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Shichinohe S, Watanabe T. Advances in Adjuvanted Influenza Vaccines. Vaccines (Basel) 2023; 11:1391. [PMID: 37631959 PMCID: PMC10459454 DOI: 10.3390/vaccines11081391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
The numerous influenza infections that occur every year present a major public health problem. Influenza vaccines are important for the prevention of the disease; however, their effectiveness against infection can be suboptimal. Particularly in the elderly, immune induction can be insufficient, and the vaccine efficacy against infection is usually lower than that in young adults. Vaccine efficacy can be improved by the addition of adjuvants, and an influenza vaccine with an oil-in-water adjuvant MF59, FLUAD, has been recently licensed in the United States and other countries for persons aged 65 years and older. Although the adverse effects of adjuvanted vaccines have been a concern, many adverse effects of currently approved adjuvanted influenza vaccines are mild and acceptable, given the overriding benefits of the vaccine. Since sufficient immunity can be induced with a small amount of vaccine antigen in the presence of an adjuvant, adjuvanted vaccines promote dose sparing and the prompt preparation of vaccines for pandemic influenza. Adjuvants not only enhance the immune response to antigens but can also be effective against antigenically different viruses. In this narrative review, we provide an overview of influenza vaccines, both past and present, before presenting a discussion of adjuvanted influenza vaccines and their future.
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Grants
- JP16H06429, JP16K21723, JP17H05809, JP16H06434, JP22H02521, JP22H02876 Japan Society for the Promotion of Science
- JP20jk0210021h0002, JP19fk0108113, JP223fa627002, JP22am0401030, JP23fk0108659, JP22gm1610010 Japan Agency for Medical Research and Development
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Affiliation(s)
- Shintaro Shichinohe
- Department of Molecular Virology, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Tokiko Watanabe
- Department of Molecular Virology, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
- Center for Infectious Disease and Education and Research (CiDER), Osaka University, Osaka 565-0871, Japan
- Center for Advanced Modalities and DDS (CAMaD), Osaka University, Osaka 565-0871, Japan
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Kotagal S. Update on Central Hypersomnia Disorders in Children. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Buonocore SM, van der Most RG. Narcolepsy and H1N1 influenza immunology a decade later: What have we learned? Front Immunol 2022; 13:902840. [PMID: 36311717 PMCID: PMC9601309 DOI: 10.3389/fimmu.2022.902840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
In the wake of the A/California/7/2009 H1N1 influenza pandemic vaccination campaigns in 2009-2010, an increased incidence of the chronic sleep-wake disorder narcolepsy was detected in children and adolescents in several European countries. Over the last decade, in-depth epidemiological and immunological studies have been conducted to investigate this association, which have advanced our understanding of the events underpinning the observed risk. Narcolepsy with cataplexy (defined as type-1 narcolepsy, NT1) is characterized by an irreversible and chronic deficiency of hypocretin peptides in the hypothalamus. The multifactorial etiology is thought to include genetic predisposition, head trauma, environmental triggers, and/or infections (including influenza virus infections), and an increased risk was observed following administration of the A/California/7/2009 H1N1 vaccine Pandemrix (GSK). An autoimmune origin of NT1 is broadly assumed. This is based on its strong association with a predisposing allele (the human leucocyte antigen DQB1*0602) carried by the large majority of NT1 patients, and on links with other immune-related genetic markers affecting the risk of NT1. Presently, hypotheses on the underlying potential immunological mechanisms center on molecular mimicry between hypocretin and peptides within the A/California/7/2009 H1N1 virus antigen. This molecular mimicry may instigate a cross-reactive autoimmune response targeting hypocretin-producing neurons. Local CD4+ T-cell responses recognizing peptides from hypocretin are thought to play a central role in the response. In this model, cross-reactive DQB1*0602-restricted T cells from the periphery would be activated to cross the blood-brain barrier by rare, and possibly pathogen-instigated, inflammatory processes in the brain. Current hypotheses suggest that activation and expansion of cross-reactive T-cells by H1N1/09 influenza infection could have been amplified following the administration of the adjuvanted vaccine, giving rise to a “two-hit” hypothesis. The collective in silico, in vitro, and preclinical in vivo data from recent and ongoing research have progressively refined the hypothetical model of sequential immunological events, and filled multiple knowledge gaps. Though no definitive conclusions can be drawn, the mechanistical model plausibly explains the increased risk of NT1 observed following the 2009-2010 H1N1 pandemic and subsequent vaccination campaign, as outlined in this review.
