic persists. The higher cortisol and IgG antibodies produced by female hormones protect them from COVID-19 infection.

Prolongation of the Menstrual Cycle After Receipt of the Primary Series and Booster Doses of mRNA Coronavirus Disease 2019 (COVID-19) Vaccination

OBJECTIVE

To quantitatively evaluate the effect of a booster vaccination dose against coronavirus disease 2019 (COVID-19) on menstrual cycle in a large-scale retrospective cohort study using a menstrual cycle tracking smartphone application (app).

METHODS

Prospectively or retrospectively recorded data, including the start and finish dates of menstrual cycles, were collected with the app. Detailed data on vaccinations, side effects, and participants' characteristics were retrospectively collected from a questionnaire on the app. For each COVID-19 vaccination shot (first, second, and third), within-individual changes in menstrual cycle length up to the fourth postvaccination cycle were evaluated.

RESULTS

Among the 7,376 and 6,873 participants who had the first and second COVID-19 vaccine doses in different menstrual cycles, respectively, menstrual cycles immediately after the vaccination (first postvaccination cycles) were an average of 0.22 days (95% CI, 0.06-0.39) and 0.37 days (95% CI, 0.20-0.54) longer than the prevaccination cycle. In contrast, among the 1,672 participants who received the first and second doses in the same cycle, the first postvaccination cycle was an average of 4.21 days (95% CI, 3.69-4.72) longer. The second to fourth postvaccination cycles returned to the level of the prevaccination cycle. However, among the 4,768 participants who had the third COVID-19 vaccine dose, the menstrual cycle immediately after the vaccination was an average of 1.20 days (95% CI, 1.00-1.40) longer, with prolongation of cycles of 0.27 days (95% CI, 0.10-0.44) to 0.41 days (95% CI, 0.22-0.59) persisting from the second to the fourth postvaccination cycle.

CONCLUSION

The booster shot against COVID-19 may have a greater and longer-lasting effect on menstrual cycles than the primary-series shots. Although the effect size was small, evidence on the side effects of immunization on menstruation should be accumulated.

Prevalence of menstrual irregularities after coronavirus disease 2019 vaccination: A cross-sectional study in the Eastern Province, Saudi Arabia

BACKGROUND

Reports indicate that there are menstrual cycle disturbances following coronavirus disease 2019 (COVID-19) vaccination. The present study explored the prevalence of menstrual irregularities after COVID-19 vaccination and the association of menstrual irregularities with vaccine type, doses, immediate adverse effects, history of COVID-19 infection, and its severity.

MATERIALS AND METHODS

For this cross-sectional study, 406 women of reproductive age completed an online survey about the postvaccine changes in their menstruation (cycle duration, bleeding days, and bleeding amount), COVID-19 vaccine history (doses, type of vaccine, and immediate adverse effects), history of COVID-19 infection, and its severity. Data was analyzed using SPSS; descriptive statistics were computed and Chi-square test, and binary logistic regression analysis were performed.

RESULTS

Of the total 406 women, 45% reported postvaccine changes in their menstrual cycle. The most common menstrual change was increased dysmenorrhea (68%), followed by an increase in the length of the cycle (52%). There was a significant association between postvaccine menstrual changes and the age, marital status, and family history of menstrual irregularities. No association was observed between postvaccine menstrual changes and COVID-19 vaccine-and COVID-19 infection-related variables. As per the best-fit model of our predictors, the odds of having postvaccine menstrual changes were 0.41 times less in "single" women (confidence interval [CI] = 0.26-0.27; P < 0.001) and 1.714 times greater in women who had a "family history of menstrual irregularities" (CI = 1.092-2.690; P = 0.02), respectively.

CONCLUSION

A substantial number of women complained of postvaccine menstrual changes regardless of their age, type of COVID-19 vaccine, doses, immediate adverse effects, and COVID-19 infection history/severity. Being "single" decreased the probability, whereas having a family history of menstrual irregularities increased the probability significantly of having postvaccine menstrual changes.

[HPV vaccinations and cervical cancer in Japan: Flaws in alleged experimental evidence for molecular mimicry and animal models of HPV vaccine-induced "adverse reactions "]

In Japan, around 3,000 females have died of cervical cancer annually. Cervical cancer is caused by sexually transmitted infections of the human papillomavirus (HPV); it is preventable by vaccinations against oncogenic HPV types, such as types 16 and 18. In Japan, the proactive recommendations for HPV vaccinations were suspended in June 2013 due to public concerns about neuropsychological "diverse symptoms" following HPV vaccinations. The suspension resulted in the vaccination rate less than 1% among the eligible population. In April 2022, the Japanese government resumed the proactive HPV vaccination recommendations after 9 years of the suspension. Many Japanese people, however, still have concerns about the "diverse symptoms" as adverse reactions following HPV vaccinations. In this article, we critically evaluated the manuscripts cited in the HPV vaccine lawsuits in Japan, including computational and animal studies, which have been used as the theoretical basis for how HPV vaccinations could induce the "diverse symptoms." We concluded that all the manuscripts had scientific flaws, which should not be used to prove that HPV vaccinations could induce the adverse reactions. We wish that our current evaluation would contribute to eliminating baseless concerns about HPV vaccines, eventually increasing the rate of HPV vaccinations in Japan.

