A natural language processing framework to analyse the opinions on HPV vaccination reflected in twitter over 10 years (2008 - 2017)

Figures & data

Figure 1. An NLP framework for HPV tweets analysis.

Figure 2. Example of sentiment analysis.

Figure 3. Example of entity extraction and analysis.

Table 1. Number of tweets of each year.

Year	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017
Number	581	11372	14895	41571	27865	48203	33278	40898	35600	32837

Figure 4. Boxplot of sentiment scores changes over 10 years.

Figure 5. (a) Phrase cloud of positive tweets. (b) Phrase cloud of negative tweets.

Table 2. Sample positive and negative tweets contain “CDC”, “FDA”, or “MERCK”.

Entity	Sentiment	Sample Tweets (year)
“CDC”	Positive	CDC Panel Recommends HPV Vaccine Cervarix For Girls, Optional Gardasil Vaccination For Boys (2009) The CDC considers Gardasil safe and effective and says its side effect profile is comparable to other vaccines. (2013) RT opa1: HPV vaccines protect against types of HPV that cause cervical cancer. CDC recommends that girls & boys aged 11–12 get three … (2013) Via @NPR: CDC Endorses A More Effective #HPV Vaccine To Prevent Cancer (2016)
	Negative	10–21-10 VAERS Data for HPV Vaccines. How many deaths will it take for the CDC and FDA to take notice. (2010) A Plea to Merck, FDA & CDC to take action & stop all Gardasil vaccination. The evidence of harm caused by Gardasil … (2011) Updated: In latest vaccine marketing fraud, CDC says Gardasil shots should be ’routine’ for boys (2012) #Gardasil kills more than the thing its suppose to protect us against. #fda #cdc why is it still on the market??? (2013) I advised against the Gardasil vaccine 3 yrs ago. NOW the CDC says OOPS only 2, NOT 3 shots needed: Maybe need 0. (2017)
“FDA”	Positive	FDA approves Gardasil for boys, young men (2009) FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV: (2014) It’s CervicalCancer Awareness Month. Learn about 3 US FDA approved HPV vaccines that can prevent it. (2016) Great news that the China FDA has approved two types of HPV vaccines in mainland China. I imagine it is still a bit cost–prohibitive for many. (2017)
	Negative	New Blog post FDA Again Says No to Expanded Gardasil Vaccine Use … (2009) FDA Records Detailing 16 New Deaths Tied 2 Gardasil: serious reports, w/213 resulting in permanent disability. (2010) FDA approves Gardasil vaccine: Gardasil will not prevent the development of anal precancerous lesions associated … (2011) HEALTH ALERT! #Merck won’t explain why 100s of #girls are having #seizures months/yrs after #Gardasil #HPV #vaccine #FDA #CDC (2012) Israel Health Ministry Considers Cancelling HPV Vaccination Due to Side Effects … Israeli scientists, had warned the FDA & CDC about the … (2013) VAERS shows almost 1000 Disabled from Gardasil that is with 1–10% reporting, wake up America our kids are sick FDA does nothing (2013) @SaneVaxx 40 young women died in the trials of #HPV #vaccines it should have been banned according to #FDA protocols. (2017)
“MERCK”	Positive	Canada Drugstore FDA Approves GARDASIL(R) For Use In Boys And Young Men: Merck & Co., Inc. ann. (2009) RT fwpharma: Two doses of Merck & Co.’s Gardasil as effective as three doses in young girls, study finds (2013) Top 5 Vaccines by 2020–1) Prevnar pfizer 2) Pentacel sanofi 3) Gardasil Merck 4) Fluzone sanofi 5) Pediarix GSK (2014) Merck Systematic Review of 58 Publications of Real-World Use of GARDASIL Presented at EUROG … Read more: (2016)
	Negative	U.S. denies approval to expand use of Gardasil vaccine: The U.S. Food and Drug Administration has asked Merck & . (2009) New blog post: Merck Researcher Admits: Gardasil Guards Against Almost Nothing (2010) Not only were the Gardasil manufacturers Merck and other promoters unaware of the presence of dangerous … (2012) US court pays $6 million to Gardasil victims: Sorry Merck You Bastards Got Caught, “It’s Not Safe” (2013) PARENTS Question the Vaccine! Was Merck Deceitful about Research Concerning Ovarian Failure and GARDASIL VACCINE? (2017)

Figure 6. Frequency of “CDC”, “FDA” and “Merck” in the positive and negative tweets.