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Suliman HB, Healy Z, Zobi F, Kraft BD, Welty-Wolf K, Smith J, Barkauskas C, Piantadosi CA. Nuclear respiratory factor-1 negatively regulates TGF-β1 and attenuates pulmonary fibrosis. iScience 2022; 25:103535. [PMID: 34977500 PMCID: PMC8683592 DOI: 10.1016/j.isci.2021.103535] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/02/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
The preclinical model of bleomycin-induced lung fibrosis is useful to study mechanisms related to human pulmonary fibrosis. Using BLM in mice, we find low HO-1 expression. Although a unique Rhenium-CO-releasing molecule (ReCORM) up-regulates HO-1, NRF-1, CCN5, and SMAD7, it reduces TGFβ1, TGFβr1, collagen, α-SMA, and phosphorylated Smad2/3 levels in mouse lung and in human lung fibroblasts. ChIP assay studies confirm NRF-1 binding to the promoters of TGFβ1 repressors CCN5 and Smad7. ReCORM did not blunt lung fibrosis in Hmox1-deficient alveolar type 2 cell knockout mice, suggesting this gene participates in lung protection. In human lung fibroblasts, TGFβ1-dependent production of α-SMA is abolished by ReCORM or by NRF-1 gene transfection. We demonstrate effective HO-1/NRF-1 signaling in lung AT2 cells protects against BLM induced lung injury and fibrosis by maintaining mitochondrial health, function, and suppressing the TGFβ1 pathway. Thus, protection of AT2 cell mitochondrial integrity via HO-1/NRF-1 presents an innovative therapeutic target.
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Affiliation(s)
- Hagir B. Suliman
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Zachary Healy
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
| | - Fabio Zobi
- Department of Chemistry, University of Fribourg, Fribourg, Switzerland
| | - Bryan D. Kraft
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
| | - Karen Welty-Wolf
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
| | - Joshua Smith
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
| | - Christina Barkauskas
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
| | - Claude A. Piantadosi
- Department of Medicine, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
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5
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McEntire CRS, Song KW, McInnis RP, Rhee JY, Young M, Williams E, Wibecan LL, Nolan N, Nagy AM, Gluckstein J, Mukerji SS, Mateen FJ. Neurologic Manifestations of the World Health Organization's List of Pandemic and Epidemic Diseases. Front Neurol 2021; 12:634827. [PMID: 33692745 PMCID: PMC7937722 DOI: 10.3389/fneur.2021.634827] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
The World Health Organization (WHO) monitors the spread of diseases globally and maintains a list of diseases with epidemic or pandemic potential. Currently listed diseases include Chikungunya, cholera, Crimean-Congo hemorrhagic fever, Ebola virus disease, Hendra virus infection, influenza, Lassa fever, Marburg virus disease, Neisseria meningitis, MERS-CoV, monkeypox, Nipah virus infection, novel coronavirus (COVID-19), plague, Rift Valley fever, SARS, smallpox, tularemia, yellow fever, and Zika virus disease. The associated pathogens are increasingly important on the global stage. The majority of these diseases have neurological manifestations. Those with less frequent neurological manifestations may also have important consequences. This is highlighted now in particular through the ongoing COVID-19 pandemic and reinforces that pathogens with the potential to spread rapidly and widely, in spite of concerted global efforts, may affect the nervous system. We searched the scientific literature, dating from 1934 to August 2020, to compile data on the cause, epidemiology, clinical presentation, neuroimaging features, and treatment of each of the diseases of epidemic or pandemic potential as viewed through a neurologist's lens. We included articles with an abstract or full text in English in this topical and scoping review. Diseases with epidemic and pandemic potential can be spread directly from human to human, animal to human, via mosquitoes or other insects, or via environmental contamination. Manifestations include central neurologic conditions (meningitis, encephalitis, intraparenchymal hemorrhage, seizures), peripheral and cranial nerve syndromes (sensory neuropathy, sensorineural hearing loss, ophthalmoplegia), post-infectious syndromes (acute inflammatory polyneuropathy), and congenital syndromes (fetal microcephaly), among others. Some diseases have not been well-characterized from a neurological standpoint, but all have at least scattered case reports of neurological features. Some of the diseases have curative treatments available while in other cases, supportive care remains the only management option. Regardless of the pathogen, prompt, and aggressive measures to control the spread of these agents are the most important factors in lowering the overall morbidity and mortality they can cause.
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Affiliation(s)
- Caleb R. S. McEntire
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Kun-Wei Song
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Robert P. McInnis
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - John Y. Rhee
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Michael Young
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Erika Williams
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Leah L. Wibecan
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Neal Nolan
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Amanda M. Nagy
- Massachusetts General Hospital (MGH)-Brigham Pediatric Neurology Residency Program, Boston, MA, United States
| | - Jeffrey Gluckstein
- Massachusetts General Hospital (MGH)-Brigham Neurology Residency Program, Boston, MA, United States
| | - Shibani S. Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Abstract
Influenza poses a significant disease burden on children worldwide, with high rates of hospitalization and substantial morbidity and mortality. Although the clinical presentation of influenza in children has similarities to that seen in adults, there are unique aspects to how children present with infection that are important to recognize. In addition, children play a significant role in viral transmission within communities. Growing evidence supports the idea that early influenza infection can uniquely establish lasting immunologic memory, making an understanding of how viral immunity develops in this population critical to better protect children from infection and to facilitate efforts to develop a more universally protective influenza vaccine.