Effects of SARS-CoV-2 Vaccination on Menstrual Cycle: An Italian Survey-Based Study

Vaccination against SARS-CoV-2 has played a critical role in controlling the spread of the pandemic. The main side effects of SARS-CoV-2 vaccination include fever and fatigue; however, the potential impacts on menstrual cycles are to be determined. Given the limited number of studies suggesting menstrual changes post vaccination, this study investigates the correlation between COVID-19 vaccines and menstrual cycle changes in fertile-aged Italian women. A questionnaire was distributed from 1 October to 31 November 2022, focusing on menstrual rhythm and flow changes post vaccination. The analysis involved 471 participants. The study observed a shift from a regular to an irregular menstrual rhythm (p < 0.001), and changes in menstrual duration (p = 0.008 and p < 0.001 for first and second doses, respectively) and flow volume (p < 0.001). Most patients with irregular rhythms were vaccinated in the proliferative phase of their cycle. Within six months post vaccination, 74.2% of women with irregular post-vaccination rhythms reported a return to normality. These findings indicate primarily transient menstrual changes following mRNA COVID-19 vaccination, suggesting the vaccines' safety for women of reproductive age.

Public perception of the resumption of HPV vaccine recommendation in Japan: Twitter content analysis

On 12 November 2021, after a stagnation of 8.5 years, Japan decided to resume proactive recommendations for HPV vaccines. However, it is not known how the public reacted to the resumption of proactive recommendations for HPV vaccines, which are key elements in health communication that promote HPV vaccination. This study aimed to capture discussions on HPV vaccination on Twitter and to identify user characteristics, sentiments, discussed themes and their potential reach before and after 12 November 2021, when the Ministry of Health, Labour, and Welfare's decision to resume proactive recommendation for HPV vaccines was first reported by the media in Japan. This study conducted a content analysis of tweets related to HPV vaccines posted on 11 November and 12 November 2021. Tweets were coded in terms of user characteristics, sentiments (i.e. positive, negative and neutral) and themes. Reach was measured by the number of retweets, likes and followers. A total of 3623 tweets were identified. The results showed that approximately 50% of health professionals and researchers tweeted neutral content about HPV vaccines. The most frequently discussed theme was the safety and side effects of HPV vaccines, which was accompanied by mainly negative sentiments. Although health professionals and researchers are influential on Twitter, half of them tweeted neutrally about HPV vaccines. Influential professionals, such as health professionals and researchers, are expected to disseminate accurate information to correct misinformation and recommend HPV vaccination on Twitter to overcome the HPV vaccination crisis, which is characterized by the low vaccination rates.

Association between administration or recommendation of the human papillomavirus vaccine and primary care physicians' knowledge about vaccination during proactive recommendation suspension: a nationwide cross-sectional study in Japan

OBJECTIVE

The Japanese government suspended the proactive recommendation of the human papillomavirus vaccine (HPVv) in 2013, and the vaccination rate of HPVv declined to <1% during 2014-2015. Previous studies have shown that the recommendation by a physician affects a recipient's decision to receive a vaccine, and physicians' accurate knowledge about vaccination is important to increase vaccine administration. This study aimed to evaluate the association between physicians' knowledge of vaccination and the administration or recommendation of HPVv by primary care physicians (PCPs) in the absence of proactive recommendations from the Japanese government.

DESIGN

Cross-sectional study analysed data obtained through a web-based, self-administered questionnaire survey.

SETTING

The questionnaire was distributed to Japan Primary Care Association (JPCA) members.

PARTICIPANTS

JPCA members who were physicians and on the official JPCA mailing list (n=5395) were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary and secondary outcomes were the administration and recommendation of HPVv, respectively, by PCPs. The association between PCPs' knowledge regarding vaccination and each outcome was determined based on their background and vaccination quiz scores and a logistic regression analysis to estimate the adjusted ORs (AORs).

RESULTS

We received responses from 1084 PCPs and included 981 of them in the analysis. PCPs with a higher score on the vaccination quiz were significantly more likely to administer the HPVv for routine and voluntary vaccination (AOR 2.28, 95% CI 1.58 to 3.28; AOR 2.71, 95% CI 1.81 to 4.04, respectively) and recommend the HPVv for routine and voluntary vaccination than PCPs with a lower score (AOR 2.17, 95% CI 1.62 to 2.92; AOR 1.88, 95% CI 1.32 to 2.67, respectively).

