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Whether human papillomavirus (HPV) vaccine is more or less painful than other vaccines is uncertain. As part of a larger study on the immunogenicity of HPV vaccine, investigators randomized 72 girls (aged 9–13 years, 40%; aged 14–18 years, 60%) to receive their third dose of HPV vaccine before or after other concomitantly administered vaccines. Participants were not blinded to the vaccines they received, and staff were instructed to administer HPV vaccine in the non-dominant arm and other vaccines in the dominant arm. Pain was assessed with the Faces Pain Scale–Revised (scores, 0–10).
Overall, 52% of girls receiving HPV vaccine first versus 82% of girls receiving other injections first assigned a higher pain score to the HPV-vaccine arm compared with the other-vaccine arm (P=0.005). Among 64 girls receiving vaccines per protocol, the median pain score was lower for HPV vaccine given first versus HPV vaccine given last (2 vs. 4; P=0.022).
Walter EB et al. Pain in adolescent girls receiving HPV vaccine with concomitantly administered vaccines. Pediatr Infect Dis J 2014 Aug 28; [e-pub ahead of print] (http://dx.doi.org/10.1097/INF.0000000000000537)
Comment
We don't know if these results would hold true for the first and second HPV vaccine doses, and I wish the study design were more rigorous (including randomization of which arm gets the HPV vaccine and blinding of staff and participants). Nonetheless, the results are intriguing, and I think it is at least worth trying the approach of giving the HPV vaccine first to determine if your results match these.