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Affiliation(s)
- Jennifer Nayak
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Rochester Medical Center, Rochester, New York 14642-0001, USA
| | - Gregory Hoy
- Medical Scientist Training Program, Medical School, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
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Tau N, Yahav D, Shepshelovich D. Vaccine safety - is the SARS-CoV-2 vaccine any different? Hum Vaccin Immunother 2020; 17:1322-1325. [PMID: 33270474 DOI: 10.1080/21645515.2020.1829414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Vaccines have changed modern medicine, and are a mainstay in reducing morbidity and mortality from infections. Our research group recently published a study in which we found that vaccines approved by the US Food and Drugs Administration were safe with few clinically important post-approval adverse effects. The current COVID-19 pandemic presents regulators with the unprecedented challenge of balancing a public demand for the rapid development and approval of a safe and effective SARS-CoV-2 vaccine without compromising the strict pre-marketing requirements used for previous vaccines. Here, we review the approval process and safety profiles of FDA approved vaccines and discuss some of the challenges currently facing the FDA regarding the SARS-CoV-2 vaccine approval.
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Affiliation(s)
- Noam Tau
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Daniel Shepshelovich
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department is Internal Medicine I, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Spruyt K. Narcolepsy Presentation in Diverse Populations: an Update. CURRENT SLEEP MEDICINE REPORTS 2020; 6:239-250. [PMID: 33251089 PMCID: PMC7686447 DOI: 10.1007/s40675-020-00195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/05/2022]
Abstract
Purpose of Review We performed a literature search to generate incidence and prevalence rates of narcolepsy in diverse populations based on current available data. Recent Findings With an onset in childhood, narcolepsy often has a delayed diagnosis due to symptoms of excessive daytime sleepiness not being recognized or being misdiagnosed. Clinical, electrophysiological, and biological tests are needed in order to diagnose narcolepsy. At the same time, the discovery of the link with the immunoregulatory human leukocyte antigen complex and the adverse events in relation to the H1N1 pandemic vaccines have shuffled the epidemiological numbers. Summary In this meta-review, we pooled incidence rates and prevalence rates reported in 30 countries or from 209 sets of data. Findings are reported per age, continent, and proxy race/ethnicity as well as period (i.e., before/after the pandemic). This meta-review showed that narcolepsy occurs in 0.87–1.21 of the world population, with specifically NT1 being investigated. Its pooled incidence rate in vaccinated samples is 1.58. There is furthermore an underreporting of narcolepsy in ethnic/race and gender minorities, of childhood narcolepsy type 2 and potential comorbid conditions masking the clinical complaints and hence timely diagnosis.
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Affiliation(s)
- Karen Spruyt
- School of Medicine, INSERM, University Claude Bernard, Lyon, France
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Stowe J, Andrews N, Gringras P, Quinnell T, Zaiwalla Z, Shneerson J, Miller E. Reassessment of the risk of narcolepsy in children in England 8 years after receipt of the AS03-adjuvanted H1N1 pandemic vaccine: A case-coverage study. PLoS Med 2020; 17:e1003225. [PMID: 32926731 PMCID: PMC7489954 DOI: 10.1371/journal.pmed.1003225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early studies of narcolepsy after AS03-adjuvanted pandemic A/H1N12009 vaccine (Pandemrix) could not define the duration of elevated risk post-vaccination nor the risk in children aged under 5 years who may not present until much older. METHODS/FINDINGS Clinical information and sleep test results, extracted from hospital notes at 3 large pediatric sleep centers in England between September 2017 and June 2018 for narcolepsy cases aged 4-19 years with symptom onset since January 2009, were reviewed by an expert panel to confirm the diagnosis. Vaccination histories were independently obtained from general practitioners (GPs). The odds of vaccination in narcolepsy cases compared with the age-matched English population was calculated after adjustment for clinical conditions that were indications for vaccination. GP questionnaires were returned for 242 of the 244 children with confirmed narcolepsy. Of these 5 were under 5 years, 118 were 5-11 years, and 119 were 12-19 years old at diagnosis; 39 were vaccinated with Pandemrix before onset. The odds ratio (OR) for onset at any time after vaccination was 1.94 (95% confidence interval [CI] 1.30-2.89), The elevated risk period was restricted to onsets within 12 months of vaccination (OR 6.65 [3.44-12.85]) and was highest within the first 6 months. After one year, ORs were not significantly different from 1 up to 8 years after vaccination. The ORs were similar in under five-year-olds and older ages. The estimated attributable risk was 1 in 34,500 doses. Our study is limited by including cases from only 3 sleep centers, who may differ from cases diagnosed in nonparticipating centers, and by imprecision in defining the centers' catchment population. The potential for biased recall of onset shortly after vaccination in cases aware of the association cannot be excluded. CONCLUSIONS In this study, we found that vaccine-attributable cases have onset of narcolepsy within 12 months of Pandemrix vaccination. The attributable risk is higher than previously estimated in England because of identification of vaccine-attributable cases with late diagnoses. Absence of a compensatory drop in risk 1-8 years after vaccination suggests that Pandemrix does not trigger onsets in those in whom narcolepsy would have occurred later.