CONCLUSIONS

These results suggest that providing accurate knowledge regarding vaccination to PCPs may improve their administration and recommendation of HPVv, even in the absence of active government recommendations.

Disturbances of menstrual cycle after immunization against SARS-CoV-2 and their risk factors: Cross-sectional clinical study

OBJECTIVE

Abnormalities of the menstrual cycle were reported after infection with SARS-CoV-2 and vaccination against it, but the available data are very heterogeneous, do not reflect intermenstrual variations or regional differences, and their risk factors are missing.

METHODS

We performed a survey-based study among 6383 employees and students of Ulm University Hospital in Germany between March 1 and 31, 2021. Attributes of menstrual cycles such as cycle length (CL), menses duration (MD), and bleeding volume (BV) were reported as categorical variables before and after immunization against SARS-CoV-2 (first, second, third vaccination or infection). Additionally, the potential risk factors for cycle changes were evaluated and all participants reported the subjective perception of changes, their duration, and time of occurrence.

RESULTS

The final analysis included 1726 participants. CL and BV significantly changed after vaccination, but not MD. The subjective perception showed only slight levels of agreement with the objective changes, with the highest Cohen's kappa for CL. The risk factors for the variations in CL were previous cycle irregularities, and risk factors for the changes in BV were age and body mass index. The combination of vaccines (homogenous or heterogeneous) and different types of immunization (infection and vaccination) had no significant effect on cycle irregularities.

CONCLUSION

In summary, immunization against SARS-CoV-2 causes changes in the characteristics of the menstrual cycle, which are mostly temporary. The individual risk factors, but not the type of immunization, can affect the mentioned changes.

A cross-sectional study confirms temporary post-COVID-19 vaccine menstrual irregularity and the associated physiological changes among vaccinated women in Jordan

Background

COVID-19 vaccines continue to save people's lives around the world; however, some vaccine adverse events have been a major concern which slowed down vaccination campaigns. Anecdotal evidence pointed to the vaccine effect on menstruation but evidence from the adverse event reporting systems and the biomedical literature was lacking. This study aimed to investigate the physiological changes in women during menstruation amid the COVID-19 vaccination.

Methods

A cross-sectional online survey was distributed to COVID-19 vaccinated women from Nov 2021 to Jan 2022. The results were analyzed using the SPSS software.

Results

Among the 564 vaccinated women, 52% experienced significant menstrual irregularities post-vaccination compared to before regardless of the vaccine type. The kind of menstrual irregularity varied among the vaccinated women, for example, 33% had earlier menstruation, while 35% reported delayed menstruation. About 31% experienced heavier menstruation, whereas 24% had lighter menstrual flow. About 29% had menstruation last longer, but 13% had it shorter than usual. Noteworthy, the menstrual irregularities were more frequent after the second vaccine shot, and they disappeared within 3 months on average. Interestingly, 24% of the vaccinated women reported these irregularities to their gynecologist.

Conclusion

The COVID-19 vaccine may cause physiological disturbances during menstruation. Luckily, these irregularities were short-termed and should not be a reason for vaccine hesitancy in women. Further studies are encouraged to unravel the COVID-19 vaccine adverse effect on women's health.

Underlying background of the current trend of increasing HPV vaccination coverage in Japan

Cervical cancer is prevalent among women, with a reported 604,127 cases in 2020 worldwide. The incidence of cervical cancer has been mitigated in most high-income countries by promoting the human papilloma virus (HPV) vaccine. However, in Japan, cervical cancer is still a leading cause of mortality and the most prevalent cancer among women aged between 15 and 39. This can be attributed to the 7-year suspension of HPV vaccination recommendations by the Japanese government. A decline in vaccination coverage followed this suspension, caused by a small number of reported adverse events, resulting in a steep decline in vaccination coverage from over 70% to less than 1%. However, there have been indications of a change in trend in Japan. In 2020, a group of volunteer doctors initiated awareness-raising activities through social networking services and other platforms, and the target population that received at least one dose of the vaccine in 2020 increased to 15.9%. Additionally, in July 2020, the Japanese government approved the updated 9-valent HPV vaccine and resumed recommendations in November 2021. As a result, 30.1% of those eligible for routine HPV vaccination received at least one dose of the vaccine from April to September, 2022. However, the HPV vaccine coverage in Japan is still far from the 90% recommended by the World Health Organization, and continued communication and education on the vaccines benefits are necessary to achieve optimal coverage.

