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Zhang Z, Gool JK, Fronczek R, Dauvilliers Y, Bassetti CLA, Mayer G, Plazzi G, Pizza F, Santamaria J, Partinen M, Overeem S, Peraita-Adrados R, da Silva AM, Sonka K, Del Rio-Villegas R, Heinzer R, Wierzbicka A, Young P, Högl B, Manconi M, Feketeova E, Mathis J, Paiva T, Canellas F, Lecendreux M, Baumann CR, Lammers GJ, Khatami R. New 2013 incidence peak in childhood narcolepsy: more than vaccination? Sleep 2021; 44:5903541. [PMID: 32909046 DOI: 10.1093/sleep/zsaa172] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Increased incidence rates of narcolepsy type-1 (NT1) have been reported worldwide after the 2009-2010 H1N1 influenza pandemic (pH1N1). While some European countries found an association between the NT1 incidence increase and the H1N1 vaccination Pandemrix, reports from Asian countries suggested the H1N1 virus itself to be linked to the increased NT1 incidence. Using robust data-driven modeling approaches, that is, locally estimated scatterplot smoothing methods, we analyzed the number of de novo NT1 cases (n = 508) in the last two decades using the European Narcolepsy Network database. We confirmed the peak of NT1 incidence in 2010, that is, 2.54-fold (95% confidence interval [CI]: [2.11, 3.19]) increase in NT1 onset following 2009-2010 pH1N1. This peak in 2010 was found in both childhood NT1 (2.75-fold increase, 95% CI: [1.95, 4.69]) and adulthood NT1 (2.43-fold increase, 95% CI: [2.05, 2.97]). In addition, we identified a new peak in 2013 that is age-specific for children/adolescents (i.e. 2.09-fold increase, 95% CI: [1.52, 3.32]). Most of these children/adolescents were HLA DQB1*06:02 positive and showed a subacute disease onset consistent with an immune-mediated type of narcolepsy. The new 2013 incidence peak is likely not related to Pandemrix as it was not used after 2010. Our results suggest that the increased NT1 incidence after 2009-2010 pH1N1 is not unique and our study provides an opportunity to develop new hypotheses, for example, considering other (influenza) viruses or epidemiological events to further investigate the pathophysiology of immune-mediated narcolepsy.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Jari K Gool
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands
| | - Rolf Fronczek
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Yves Dauvilliers
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov University, Moscow, Russian Federation
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit-Clinical Neurophysiology Service, University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón, University Complutense of Madrid, Madrid, Spain
| | - Antonio Martins da Silva
- Serviço de Neurofisiologia, Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Karel Sonka
- Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rafael Del Rio-Villegas
- Unidad de Neurofisiología y Trastornos del Sueño, Hospital Vithas Internacional Madrid, Madrid, Spain
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Birgit Högl
- Neurology Department, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Teresa Paiva
- Institute of Molecular Medicine Portugal, Medical Faculty Lisbon University, Lisbon, Portugal
| | - Francesca Canellas
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | | | - Gert Jan Lammers
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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2
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Levy S, McArthur I, Crow B, Zuberi S. Factors Influencing Time to Diagnosis in Childhood Narcolepsy Type 1. J Child Neurol 2019; 34:440-445. [PMID: 30913957 DOI: 10.1177/0883073819836548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the variables impacting on time from symptom onset to diagnosis in childhood narcolepsy, including presence of cataplexy, onset in infancy, administration of the H1N1 Pandemrix vaccine, and date of diagnosis following the H1N1 pandemic. DESIGN A retrospective cohort study of 42 children seen in a single tertiary pediatric neurology center between 1996 and 2016. KEY RESULTS Onset of symptoms of narcolepsy occurred between infancy and 15 years, with 92.9% of children symptomatic by 13 years. Time from reported symptom onset to diagnosis ranged from 3 months to 11 years, with 51.3% diagnosed within 12 months of symptom onset. Those patients who were reportedly symptomatic from birth had a statistically significant increased time from reported symptom onset to diagnosis. CONCLUSIONS The symptoms of childhood narcolepsy progress over time. The number of annual diagnoses in this center increased over the study period, but there is no evidence that the time from symptom onset to diagnosis is decreasing. Being reportedly symptomatic from the age of <1 year is associated with an increased time to diagnosis. We recommend raising awareness of narcolepsy among medical students and general practitioners. It is important that clinicians appreciate the clinical relevance of excessive daytime sleepiness.
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Affiliation(s)
- Sarah Levy
- 1 School of Medicine, University of Glasgow, Glasgow, UK
| | - Irene McArthur
- 2 Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Blair Crow
- 1 School of Medicine, University of Glasgow, Glasgow, UK.,2 Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Sameer Zuberi
- 1 School of Medicine, University of Glasgow, Glasgow, UK.,2 Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
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3
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Granath F, Gedeborg R, Smedje H, Feltelius N. Change in risk for narcolepsy over time and impact of definition of onset date following vaccination with
AS03
adjuvanted pandemic
A/H1N1
influenza vaccine (
P
andemrix) during the 2009
H1N1
influenza pandemic. Pharmacoepidemiol Drug Saf 2019; 28:1045-1053. [DOI: 10.1002/pds.4788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Fredrik Granath
- Clinical Epidemiology Division, Department of Medicine SolnaKarolinska Institute Stockholm Sweden
| | - Rolf Gedeborg
- Department of Efficacy and Safety 1Medical Products Agency Uppsala Sweden
| | - Hans Smedje
- Department of Women's and Children's HealthKarolinska Institute Stockholm Sweden
| | - Nils Feltelius
- Department of Scientific ExpertiseMedical Products Agency Uppsala Sweden
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4
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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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5
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The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity. Autoimmun Rev 2018. [DOI: 10.1016/j.autrev.2017.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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6
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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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