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Affiliation(s)
- Julia Stowe
- Immunisation and Countermeasures, Public Health England, London, England
- * E-mail:
| | - Nick Andrews
- Statistics and Modelling Economics Department, Public Health England, London, England
| | - Paul Gringras
- Evelina Children’s Hospital, Lambeth, London, England
| | - Timothy Quinnell
- Respiratory Support and Sleep Centre, Royal Papworth Hospital, Cambridge, England
| | | | | | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, England
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Huppertz HI. [Recommendations on the approach when unusual neurological symptoms occur in temporal association with vaccinations in childhood and adolescence]. Monatsschr Kinderheilkd 2020; 169:62-68. [PMID: 32836398 PMCID: PMC7372975 DOI: 10.1007/s00112-020-00975-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vaccinations are often administered at an age when many neurological diseases of childhood and adolescence also occur. Febrile seizures may occur following vaccination in patients with an appropriate genetic predisposition. The occurrence of narcolepsy has been described more frequently after pandemic influenza A-H1N1 vaccinations. The causality has not been proven. Data regarding an association between Guillain-Barré syndrome and influenza vaccinations are inconclusive. It was conclusively shown that vaccinations do not cause neurological disorders, such as autism and do not trigger multiple sclerosis. In summary, there is currently no confirmed evidence for the occurrence of chronic neurological diseases as a consequence of generally recommended vaccinations in Germany. If unusual neurological symptoms are observed in temporal association with vaccinations, a comprehensive evaluation is necessary to exclude a causal relationship and to diagnose the underlying neurological disease independent of the vaccination. This statement gives specific recommendations for the practical approach when neurological symptoms are observed in temporal association with vaccinations with respect to taking the patient history, initial diagnostic procedures, accurate and prompt documentation and the obligation to report the event. The committee also proposes procedures for further clarification and differential diagnostics of causal neurological diseases in childhood and adolescence.
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Affiliation(s)
- Hans-Iko Huppertz
- Deutsche Akademie für Kinder- und Jugendmedizin e. V., Chausseestr. 128/129, 10115 Berlin, Deutschland
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Suspicions of possible vaccine harms must be scrutinised openly and independently to ensure confidence. NPJ Vaccines 2020; 5:55. [PMID: 32655897 PMCID: PMC7338392 DOI: 10.1038/s41541-020-0202-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/06/2020] [Indexed: 11/09/2022] Open
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Huang WT, Huang YS, Hsu CY, Chen HC, Lee HC, Lin HC, Hsieh CF, Wu MN, Yang CH. Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan. Sleep Med 2020; 66:276-281. [DOI: 10.1016/j.sleep.2018.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
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Misra RS, Nayak JL. The Importance of Vaccinating Children and Pregnant Women against Influenza Virus Infection. Pathogens 2019; 8:pathogens8040265. [PMID: 31779153 PMCID: PMC6963306 DOI: 10.3390/pathogens8040265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Influenza virus infection is responsible for significant morbidity and mortality in the pediatric and pregnant women populations, with deaths frequently caused by severe influenza-associated lower respiratory tract infection and acute respiratory distress syndrome (ARDS). An appropriate immune response requires controlling the viral infection through activation of antiviral defenses, which involves cells of the lung and immune system. High levels of viral infection or high levels of inflammation in the lower airways can contribute to ARDS. Pregnant women and young children, especially those born prematurely, may develop serious complications if infected with influenza virus. Vaccination against influenza will lead to lower infection rates and fewer complications, even if the vaccine is poorly matched to circulating viral strains, with maternal vaccination offering infants protection via antibody transmission through the placenta and breast milk. Despite the health benefits of the influenza vaccine, vaccination rates around the world remain well below targets. Trust in the use of vaccines among the public must be restored in order to increase vaccination rates and decrease the public health burden of influenza.