A questionnaire survey on the prevention of HPV infection among females and males who came of age in Japan under various scenarios of HPV vaccine recommendation

The Japanese Ministry of Health, Labor and Welfare (MHLW) temporarily suspended recommendation for HPV vaccinations for girls in June 2013. It resumed its recommendation in November 2021. To compensate for eight years of lost overage, a 'catch-up HPV vaccination' program began in April 2022. To determine intervention needs in regards to HPV vaccine hesitancy, from October 13 2021 to April 31 2022, we surveyed 12-28 year-old vaccine-eligible males and females (281 males, 583 females). We investigated the gender and 'vaccine generational' differences in attitudes, perceptions, and future intentions regarding HPV vaccination. Two generations were defined by the vaccine recommendation environment they grew up in. The 'vaccine generation' was born in FY 1994-1999; the 'vaccine-suspension generation' born in FY 2000-2009. Knowledge regarding the HPV vaccine correlated significantly with being female, of the vaccination generation, a medical student, and having received the COVID-19 vaccine. There was a significant 'generational' difference in terms of approval of the MHLW's recommendation resumption. The attitudes, perceptions, and future intentions of Japan's two generation groups are unique and should be dealt with accordingly. HPV vaccination promotion should consider the strong gender differences we identified. As an extension of the anti-cervical cancer program, HPV vaccinations for boys should begin immediately. Our study of their unique outlooks will contribute to the discussion surrounding that implementation.

COVID-19 vaccination and menstrual cycle characteristics: A prospective cohort study

We prospectively examined the association between COVID-19 vaccination and menstrual cycle characteristics in an internet-based prospective cohort study. We included a sample of 1,137 participants who enrolled in Pregnancy Study Online (PRESTO), a preconception cohort study of couples trying to conceive, during January 2021-August 2022. Eligible participants were aged 21-45 years, United States or Canadian residents, and trying to conceive without fertility treatment. At baseline and every 8 weeks for up to 12 months, participants completed questionnaires on which they provided information on COVID-19 vaccination and menstrual cycle characteristics, including cycle regularity, cycle length, bleed length, heaviness of bleed, and menstrual pain. We fit generalized estimating equation (GEE) models with a log link function and Poisson distribution to estimate the adjusted risk ratio (RR) for irregular cycles associated with COVID-19 vaccination. We used linear regression with GEE to estimate adjusted mean differences in menstrual cycle length associated with COVID-19 vaccination. We adjusted for sociodemographic, lifestyle, medical and reproductive factors. Participants had 1.1 day longer menstrual cycles after receiving the first dose of COVID-19 vaccine (95 % CI: 0.4, 1.9) and 1.3 day longer cycles after receiving the second dose (95 % CI: 0.2, 2.5). Associations were attenuated at the second cycle post-vaccination. We did not observe strong associations between COVID-19 vaccination and cycle regularity, bleed length, heaviness of bleed, or menstrual pain. In conclusion, COVID-19 vaccination was associated with a ∼1 day temporary increase in menstrual cycle length, but was not appreciably associated with other menstrual cycle characteristics.

Carcinogenesis and management of human papillomavirus-associated cervical cancer

Approximately 95% of cervical cancer are caused by human papillomavirus (HPV) infection. Although it is estimated that HPV-associated cervical cancer will decrease with the widespread use of HPV vaccine, it may take time for HPV-associated cervical cancer to be eliminated. For the appropriate management of HPV-associated cervical cancer, it is important to understand the detailed mechanisms of cervical cancer development. First, the cellular origin of most cervical cancers is thought to be cells in the squamocolumnar junction (SCJ) of the uterine cervix. Therefore, it is important to understand the characteristics of SCJ for cervical cancer screening and treatment. Second, cervical cancer is caused by high risk HPV (HR-HPV) infection, however, the manner of progression to cervical cancer differs depending on the type of HR-HPV: HPV16 is characterized by a stepwise carcinogenesis, HPV18 is difficult to detect in precancerous lesions, and HPV52, 58 tends to remain in the state of cervical intraepithelial neoplasia (CIN). Third, in addition to the type of HPV, the involvement of the human immune response is also important in the progression and regression of cervical cancer. In this review, we demonstrate the carcinogenesis mechanism of HPV-associated cervical cancer, management of CIN, and the current treatment of CIN and cervical cancer.

COVID-19 vaccine side effects on menstrual disturbances among Iranian women

Background

Many studies reported of menstrual disturbances as possible side effects of COVID-19 vaccination. Our objective was to evaluate the association between vaccination and the occurrence of menstrual disturbances among Iranian women.

Methods

We used to google form questionnaires to collect reports of menstrual disturbances from 455 women aged 15-55 years in Iran. We estimated the relative risk of menstrual disturbances according to vaccination in a self-controlled case-series design after vaccination. We examined the occurrence of such disorders after the first, second and third doses of vaccine.

Results

Findings The prevalence of menstrual disturbance was more in latency and heavy bleeding than others disorder after vaccination, although ֮ %50 of women doesn't have any disturbance. We observed increased risks after vaccination also for other menstrual disturbances, in menopausal women too (>10%).

