子宮頸がんワクチンの副反応と神経障害

Neurologic Complications in HPV Vaccination

2013年6月〜2015年3月までの期間に，われわれは子宮頸がんワクチン接種後の副反応を呈している76名の女児を診察した。主症状は頭痛，全身倦怠感，四肢の筋力低下，立ちくらみ，起床困難，手足の疼痛であり，初回接種から本症状発現までの平均期間は5.5カ月であった。頭痛・全身倦怠感は起立性調節障害，四肢の疼痛は複合性局所疼痛症候群（CRPS）の症状として説明可能であり，病態の背景には末梢性交感神経障害が存在すると考えている。

Abstract

A relatively high incidence of chronic limb pain, frequently complicated by violent, tremulous involuntary movements, has been noted in Japanese girls following human papillomavirus vaccination. The average incubation period after the first dose of the vaccine was 5.47 ± 5.00 months. Frequent manifestations included headaches, general fatigue, coldness of the feet, limb pain, and weakness. The skin temperature of the girls with limb symptoms was slightly lower in the fingers and moderately lower in the toes. Digital plethysmograms revealed a reduced peak of the waves, especially in the toes. Limb symptoms of the affected girls were compatible with the diagnostic criteria for complex regional pain syndrome. The Schellong test identified a significant number of patients with orthostatic hypotension and a few with postural orthostatic tachycardia syndrome. Electron-microscopic examinations of the intradermal nerves showed an abnormal pathology in the unmyelinated fibers in two of the three girls examined. The symptoms observed in this study can be explained by abnormal peripheral sympathetic responses. The most common previous diagnosis in the patients was psychosomatic disease. Recently, delayed manifestation of cognitive dysfunction in the post-vaccinated girls has attracted attention. The symptoms include memory loss and difficulty in reading textbooks and/or calculation.