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Affiliation(s)
- Ravi S Misra
- Department of Pediatrics Division of Neonatology, The University of Rochester Medical Center, Rochester, NY 14623, USA
- Correspondence:
| | - Jennifer L Nayak
- Department of Pediatrics Division of Pediatric Infectious Diseases, The University of Rochester Medical Center, Rochester, NY 14623, USA;
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Cohet C, van der Most R, Bauchau V, Bekkat-Berkani R, Doherty TM, Schuind A, Tavares Da Silva F, Rappuoli R, Garçon N, Innis BL. Safety of AS03-adjuvanted influenza vaccines: A review of the evidence. Vaccine 2019; 37:3006-3021. [DOI: 10.1016/j.vaccine.2019.04.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
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15
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Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study. PLoS One 2018; 13:e0204799. [PMID: 30332477 PMCID: PMC6192586 DOI: 10.1371/journal.pone.0204799] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/07/2018] [Indexed: 12/21/2022] Open
Abstract
Background & objectives Vaccine safety signals require investigation, which may be done rapidly at the population level using ecological studies, before embarking on hypothesis-testing studies. Incidence rates were used to assess a signal of narcolepsy following AS03-adjuvanted monovalent pandemic H1N1 (pH1N1) influenza vaccination among children and adolescents in Sweden and Finland in 2010. We explored the utility of ecological data to assess incidence of narcolepsy following exposure to pandemic H1N1 virus or vaccination in 10 sites that used different vaccines, adjuvants, and had varying vaccine coverage. Methods We calculated incidence rates of diagnosed narcolepsy for periods defined by influenza virus circulation and vaccination campaign dates, and used Poisson regression to estimate incidence rate ratios (IRRs) comparing the periods during which wild-type virus circulated and after the start of vaccination campaigns vs. the period prior to pH1N1 virus circulation. We used electronic health care data from Sweden, Denmark, the United Kingdom, Canada (3 provinces), Taiwan, Netherlands, and Spain (2 regions) from 2003 to 2013. We investigated interactions between age group and adjuvant in European sites and conducted a simulation study to investigate how vaccine coverage, age, and the interval from onset to diagnosis may impact the ability to detect safety signals. Results Incidence rates of narcolepsy varied by age, continent, and period. Only in Taiwan and Sweden were significant time-period-by-age-group interactions observed. Associations were found for children in Taiwan (following pH1N1 virus circulation) and Sweden (following vaccination). Simulations showed that the individual-level relative risk of narcolepsy was underestimated using ecological methods comparing post- vs. pre-vaccination periods; this effect was attenuated with higher vaccine coverage and a shorter interval from disease onset to diagnosis. Conclusions Ecological methods can be useful for vaccine safety assessment but the results are influenced by diagnostic delay and vaccine coverage. Because ecological methods assess risk at the population level, these methods should be treated as signal-generating methods and drawing conclusions regarding individual-level risk should be avoided.
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Weibel D, Sturkenboom M, Black S, de Ridder M, Dodd C, Bonhoeffer J, Vanrolleghem A, van der Maas N, Lammers GJ, Overeem S, Gentile A, Giglio N, Castellano V, Kwong JC, Murray BJ, Cauch-Dudek K, Juhasz D, Campitelli M, Datta AN, Kallweit U, Huang WT, Huang YS, Hsu CY, Chen HC, Giner-Soriano M, Morros R, Gaig C, Tió E, Perez-Vilar S, Diez-Domingo J, Puertas FJ, Svenson LW, Mahmud SM, Carleton B, Naus M, Arnheim-Dahlström L, Pedersen L, DeStefano F, Shimabukuro TT. Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines - Multi-country assessment. Vaccine 2018; 36:6202-6211. [PMID: 30122647 PMCID: PMC6404226 DOI: 10.1016/j.vaccine.2018.08.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines. METHODS We used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009. RESULTS No changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03. CONCLUSIONS Other than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study.
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Affiliation(s)
- Daniel Weibel
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Utrecht Medical Center, Utrecht, The Netherlands
| | - Steven Black
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Maria de Ridder
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caitlin Dodd
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Bonhoeffer
- Infectiology and Vaccinology University Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
| | - Ann Vanrolleghem
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nicoline van der Maas
- Dept. Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gert Jan Lammers
- Leiden University Medical Centre, Leiden, The Netherlands; Sleep-Wake Center SEIN, Heemstede, The Netherlands
| | | | - Angela Gentile
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Vanesa Castellano
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - Diana Juhasz
- Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada
| | | | | | - Ulf Kallweit
- Bern University Hospital and University of Bern, Bern, Switzerland; Witten/Herdecke University, Department of Rehabilitation, Witten/Herdecke, Germany
| | | | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology and Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Carles Gaig
- Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Tió
- Althaia Xarxa Assistencial Universitària de Manresa, Neurology Service, Manresa, Barcelona, Spain
| | - Silvia Perez-Vilar
- Medical Informatics Department, Erasmus Medical Center, Rotterdam, The Netherlands; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain
| | - Javier Diez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain
| | | | | | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Bruce Carleton