Discussion

Menstrual disturbances were generally common regardless of vaccination. We found a significant increase in menstrual disturbances after vaccination, particularly for latency and heavier bleeding than usual, longer duration and for short interval between menstruations. Mechanisms underlying these findings may involve bleeding disturbances in general, as well as endocrine alterations of immune system stimulation and relation to hormonal secretion.

Association between SARS-CoV-2 vaccination and healthcare contacts for menstrual disturbance and bleeding in women before and after menopause: nationwide, register based cohort study

OBJECTIVES

To evaluate the risks of any menstrual disturbance and bleeding following SARS-CoV-2 vaccination in women who are premenopausal or postmenopausal.

DESIGN

A nationwide, register based cohort study.

SETTING

All inpatient and specialised outpatient care in Sweden from 27 December 2020 to 28 February 2022. A subset covering primary care for 40% of the Swedish female population was also included.

PARTICIPANTS

2 946 448 Swedish women aged 12-74 years were included. Pregnant women, women living in nursing homes, and women with history of any menstruation or bleeding disorders, breast cancer, cancer of female genital organs, or who underwent a hysterectomy between 1 January 2015 and 26 December 2020 were excluded.

INTERVENTIONS

SARS-CoV-2 vaccination, by vaccine product (BNT162b2, mRNA-1273, or ChAdOx1 nCoV-19 (AZD1222)) and dose (unvaccinated and first, second, and third dose) over two time windows (one to seven days, considered the control period, and 8-90 days).

MAIN OUTCOME MEASURES

Healthcare contact (admission to hospital or visit) for menstrual disturbance or bleeding before or after menopause (diagnosed with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes N91, N92, N93, N95).

RESULTS

2 580 007 (87.6%) of 2 946 448 women received at least one SARS-CoV-2 vaccination and 1 652 472 (64.0%) 2 580 007 of vaccinated women received three doses before the end of follow-up. The highest risks for bleeding in women who were postmenopausal were observed after the third dose, in the one to seven days risk window (hazard ratio 1.28 (95% confidence interval 1.01 to 1.62)) and in the 8-90 days risk window (1.25 (1.04 to 1.50)). The impact of adjustment for covariates was modest. Risk of postmenopausal bleeding suggested a 23-33% increased risk after 8-90 days with BNT162b2 and mRNA-1273 after the third dose, but the association with ChAdOx1 nCoV-19 was less clear. For menstrual disturbance or bleeding in women who were premenopausal, adjustment for covariates almost completely removed the weak associations noted in the crude analyses.

CONCLUSIONS

Weak and inconsistent associations were observed between SARS-CoV-2 vaccination and healthcare contacts for bleeding in women who are postmenopausal, and even less evidence was recorded of an association for menstrual disturbance or bleeding in women who were premenopausal. These findings do not provide substantial support for a causal association between SARS-CoV-2 vaccination and healthcare contacts related to menstrual or bleeding disorders.

The effects of Covid-19 mRNA vaccine on adolescence gynecological well-being

KEY MESSAGE

Menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, however, the ovarian reserve estimated by AMH is not compromised.

BACKGROUND

Recent studies have suggested that the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine causes menstrual abnormalities which led to concerns regarding its influence on the reproductive system. This study aims to investigate the influence of the SARS-CoV-2 mRNA vaccine on gynecologic well-being and future fertility of adolescent girls.

METHODS

This is a prospective cohort study conducted at a university affiliated medical center between June and July 2021. Adolescent girls aged 12-16 years who were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart) were included in the study. All participants completed a computerized questionnaire regarding their general medical and gynecological background at recruitment and 3 months later. Blood samples were collected for AMH levels before and 3 months following the first mRNA vaccine RESULTS: The study group consisted of 35 girls, and of them, follow-up was completed by questionnaire and AMH sampling in 35 (90%) and 22 (56%) girls, respectively. Among the 22/35 girls who reported regular menstruation before vaccination, seven (31.8%) experienced irregularities post-vaccination. Four of the eight pre-menarche girls included in the study reported on menarche on follow-up. Median AMH levels were 3.09 (IQR 1.96-4.82) μg/L and 2.96 (2.21-4.73) μg/L at baseline and after 3 months, respectively (p = 0.07). After controlling for age, BMI and presentation of side effects, no association was demonstrated to the change in AMH levels (AMH2-AMH1).

CONCLUSIONS

Although menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, it seems that the ovarian reserve estimated by AMH is not compromised.

CLINICAL TRIAL REGISTRATION

National Institutes of Health (NCT04748172).

COVID-19 vaccination and menstrual disorders among women: Findings from a meta-analysis study

BACKGROUND

COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the association between the COVID - 19 vaccine and menstrual irregularities. A meta-analysis was performed to estimate the pooled prevalence of a range of menstrual disorders that may occur in women following COVID - 19 vaccination.

