Article

Increased childhood incidence of narcolepsy in western Sweden after H1NI influenza vaccination

and Department of Pediatrics (A.S., N.D., T.H.), Institute of Clinical Sciences, University of Gothenburg, The Queen Silvia Children's Hospital, Göteborg, Sweden.
Neurology (Impact Factor: 8.3). 03/2013; 80(14). DOI: 10.1212/WNL.0b013e31828ab26f
Source: PubMed

ABSTRACT OBJECTIVES: To assess the incidence of narcolepsy between January 2000 and December 2010 in children in western Sweden and its relationship to the Pandemrix vaccination, and to compare the clinical and laboratory features of these children. METHODS: The children were identified from all local and regional pediatric hospitals, child rehabilitation centers, outpatient pediatric clinics, and regional departments of neurophysiology. Data collection was performed with the aid of a standardized data collection form, from medical records and telephone interviews with patients and parents. The laboratory and investigational data were carefully scrutinized. RESULTS: We identified 37 children with narcolepsy. Nine of them had onset of symptoms before the H1N1 vaccination and 28 had onset of symptoms in relationship to the vaccination. The median age at onset was 10 years. All patients in the postvaccination group were positive for human leukocyte antigen (HLA)-DQB1*0602. Nineteen patients in the postvaccination group, compared with one in the prevaccination group, had a clinical onset that could be dated within 12 weeks. CONCLUSION: Pandemrix vaccination is a precipitating factor for narcolepsy, especially in combination with HLA-DQB1*0602. The incidence of narcolepsy was 25 times higher after the vaccination compared with the time period before. The children in the postvaccination group had a lower age at onset and a more sudden onset than that generally seen.

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    • "Animal narcolepsy models and optogenetic device studies have shown that hypocretin maintains wakefulness, increases arousal, and suppresses REM and non-REM sleep [8] [9]. The observed association of narcolepsy with streptococcal [10] and H1N1 [11] infections and with H1N1 vaccination [12] [13] [14] [15] further supports the concept that narcolepsy is an immune-mediated disease. "
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