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Their symptoms improved after the intravenous administration of methylprednisolone, with no sign of relapse.

The authors estimated a prevalence of 0.05 per 100,000 for ADEM after the HPV vaccine administration in Japan, according to the data from the Pharmaceutical and Medical Devices Agency (PMDA; c.f.

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RNs and LPNs: For renewal of a three year license, the requirement is 36 contact hours.

For renewal of a license that has been issued for less than three years, the requirement is 24 contact hours.

Makoto Yoneda Graduate School of Nursing and Social Welfare Sciences, Fukui Prefectural University, Japan The immunization of adolescent girls with the human papilloma virus (HPV) vaccines, a bivalent CervarixⓇ and a quadrivalent GardasilⓇ, has been widely introduced to prevent uterine and cervical cancer (1).

Since the regulatory approval of the first quadrivalent HPV vaccine in 2006 and later the bivalent HPV vaccine, as of 2011, about 120 million doses have been distributed worldwide (1).

0.1-0.2 per 100,000 of post-vaccination ADEM in total) (8), and emphasized the importance of further data accumulation in their survey of the relationship between the HPV vaccines and ADEM (7).

In a large epidemiologic study, ADEM preceded by vaccination was infrequent but not rare (around 5%) (9) and tended to occur after the booster vaccination rather than after the first application, just as in the cases reported in this issue (6, 7).

These adverse effects comprise varied clinical manifestations, such as orthostatic intolerance; postural tachycardia syndrome; pain or coldness of ambiguous origin in the limbs, as with complex regional pain syndrome; involuntary movements; abnormal behavior resembling psychosis; headaches; general fatigue; Guillain-Barré syndrome; acute cerebellar ataxia; and acute disseminated encephalomyelitis (ADEM) (2-6). reported two cases of ADEM after the administration of HPV vaccines in this issue (7).

Both patients presented with neurological symptoms after the second administration of the HPV vaccine.

The Mandatory Abuse Course taken to meet this requirement MUST be a course that has been approved by the Public Health Abuse Education Review Panel.

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