METHODS

After searching for epidemiological studies, we systematically performed a meta-analysis on PubMed/Medline, EMBASE, and Science Direct. Sixteen studies were finally included in the study. We estimated the pooled prevalence and corresponding 95 % confidence intervals (CIs) for a group of menstrual disorders, including menorrhagia, polymenorrhea, abnormal cycle length, and oligomenorrhea. Heterogeneity was assessed using the I² statistic and the Q test.

RESULTS

Overall, the pooled prevalence of menorrhagia was 24.24 % (pooled prevalence 24.24 %; 95 % CI: 12.8-35.6 %). The pooled prevalence of polymenorrhea was 16.2 % (pooled prevalence: 16.2 %; 95 % CI: 10.7-21.6 %). The pooled prevalence of abnormal cycle length was relatively lower than that of the other disorders (pooled prevalence: 6.6 %; 95 % CI: 5.0-8.2 %). The pooled prevalence of oligomenorrhea was 22.7 % (95 % CI: 13.5-32.0 %).

CONCLUSION

The findings indicate that menorrhagia, oligomenorrhea, and polymenorrhea were the most common menstrual irregularities after vaccination. The findings also suggest that a relatively high proportion of women suffer from menstrual irregularities. Further longitudinal studies are needed to confirm the causal relationship between COVID-19 vaccination and menstrual irregularities.

National surveillance data analysis of COVID-19 vaccine uptake in England by women of reproductive age

Women of reproductive age are a group of particular concern with regards to vaccine uptake, related to their unique considerations of menstruation, fertility, and pregnancy. To obtain vaccine uptake data specific to this group, we obtained vaccine surveillance data from the Office for National Statistics, linked with COVID-19 vaccination status from the National Immunisation Management Service, England, from 8 Dec 2020 to 15 Feb 2021; data from 13,128,525 such women at population-level, were clustered by age (18-29, 30-39, and 40-49 years), self-defined ethnicity (19 UK government categories), and index of multiple deprivation (IMD, geographically-defined IMD quintiles). Here we show that among women of reproductive age, older age, White ethnicity and being in the least-deprived index of multiple deprivation are each independently associated with higher vaccine uptake, for first and second doses; however, ethnicity exerts the strongest influence (and IMD the weakest). These findings should inform future vaccination public messaging and policy.

Abnormal Uterine Bleeding Among COVID-19 Vaccinated and Recovered Women: a National Survey

The objective of this research was to characterize menstrual changes including amount, duration, and frequency among COVID-19 vaccinated and infected women. We conducted an online nationwide questionnaire survey on premenopausal, non-pregnant women over 18 years of age in Israel, querying about any changes in their menstrual patterns after COVID-19 vaccination or infection. In total, 10,319 women responded, of which 7904 met the inclusion criteria. Changes in menstrual patterns following COVID-19 vaccination or infection were reported in 3689/7476 (49.3%) women compared with 202/428 (47.2%) women, respectively, (P = .387). The most commonly described menstrual disturbance was excessive bleeding (heavy, prolonged, or intermenstrual) in both the vaccinated and infected groups, (80.6% versus 81.4%, respectively, P = .720). Among women who experienced abnormal uterine bleeding (AUB), in most cases (61.1%), it occurred between the vaccination and the ensuing menstrual period. Menstrual disturbances were similar in type among the vaccinated and infected women. In conclusion, AUB emerged as a side effect of the BNT162b2 vaccine and a symptom of the COVID-19 infection and was characterized mainly by excessive bleeding. Although the precise incidence could not be determined in this study, the type of bleeding disorder as well as the characterization of risk factors including increasing age and a baseline menstrual pattern of prolonged, frequent, and heavy menses are well defined. The incidence and the long-term consequences of the BNT162b2 vaccine on uterine bleeding warrant further investigation.

Imprecision in adverse event reports following immunization against HPV in Japan and COVID-19 in the USA, UK, and Japan-and the effects of vaccine hesitancy and government policy

INTRODUCTION

Erroneous reports of adverse events following immunization (AEFIs) likely exacerbated the 2013 collapse of Japan's HPV immunization program. A similar phenomenon characterized the first months of COVID-19 immunization programs in the USA, UK, and Japan with high rates of reported anaphylaxis. These reports illustrate the susceptibility of supposedly objective medical judgments to public anxiety.

PURPOSE AND METHODS

This study documents inaccuracies in reported AEFIs using three quantitative methods.

RESULTS

One of these quantitative methods revealed that false-positive rates for anaphylaxis reports following HPV and later COVID-19 vaccination ranged from 74 to 91 percent. However, unlike HPV vaccinations in Japan, anaphylaxis reports following COVID-19 vaccines fell in Japan, the USA and the UK in the latter months of 2021. Nevertheless, false-positive rates for anaphylaxis reports remained high, suggesting a high degree of imprecision in serious AEFI reports from many countries for many vaccines. Japan's HPV immunization program indicates that media reports, patient hesitancy, healthcare providers' perspectives on vaccine safety, and consistency of government messaging, all influence report number and accuracy. A parallel publication analyzes in depth how such factors affect AEFI reports.