Table 3. Top frequent location entities in positive tweets.

Year	Location (Frequency)	Sample Tweets
2010	Island (4)	HPV vaccination high among Maori and Island women: Young Maori and Pacific Island women are leading the way in the … HPV vaccination high among Maori and Island women: … Island women are leading the way in the uptake of the HPV
2011	Europe (18)	Europe authorizes the use of an HPV vaccine in children: Gardasil can be administered to children from … Europe authorizes use of papillomavirus vaccine in children and young people. “Gardasil” Prevents diseases linked to HPV and its propagation Europe approves papilloma vaccination for men with Gardasil. What good! Now, to see if we are financed like women.
2012	Europe (14)	HPV vaccine now use to protect schoolgirls – Pharmacy Europe: … EU advises all girls need HPV vaccines: All girls in Europe should be immunised against the … ECDC updated guidance on HPV vaccination in Europe: Focus on reaching all girls
2013	Africa (11)	$5/dose Gardasil for 8 countries in Asia/Africa, to vaccinate abt 180K girls GAVIAlliance could you talk about GAVI’s efforts to expand HPV vaccines to southern Africa to prevent cervical cancer? “This is an important moment for Kenyan women” HPV Vaccines reach #Kenya! Important step for #womenshealth in #Africa
2014	Europe (95)	Europe approves the indication of ‘Gardasil’ (Sanofi Pasteur MSD) for the prevention of anal cancer RT WHO Europe VPI: Ireland achieved 81.9% uptake among 12–yr–old girls in 1st yr of HPV vaccination. Gardasil: New 2–dose Schedule Granted Positive CHMP Opinion for Europe’s Leading HPV Vaccine The European Union gives the green light to the indication of the Gardasil vaccine against HPV for the prevention of cancer …
2015	Europe (100)	Vaccine. Organization and quality of HPV vaccination programs in Europe. May 14, 2015 More than 200 doctors across Europe are calling for a halt on the routine use of the HPV vaccination Europe recommends Gardasil 9, a new HPV vaccine that covers 5 additional antigens for immunization HPV vaccination for boys gets strong backing at European Cancer Conference today ECC2015
2016	Northern Cape (11)	Northern Cape wakes up to HPV vaccination for girls Northern Cape Resumes HPV Vaccination
2017	Europe (6)	Breakthroughs like HPV vaccination help to prevent cervical cancer affecting more than 58,000 women in Europe every year WHO Europe resource Talking with patients & parents about HPV vaccination for girls

Table 4. Top frequent location entities in negative tweets.

Year	Location (Frequency)	Sample Tweets
2010	Europe (2)	@SonyaVanSickle My mistake. Gardasil is still sold in Europe @SonyaVanSickle AGREED! What are people thinking with Gardasil? From my understanding Europe has even dropped the drug as too dangerous.
2011 2012 2013	America (7) Europe (3) Southern US (14)	RT Americas Hope Gardasil boys come marching in – 4 new Gardasil deaths reported to VAERS PP/Vaccine shills now pushing Gardasil jab on teens who don’t even have sex. Europe Requires Warning Labels on Foods with Artificial Colors HPV vaccination rates alarmingly low among young women in Southern US Why is the HPV vaccination less likely to happen in the south? HPV vaccination less likely to happen in South than elsewhere: Initiation and completion rates for the human p … Be careful in the South! HPV vaccination rates alarmingly low among young women in Southern US
2015	Central and South America (23)	HPV Vaccines: Updates from Central and South America. First Reported Fatality after Gardasil in Colombia HPV Vaccine Injuries and Deaths Now Being Reported from Central and South America. HPV Gardasil vaccines
2017	Europe (5)	Gardasil is being banned in Europe because of the high rate of vaccine related injury China and Japan both stopped gardasil cause of severe reactions.Europe does not have the same as Us schedule. we push double the vaccines

Table 5. Phrase association mining for negative tweets.