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Monika Naus
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lisen Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Pedersen
- Clinical Medicine/Epidemiology, Aarhus University, Aarhus, Denmark
| | - Frank DeStefano
- Centers for Disease Control and Prevention (CDC), Immunization Safety Office, Atlanta, USA
| | - Tom T Shimabukuro
- Centers for Disease Control and Prevention (CDC), Immunization Safety Office, Atlanta, USA
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Abstract
PURPOSE OF REVIEW After the connection between AS03-adjuvanted pandemic H1N1 vaccine Pandemrix and narcolepsy was recognized in 2010, research on narcolepsy has been more intensive than ever before. The purpose of this review is to provide the reader with current concepts and recent findings on the Pandemrix-associated narcolepsy. RECENT FINDINGS After the Pandemrix vaccination campaign in 2009-2010, the risk of narcolepsy was increased 5- to 14-fold in children and adolescents and 2- to 7-fold in adults. According to observational studies, the risk of narcolepsy was elevated for 2 years after the Pandemrix vaccination. Some confounding factors and potential diagnostic biases may influence the observed narcolepsy risk in some studies, but it is unlikely that they would explain the clearly increased incidence in all the countries where Pandemrix was used. An increased risk of narcolepsy after natural H1N1 infection was reported from China, where pandemic influenza vaccination was not used. There is more and more evidence that narcolepsy is an autoimmune disease. All Pandemrix-associated narcolepsy cases have been positive for HLA class II DQB1*06:02 and novel predisposing genetic factors directly linking to the immune system have been identified. Even though recent studies have identified autoantibodies against multiple neuronal structures and other host proteins and peptides, no specific autoantigens that would explain the disease mechanism in narcolepsy have been identified thus far. There was a marked increase in the incidence of narcolepsy after Pandemrix vaccination, especially in adolescents, but also in young adults and younger children. All vaccine-related cases were of narcolepsy type 1 characterized by hypocretin deficiency in the central nervous system. The disease phenotype and the severity of symptoms varied considerably in children and adolescents suffering from Pandemrix-associated narcolepsy, but they were indistinguishable from the symptoms of idiopathic narcolepsy. Narcolepsy type 1 is most likely an autoimmune disease, but the mechanisms have remained elusive.
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18
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Vaccine-associated inflammatory diseases of the central nervous system: from signals to causation. Curr Opin Neurol 2018; 29:362-71. [PMID: 27023738 DOI: 10.1097/wco.0000000000000318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW As the most cost-effective intervention in preventive medicine and as a crucial element of any public health program, vaccination is used extensively with over 90% coverage in many countries. As approximately 5-8% of the population in developed countries suffer from an autoimmune disorder, people with an autoimmune disease are most likely to be exposed to some vaccines before or after the disease onset. In fact, a number of inflammatory disorders of the central nervous system have been associated with the administration of various vaccines. These adverse events, be they spurious associations or genuine reactions to the vaccine, may lead to difficulties in obtaining public trust in mass vaccination programs. There is, thus, an urgent need to understand whether vaccination triggers or enhances autoimmune responses. RECENT FINDINGS By reviewing vaccine-associated inflammatory diseases of the central nervous system, this study describes the current knowledge on whether the safety signal was coincidental, as in the case of multiple sclerosis with several vaccines, or truly reflected a causal link, as in narcolepsy with cataplexy following pandemic H1N1 influenza virus vaccination. SUMMARY The lessons learnt emphasize a central role of thorough, ideally prospective, epidemiological studies followed, if the signal is deemed plausible or real, by immunological investigations.
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19
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Sarkanen TO, Alakuijala APE, Dauvilliers YA, Partinen MM. Incidence of narcolepsy after H1N1 influenza and vaccinations: Systematic review and meta-analysis. Sleep Med Rev 2017; 38:177-186. [PMID: 28847694 DOI: 10.1016/j.smrv.2017.06.006] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022]
Abstract
An increased incidence of narcolepsy was seen in many countries after the pandemic H1N1 influenza vaccination campaign in 2009-2010. The H1N1 vaccine - narcolepsy connection is based on observational studies that are prone to various biases, e.g., confounding by H1N1 infection, and ascertainment, recall and selection biases. A direct pathogenic link has, however, remained elusive. We conducted a systematic review and meta-analysis to analyze the magnitude of H1N1 vaccination related risk and to examine if there was any association with H1N1 infection itself. We searched all articles from PubMed, Web of Science and Scopus, and other relevant sources reporting the incidence and risk of post-vaccine narcolepsy. In our paper, we show that the risk appears to be limited to only one vaccine (Pandemrix®). During the first year after vaccination, the relative risk of narcolepsy was increased 5 to 14-fold in children and adolescents and 2 to 7-fold in adults. The vaccine attributable risk in children and adolescents was around 1 per 18,400 vaccine doses. Studies from Finland and Sweden also appear to demonstrate an extended risk of narcolepsy into the second year following vaccination, but such conclusions should be interpreted with a word of caution due to possible biases. Benefits of immunization outweigh the risk of vaccination-associated narcolepsy, which remains a rare disease.