CONCLUSION

Confidence in the safety of the COVID-19 vaccines may have been bolstered trough rapid monitoring of AEFI reports and communication of these findings. This may partly explain the different trajectories of serious AEFI following HPV immunizations in Japan and COVID-19 immunizations in the USA, UK, and Japan.

Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to?

According to the WHO, as of January 2023, more than 850 million cases and over 6.6 million deaths from COVID-19 have been reported worldwide. Currently, the death rate has been reduced due to the decreased pathogenicity of new SARS-CoV-2 variants, but the major factor in the reduced death rates is the administration of more than 12.8 billion vaccine doses globally. While the COVID-19 vaccines are saving lives, serious side effects have been reported after vaccinations for several premature non-communicable diseases (NCDs). However, the reported adverse events are low in number. The scientific community must investigate the entire spectrum of COVID-19-vaccine-induced complications so that necessary safety measures can be taken, and current vaccines can be re-engineered to avoid or minimize their side effects. We describe in depth severe adverse events for premature metabolic, mental, and neurological disorders; cardiovascular, renal, and autoimmune diseases, and reproductive health issues detected after COVID-19 vaccinations and whether these are causal or incidental. In any case, it has become clear that the benefits of vaccinations outweigh the risks by a large margin. However, pre-existing conditions in vaccinated individuals need to be taken into account in the prevention and treatment of adverse events.

The effect of BNT162b2 SARS-CoV-2 mRNA vaccine on menstrual cycle symptoms in healthy women

OBJECTIVE

To investigate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA BNT162b2 vaccine on women's menstrual cycle.

METHODS

In this questionnaire-based cross-sectional study, we assessed menstrual pattern and changes in women who completed the SARS-CoV-2 mRNA BNT162b2 vaccine 3 months before and after receiving the vaccine. Included were women aged 18-50 years without known gynecologic comorbidities who regularly monitor their menstruation through electronic calendars. All participants competed a detailed questionnaire on their menstrual symptoms including information on any irregular bleeding. To minimize bias, each woman served as a self-control before and after vaccination. Primary outcome was rate of irregular bleeding following vaccination and secondary outcome was presence of any menstrual change, including irregular bleeding, mood changes, or dysmenorrhea following the vaccine.

RESULTS

A total of 219 women met the inclusion critieria. Of them, 51 (23.3%) experienced irregular bleeding following the vaccine. Almost 40% (n = 83) of study participants reported any menstrual change following vaccination. Parity was positively asssociated with irregular bleeding with 26 (50%) of those suffering from irregular bleeding being multiparous compared with only 53 (31.5%) of women with no irregular bleeding (nulliparous 46% vs 60%, multiparous 50% vs 31%, rest 4% vs 8%, P = 0.049). The presence of medical comorbidities was also significantly higher among patients who experienced irregular bleeding (20.0% vs 6.0%, P = 0.003).

CONCLUSION

Our study shows relatively high rates of irregular bleeding and menstrual changes after receiving the SARS-CoV-2 mRNA BNT162b2 vaccine. Further research is needed to confirm our findings and to better characterize the magnitude of change and any possible long-term implications.

Long-term adverse events of three COVID-19 vaccines as reported by vaccinated physicians and dentists, a study from Jordan and Saudi Arabia

Assessment of safety of COVID-19 vaccines is an ongoing process. This study aims to explore long-term adverse events reported by physicians and dentists who received at least two COVID-19 vaccine doses. A group of physicians and dentists were invited to complete a validated questionnaire that was composed of items on: socio-demographics, medical history, administered vaccines, and long-term adverse events (LTAE). Data of a total of 498 practitioners were included. Age ranged from 22 to 71 years (mean age= 35.75 ± 11.74) with a female majority (N = 348, 69.9%). The most frequently administered vaccines were Pfizer-BioNtech, Sinopharm and AstraZeneca vaccines. A total of 80 (16.0%) participants reported LTAEs which were mainly fatigue, menstrual disturbances, myalgia, arthralgia, dizziness, and headache (N = 32, 15, 8, 6, 4, and 4, respectively). There was no statistically significant association between LTAEs and: age, gender, or medical history (P > .05). The collective symptoms of fatigue, myalgia, arthralgia, dizziness, and headache were significantly associated with Sinopharm vaccine (P = .04). This was further confirmed by general linear multivariate model analysis. Less than 20% of COVID-19 vaccine recipients may complain of LTAEs that are mostly fatigue-related. It seems that factors such as age, gender, and medical status play a negligible role in development of these AEs. On the other hand, Sinopharm vaccine showed the highest significant association with these AEs followed by AstraZeneca vaccine.