Year	Keyword	Associated Phrase	Association Score	Tweets
2008	immunization	kill	0.905	Gardasil HPV vaccine for girls kills teens; do a ‘google’ or ‘yahoo’ search;
2009	Gardasilbeware	danger	0.543	The Latest News About Gardasil Vaccine Danger From Gardasilbeware
	raise concerns	safety continues	0.948	Gardasil safety continues to raise concerns
	Gardasil	deaths	0.871	28 Deaths Tied To Gardasil, Watchdog Says -
2010	vaccine	people concerned	0.543	Gardasil vaccine for cervical cancer unproven and dangerous.
	vaccine	adverse reactions	0.264	Gardasil HPV vaccine touted to fight cervical cancer, has killed 71 girls and caused thousands of adverse reactions.
	Gardasil	death	0.854	Vaccines-Cervarix, Gardasil, Death, And Extreme Side Effects
2011	gardasil	injured	0.521	1000s Injured gardasil learn more truthaboutgardasil.org kids are DYING Merck do something FDAmedwatch cdc health girls boys cancer
2012	hpv vaccines	injured	0.348	FDArecalls how about recalling Gardasil, 25,548 have been injured and 111 are DEAD! woman boys HPV Vaccines CDC Merck health girls
	vaccine marketing	marketing fraud	0.515	In latest vaccine marketing fraud, CDC says Gardasil shots should be ’routine’ for boys
	Gardasil	adverse reaction	0.519	there are so many adverse reaction to Gardasil but the media does not publish them.
2013	cervical cancer	serious adverse	0.371	Gardasil has been associated with as many serious adverse events as there are deaths from cervical cancer developing per year
	Gardasil	fraudulent	0.588	Most Gardasil ’safety’ data discovered to be fraudulent HPV vaccine cervarix
2014	vaccines	deaths	0.272	Supreme Court in #India to Rule on #Merck Fraud Regarding #HPV #Vaccine Deaths
2015	Gardasil	scandal	0.311	6248 Permanent Injuries and 144 Deaths Following Gardasil HPV Vaccine: Coincidence or Scandal?
2016	faulty vaccines	injuries caused	0.531	Irish teens taking on Gardasil manufacturers after suffering from long-term injuries caused by the faulty vaccines
	HPV vaccine	killed	0.312	Gardasil exposed: HPV vaccine is being tested on infants it has killed permanently injured thousand
	HPV vaccines	adverse effects	0.871	HPV Vaccines account for over 44% of all adverse reactions.
2017	HPV vaccines	side effects	0.363	the side effects for the hpv vaccines are so annoying i do not recommend

Table 6. Phrase association mining for positive tweets.

Year	Keyword	Associated Phrase	Association Score	Tweets
2008	cervical cancer	prevents	0.811	@violetblue I have one (of three) Gardasil shot to go, nice to know it could possibly prevent other nasties other than cervical cancer!
2009	continued vaccination	agency recommends	0.958	Published a new post: European Medicines Agency Recommends Continued Vaccination With Gardasil
	cervical disease	at preventing	0.642	Buy Vemma Merck’s Gardasil Effective At Preventing HPV, Cervical Disease In Older Women, Study Finds: M.
2010	cervical cancers	included in	0.519	Two human papillomavirus types included in HPV vaccines cause 71% of cervical cancers
2011	cervical legions	evidence summary	0.630	Immunization News! Evidence summary shows HPV vaccination is helping prevent cervical legions in young women
2012	vaccination campaigns	best practices	0.803	MT Video webinars on best practices from HPV vaccination campaigns in LMIC countries from Cervical Cancer
	cervical cancers	cause most	0.793	Two vaccines, Cervarix and Gardasil, protect against most of the types of HPV that cause most cervical cancers
2013	vaccinations valuable	anal	0.789	hpv vaccinations valuable protection for boys too – protects against anal, penile, neck cancers
	vaccination rates	hpv vaccination	0.405	Great project in Kentucky to try and boost HPV vaccination rates!
2014	reduces cervical	lesion	0.953	HPV Vaccination Reduces Cervical Lesion Risk at Population Level: Cohort study in Denmark shows reduction in r …
2015	newer vaccinations	over time	0.942	@AJemaineClement @djnrrd We need unbiased, longer studies, and monitor over time. Especially on the newer vaccinations like Gardasil.
2016	cervical cancers	whole range	0.404	Ladies, protect yourselves against a whole range of cervical cancers by starting on an HPV vaccination course today!
2017	cervical screens	lifetime	0.670	HPV vaccination means women only need three cervical screens in a lifetime, study suggests …