key: cord-0872614-384l595p authors: Katz, A.; Tepper, Y.; Eran, A.; Birk, O. title: Web and social media searches highlight menstrual irregularities as a global concern in COVID-19 vaccinations date: 2022-02-01 journal: nan DOI: 10.1101/2022.01.30.22270125 sha: ec790edadcd1a323245830a6144c524ceab16b93 doc_id: 872614 cord_uid: 384l595p Background: Delineation of public concerns that prevent vaccine compliance is a major step in generating assurances and enhancing the success of COVID-19 prevention programs. We therefore sought to identify public concerns associated with COVID-19 vaccines, as reflected by web and social media searches, with a focus on menstrual irregularities. Methods: We used trajectory analyses of web and social media search data in combination with global COVID-19 data to reveal time-dependent correlations between vaccination rates and the relative volume of vaccine and period related searches. Results: A surge of period and vaccine related google searches followed the commencement of vaccination programs in English speaking countries, and across the United States. TikTok users were more engaged in period problems in 2021 than ever before. Conclusions: National and state-level correlations between COVID-19 vaccinations and online activity demonstrate a global major concern of vaccine-related menstrual irregularities. Whether it is a potential side effect or an unfounded worry, monitoring of web and social media activity could reveal the public perception of COVID-19 prevention efforts, which could then be directly addressed and translated into insightful public health strategies. Women around the world have reported a link between COVID-19 vaccinations and changes in their menstrual cycle regularity and intensity 1 . One of the early reports was a tweet by Kathryn Clancy, a Professor of Anthropology at the University of Illinois, which was followed by hundreds of responses of women identifying with her concerns, and in many cases reflecting on having similar menstrual irregularities following vaccination. Later reports on menstrual irregularities following vaccination were met with criticism 2 , some suggesting that pandemic-related stress might be the cause of irregularities. Antivaxxers later highlighted the worries regarding possible vaccine-induced menstrual irregularities, expanding unverified and often manipulative concerns, and promoting fears of vaccineassociated abortions and infertility 3, 4 . Recent studies have examined the effects of COVID-19 disease 5 and vaccines 6,7 on menstrual irregularities, suggesting lack of adequate reporting of such irregularities due to women's reluctance to discuss these matters with their physicians 8 . Yet whether these are anecdotal reports amplified by antivaxxers or a true uncharted association remains largely unknown. To examine the spread and magnitude of this potential link we mined web and social media search data and its relation to the specific timing of national and state-level COVID-19 vaccination drives. We used Google Trends 9 to examine the relative volume of searches for the combination of "vaccine" and "period" in English speaking countries and across the US between January 2020 and November 2021. Google Trends, a powerful tool for analyzing population behavior and trends, has been utilized in several public health studies 10 , including in relation to the COVID-19 pandemic 11, 12 . Google trends is capable of summarizing time and location-specific searches, enabling integrative spatiotemporal analyses. We also mined TikTok, a social network serving more than a billion users, 53% of whom are female and 78% of whom are under the age of 24 13 . Using Analisa.io (https://analisa.io), we examined the activity of "#periodproblems" from January 2019 to October 2021. We integrated the search data with COVID-19 vaccination data obtained from Our World In Data (https://ourworldindata.org/covid-vaccinations) and other COVID-19 aggregated statistics, including the number of cases and deaths, obtained from https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data. Our All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 1, 2022. ; python code that performs and visualizes all analyses is freely available at https://github.com/SgtTepper/CovidSearchTrends/. Specifically, it mines Google Trends via pytrends, integrates the results with COVID statistics using pandas, computes Spearman correlations, plots co-occurring multimodal data on the same timeline using seaborn, and plots relative search volume by state using plotly. In English speaking countries, the relative volume of Google searches for the combination of terms "period" and "vaccine" grew dramatically following the initiation of COVID-19 vaccination drives, with a later 3-5-fold further increase once ~50% of the population has been vaccinated (Figure 1 ). Country-specific timing of surges in "vaccine and period" related searches and its temporal relation to the local vaccination drive control for possible effects of geographic location and the local culture. Note that the analyses focused on countries sharing English as the main language, ensuring the searches were done mostly with similar wording and adequate spelling. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 1, 2022. ; Similar relations were detected within the United States (Figure 2) . Overall, Google searches for the combination of "period" and "vaccine" were frequent between October 2020 and October 2021, to a somewhat lesser extent in the mid-U.S (Figure 2A) . As exemplified in Figure 2b -2m, searches for the combined terms "period" and "vaccine" became extremely prominent with the initiation of COVID-19 vaccines in each state. Notably, further major peaks in searches for the terms "period" and "vaccine" appeared 2-6 months following initiation of vaccines, suggesting that searches did not only reflect worries, but were possibly triggered by menstrual irregularities following vaccines. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 1, 2022. ; https://doi.org/10.1101/2022.01.30.22270125 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 1, 2022. This study highlights the use of an array of social media big data analyses, combining Google Trends and TikTok (representing a significantly younger cohort), in identifying public trends preventing vaccine compliance across different states and countries. Prior studies proved retrospectively through Google trends facts that were previously known, such as the initiation of the pandemic or effects of COVID-19 disease on smell. In contrast, this study highlights social media big data analysis as an effective massive-scale tool in the initial identification and determination of adverse effects (as well as positive effects) of the COVID-19 vaccine. Moreover, it verifies the findings across various states in the U.S. and other countries, ruling out effects of local trends, climates, publicities and regulations, as well as enables delineation of different effects of the various COVID-19 vaccines given in different states or countries. Thus, web and social media analyses enable improved strategies in identifying public health concerns and determining public health policies to improve vaccine compliance. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 1, 2022. ; https://doi.org/10.1101/2022.01.30.22270125 doi: medRxiv preprint Effect of COVID-19 vaccination on menstrual periods in a retrospectively recruited cohort Women Say COVID Vaccine Side Effects Impact Their Periods, So Why Don't Doctors Care? Haaretz Opinion | The False Rumors About Vaccines That Are Scaring Women Social media influencers are spreading wild rumors about COVID-19 vaccines and periods Analysis of sex hormones and menstruation in COVID-19 women of childbearing age COVID-19 vaccination and menstrual cycle changes: A United Kingdom (UK) retrospective case-control study Association Between Menstrual Cycle Length and Coronavirus Disease 2019 (COVID-19) Vaccination: A U The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay Google Trends Syndromic Surveillance for E-Cigarette, or Vaping, Product Use-Associated Lung Injury Internet search patterns reveal clinical course of COVID-19 disease progression and pandemic spread across 32 countries. npj Digit COVID-19 predictability in the United States using Google Trends time series TikTok global creators by age 2021 Are COVID-19 vaccines safe in pregnancy? SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility Researchers will study whether the vaccines affect women's periods. The New York Times San Diego to take part in Moderna's massive COVID-19 vaccine trial -The San Diego Union-Tribune Moderna's Fully Enrolled Phase 3 COVE Study of mRNA-1273 | Moderna A Nursing Researcher's Experience in a COVID-19 Vaccine Trial