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Affiliation(s)
- Tomi O Sarkanen
- Central Finland Central Hospital, Department of Neurology, Jyväskylä, Finland; University of Helsinki, Department of Neurological Sciences, Helsinki, Finland.
| | - Anniina P E Alakuijala
- University of Helsinki, Department of Neurological Sciences, Helsinki, Finland; HUS Medical Imaging Center, Helsinki University Central Hospital, Department of Clinical Neurophysiology, Finland
| | - Yves A Dauvilliers
- Gui-de-Chauliac Hospital, CHU Montpellier, Inserm, U1061, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, Sleep Disorders Center, France
| | - Markku M Partinen
- University of Helsinki, Department of Neurological Sciences, Helsinki, Finland; Helsinki Sleep Clinic, Vitalmed Research Centre, Finland
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20
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Cohet C, Rosillon D, Willame C, Haguinet F, Marenne MN, Fontaine S, Buyse H, Bauchau V, Baril L. Challenges in conducting post-authorisation safety studies (PASS): A vaccine manufacturer's view. Vaccine 2017; 35:3041-3049. [PMID: 28465097 DOI: 10.1016/j.vaccine.2017.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/13/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
Post-authorisation safety studies (PASS) of vaccines assess or quantify the risk of adverse events following immunisation that were not identified or could not be estimated pre-licensure. The aim of this perspective paper is to describe the authors' experience in the design and conduct of twelve PASS that contributed to the evaluation of the benefit-risk of vaccines in real-world settings. We describe challenges and learnings from selected PASS of rotavirus, malaria, influenza, human papillomavirus and measles-mumps-rubella-varicella vaccines that assessed or identified potential or theoretical risks, which may lead to changes to risk management plans and/or to label updates. Study settings include the use of large healthcare databases and de novo data collection. PASS methodology is influenced by the background incidence of the outcome of interest, vaccine uptake, availability and quality of data sources, identification of the at-risk population and of suitable comparators, availability of validated case definitions, and the frequent need for case ascertainment in large databases. Challenges include the requirement for valid exposure and outcome data, identification of, and access to, adequate data sources, and mitigating limitations including bias and confounding. Assessing feasibility is becoming a key step to confirm that study objectives can be met in a timely manner. PASS provide critical information for regulators, public health agencies, vaccine manufacturers and ultimately, individuals. Collaborative approaches and synergistic efforts between vaccine manufacturers and key stakeholders, such as regulatory and public health agencies, are needed to facilitate access to data, and to drive optimal study design and implementation, with the aim of generating robust evidence.
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21
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Bomfim IL, Lamb F, Fink K, Szakács A, Silveira A, Franzén L, Azhary V, Maeurer M, Feltelius N, Darin N, Hallböök T, Arnheim-Dahlström L, Kockum I, Olsson T. The immunogenetics of narcolepsy associated with A(H1N1)pdm09 vaccination (Pandemrix) supports a potent gene-environment interaction. Genes Immun 2017; 18:75-81. [PMID: 28332559 DOI: 10.1038/gene.2017.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
The influenza A(H1N1)pdm09 vaccination campaign from 2009 to 2010 was associated with a sudden increase in the incidence of narcolepsy in several countries. Narcolepsy with cataplexy is strongly associated with the human leukocyte antigen (HLA) class II DQB1*06:02 allele, and protective associations with the DQB1*06:03 allele have been reported. Several non-HLA gene loci are also associated, such as common variants of the T-cell receptor-α (TRA), the purinergic receptor P2RY11, cathepsin H (CTSH) and TNFSF4/OX40L/CD252. In this retrospective multicenter study, we investigated if these predisposing gene loci were also involved in vaccination-associated narcolepsy. We compared HLA- along with single-nucleotide polymorphism genotypes for non-HLA regions between 42 Pandemrix-vaccinated narcolepsy cases and 1990 population-based controls. The class II gene loci associations supported previous findings. Nominal association (P-value<0.05) with TRA as well as suggestive (P-value<0.1) associations with P2RY11 and CTSH were found. These associations suggest a very strong gene-environment interaction, in which the influenza A(H1N1)pdm09 strain or Pandemrix vaccine can act as potent environmental triggers.