A favorable impression of vaccination leads to a better vaccination rate for the human papillomavirus vaccine: A Japanese questionnaire survey investigation

Background

The Japanese vaccination rate for infants and children is seemingly excellent, except for the human papillomavirus (HPV) vaccine. Regardless of its efficacy, the inoculation rate in Japan has dropped to approximately 1 % since 2013 because of negative information about vaccine side effects. We aimed to demonstrate the factors that lead to low vaccine acceptance rates (e.g., caregiver attitudes, popular misconceptions) to inform the relevant target demographic of a stronger intention to immunize and to facilitate recovery of HPV vaccine coverage.

Methods

We conducted this study using data from two questionnaire surveys. Statistical analyses of factors affecting vaccine impressions and mediation effects of HPV vaccine impressions were performed. The difference in the knowledge about each vaccine was evaluated.

Results

Of the respondents, 95.9 % reported their intent to vaccinate their infants, whereas 58.2-78.3 % felt that they sufficiently understood the aims, efficacy, and risks of vaccination and 66.6 % had a positive impression of vaccines. Overall, 21.3 % of parents responded that they planned to have their child vaccinated against HPV, and 25.8 % had a favorable impression of this vaccine. Among factors affecting vaccine impressions, we found that parents had anxiety about vaccines when they felt that their knowledge of vaccines was insufficient. Additionally, impressions of the HPV vaccine had a mediating effect on the association between the impressions of infant vaccines and parents' intent to provide the vaccine to their children.

Conclusion

These findings show that as a society, we need to improve impressions and knowledge regarding vaccines, including but not exclusively the HPV vaccine. Moreover, although the recovery of HPV vaccine coverage is strongly desired for improving public health, simply improving impressions about the HPV vaccine or educating parents with substantive knowledge is insufficient. Instead, improving impressions and understanding of the vaccination itself is necessary.

High rates of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic in Japan

This study aimed to 1) determine the prevalence and contents of vaccine hesitancy among pregnant women during the coronavirus disease 2019 (COVID-19) pandemic and 2) evaluate its association with maternal sociodemographic factors. A cross-sectional survey was conducted between August and December 2020 among pregnant women between 28 and 32 weeks of gestation who received antenatal care at four clinics and hospitals in Niigata City, Japan. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines survey, and associations between vaccine hesitancy and sociodemographic factors were analyzed. In total, 113/200 (56.5%) subjects responded to the survey. Overall, 46/113 (40.7%) pregnant women were resistant or hesitant to receive the vaccine. Women with vaccine hesitancy were more likely to fear adverse reactions (concern 79.6%, not concerned 15.9%, and not sure 4.4%), safety (concerned 69.0%, not concerned 23.9%, and not sure 7.1%), and efficacy (concerned 47.8%, not concerned 35.4%, and not sure 16.8%) compared to those without vaccine hesitancy (P < .01, < .01, and <.01, respectively). In the multivariate logistic regression analyses, primipara women had higher rates of vaccine hesitancy than multipara pregnant women (odds ratio: 2.38, P = .04). In conclusion, the prevalence of vaccine hesitancy among pregnant Japanese women, especially primipara women, was higher than that in other countries during the COVID-19 pandemic. Their major concerns were adverse reactions, safety, and the efficacy of childhood vaccines. Further strategies are needed to provide appropriate vaccine information to prevent vaccine-preventable diseases in both infants and children.

Survey of pediatricians concerning the human papillomavirus vaccine in Japan: Positive attitudes toward vaccination during the period of proactive recommendation being withheld

In 2013, the human papillomavirus (HPV) vaccine was introduced as a national immunization program in Japan. However, because of a wide range of symptoms after vaccination, the Japanese Ministry of Health, Labor and Welfare decided to withhold proactive recommendations, a situation that has continued for more than eight years. During the withholding, absent any scientific or epidemiological evidence to support a relationship between HPV vaccines and symptoms, we surveyed pediatricians at Osaka Pediatric Association and analyzed the changing of attitudes in 2020 (n = 200) and 2021 (n = 190). A total of 44.5% respondents in 2020 and 67.9% in 2021 offered HPV vaccination to targets at the time the questionnaire was administered, indicating that the rate of pediatricians providing vaccines had increased significantly (p < .001). A total of 74.0% of respondents in 2020 and 77.9% in 2021 had a positive opinion of HPV vaccination (p = .369), and 64.3% in 2020 and 78.3% in 2021 were "not at all concerned or had almost no concern" about HPV vaccination (p = .002). These results suggest that, in general, most physicians who are primarily responsible for HPV vaccination in a given field had a positive attitude toward vaccination during the proactive recommendation having been withheld.