Peripheral Sympathetic Nerve Dysfunction in Adolescent Japanese Girls Following Immunization with the Human Papillomavirus Vaccine.

To the Editor We write this letter to voice our concerns about methods used and impressions created regarding any possible relationship between the human papillomavirus (HPV) vaccine and adverse events following immunization (AEFI) in Japanese adolescent girls in the paper by Kinoshita et al. (1). We contend that the paper does not demonstrate any relationship between vaccination and adverse events, which are poorly-defined and include an eclectic range of symptoms. We feel that the paper’s title and stated objective may mislead the non-expert reader to conclude that such a relationship exists. Furthermore, the assertion that vaccination is “legally required” in Japan is incorrect and may add fuel to claims by the anti-vaccine movement. To reiterate, vaccinating a child against HPV in Japan is voluntary, not mandatory.