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Affiliation(s)
- I L Bomfim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - F Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - A Szakács
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - A Silveira
- Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - L Franzén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - V Azhary
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | | | - N Darin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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22
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Van Effelterre T, Dos Santos G, Shinde V. Twin Peaks: A/H1N1 Pandemic Influenza Virus Infection and Vaccination in Norway, 2009-2010. PLoS One 2016; 11:e0151575. [PMID: 27010830 PMCID: PMC4807012 DOI: 10.1371/journal.pone.0151575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/01/2016] [Indexed: 01/07/2023] Open
Abstract
Background Vaccination campaigns against A/H1N1 2009 pandemic influenza virus (A/H1N1p) began in autumn 2009 in Europe, after the declaration of the pandemic at a global level. This study aimed to estimate the proportion of individuals vaccinated against A/H1N1p in Norway who were already infected (asymptomatically or symptomatically) by A/H1N1p before vaccination, using a mathematical model. Methods A dynamic, mechanistic, mathematical model of A/H1N1p transmission was developed for the Norwegian population. The model parameters were estimated by calibrating the model-projected number of symptomatic A/H1N1p cases to the number of laboratory-confirmed A/H1N1p cases reported to the surveillance system, accounting for potential under-reporting. It was assumed in the base case that the likelihood of vaccination was independent of infection/disease state. A sensitivity analysis explored the effects of four scenarios in which current or previous symptomatic A/H1N1p infection would influence the likelihood of being vaccinated. Results The number of model-projected symptomatic A/H1N1p cases by week during the epidemic, accounting for under-reporting and timing, closely matched that of the laboratory-confirmed A/H1N1p cases reported to the surveillance system. The model-projected incidence of symptomatic A/H1N1p infection was 27% overall, 55% in people <10 years old and 41% in people 10–20 years old. The model-projected percentage of individuals vaccinated against A/H1N1p who were already infected with A/H1N1p before being vaccinated was 56% overall, 62% in people <10 years old and 66% in people 10–20 years old. The results were sensitive to assumptions about the independence of vaccination and infection; however, even when current or previous symptomatic A/H1N1p infection was assumed to reduce the likelihood of vaccination, the estimated percentage of individuals who were infected before vaccination remained at least 32% in all age groups. Conclusion This analysis suggests that over half the people vaccinated against A/H1N1p in Norway during the 2009 pandemic may already have been infected by A/H1N1p before being vaccinated.
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Affiliation(s)
| | - Gaël Dos Santos
- Business & Decision Life Sciences (on behalf of GSK Vaccines), Brussels, Belgium
| | - Vivek Shinde
- GSK Vaccines, King of Prussia, PA, United States of America
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23
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Vaccination of Adult Patients with Systemic Lupus Erythematosus in Portugal. Int J Rheumatol 2016; 2016:2845617. [PMID: 27069477 PMCID: PMC4812392 DOI: 10.1155/2016/2845617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/16/2016] [Indexed: 12/16/2022] Open
Abstract
In the wake of the Portuguese vaccination program 50th anniversary it seems appropriate to review vaccination in patients with systemic lupus erythematosus. Controversial issues as regards the association between autoimmune diseases, infections, and vaccines are discussed as well as vaccine safety and efficacy issues as regards chronic immunosuppressant (IS) drug therapy. After a brief overview of national policies, specific recommendations are made as regards vaccination for adult patients with SLE with a particular focus on current IS therapy and unmet needs.
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24
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Bollaerts K, Shinde V, Dos Santos G, Ferreira G, Bauchau V, Cohet C, Verstraeten T. Application of Probabilistic Multiple-Bias Analyses to a Cohort- and a Case-Control Study on the Association between Pandemrix™ and Narcolepsy. PLoS One 2016; 11:e0149289. [PMID: 26901063 PMCID: PMC4762678 DOI: 10.1371/journal.pone.0149289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/24/2015] [Indexed: 12/26/2022] Open
Abstract
Background An increase in narcolepsy cases was observed in Finland and Sweden towards the end of the 2009 H1N1 influenza pandemic. Preliminary observational studies suggested a temporal link with the pandemic influenza vaccine Pandemrix™, leading to a number of additional studies across Europe. Given the public health urgency, these studies used readily available retrospective data from various sources. The potential for bias in such settings was generally acknowledged. Although generally advocated by key opinion leaders and international health authorities, no systematic quantitative assessment of the potential joint impact of biases was undertaken in any of these studies. Methods We applied bias-level multiple-bias analyses to two of the published narcolepsy studies: a pediatric cohort study from Finland and a case-control study from France. In particular, we developed Monte Carlo simulation models to evaluate a potential cascade of biases, including confounding by age, by indication and by natural H1N1 infection, selection bias, disease- and exposure misclassification. All bias parameters were evidence-based to the extent possible. Results Given the assumptions used for confounding, selection bias and misclassification, the Finnish rate ratio of 13.78 (95% CI: 5.72–28.11) reduced to a median value of 6.06 (2.5th- 97.5th percentile: 2.49–15.1) and the French odds ratio of 5.43 (95% CI: 2.6–10.08) to 1.85 (2.5th—97.5th percentile: 0.85–4.08). Conclusion We illustrate multiple-bias analyses using two studies on the Pandemrix™-narcolepsy association and advocate their use to better understand the robustness of study findings. Based on our multiple-bias models, the observed Pandemrix™-narcolepsy association consistently persists in the Finnish study. For the French study, the results of our multiple-bias models were inconclusive.
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Affiliation(s)
- Kaatje Bollaerts
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001 Leuven, Belgium
- * E-mail:
| | - Vivek Shinde
- GSK Vaccines, 2301 Renaissance Boulevard, King of Prussia, PA 19406, United States of America
| | - Gaël Dos Santos
- Business & Decision Life Sciences (contractor for GSK Vaccines), Rue Saint Lambert 141, 1200 Brussels, Belgium
| | | | | | | | - Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III Laan 1, 3001 Leuven, Belgium
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