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Incidence of narcolepsy in Norwegian children and adolescents after vaccination against H1N1 influenza A.
Sleep Med. 2013 Sep; 14(9):867-71.SM

Abstract

BACKGROUND

From October 2009 to January 2010, approximately 470,000 children and adolescents in Norway ages 4-19 years were vaccinated with Pandemrix® against influenza A (H1N1 subtype). The vaccination coverage in this age cohort was approximately 50%.

OBJECTIVES

Our study was performed to evaluate the possible association between Pandemrix® vaccination and narcolepsy in Norway.

METHODS

Children and adolescents with sudden onset of excessive daytime sleepiness (EDS) and cataplexy occurring after the 2009-2010 vaccination period were registered by the National Institute of Public Health in cooperation with the Norwegian Resource Center for AD/HD, Tourette Syndrome, and Narcolepsy.

RESULTS

Fifty-eight vaccinated children and adolescents (35 girls, 23 boys) ages 4-19 years (mean age, 10.5 years) were diagnosed as new cases of confirmed narcolepsy and were included in our study during 2010 and 2011. Forty-two children had onset of symptoms within 6 months after vaccination, with 12 of them having symptoms within the first 6 weeks. All had EDS, 46 had documented cataplexy, 47 had mean sleep latency less than 8 min, and 43 had two or more sleep-onset rapid eye movement sleep (SOREM) periods in multiple sleep latency tests (MSLT). Cerebrospinal fluid (CSF) hypocretin levels were measured in 41 patients, with low levels in all. Thirty seven patients that were analyzed had tissue type HLADQB1*0602. During the same period, 10 unvaccinated cases were reported (mean age, 12.5 years).

CONCLUSION

The data collected during 3 years following vaccination showed a significantly increased risk for narcolepsy with cataplexy (P<.0001) and reduced CSF hypocretin levels in vaccinated children ages 4-19 years the first year after Pandemrix® vaccination, with a minimum incidence of 10 of 100,000 individuals per year. The second year after vaccination, the incidence was 1.1 of 100,000 individuals per year, which was not significantly different from the incidence of 0.5-1 of 100,000 per year in unvaccinated children during the same period.

Authors+Show Affiliations

Norwegian Resource Center for AD/HD, Oslo University Hospital, Norway. msheier@online.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23773727

Citation

Heier, M S., et al. "Incidence of Narcolepsy in Norwegian Children and Adolescents After Vaccination Against H1N1 Influenza A." Sleep Medicine, vol. 14, no. 9, 2013, pp. 867-71.
Heier MS, Gautvik KM, Wannag E, et al. Incidence of narcolepsy in Norwegian children and adolescents after vaccination against H1N1 influenza A. Sleep Med. 2013;14(9):867-71.
Heier, M. S., Gautvik, K. M., Wannag, E., Bronder, K. H., Midtlyng, E., Kamaleri, Y., & Storsaeter, J. (2013). Incidence of narcolepsy in Norwegian children and adolescents after vaccination against H1N1 influenza A. Sleep Medicine, 14(9), 867-71. https://doi.org/10.1016/j.sleep.2013.03.020
Heier MS, et al. Incidence of Narcolepsy in Norwegian Children and Adolescents After Vaccination Against H1N1 Influenza A. Sleep Med. 2013;14(9):867-71. PubMed PMID: 23773727.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of narcolepsy in Norwegian children and adolescents after vaccination against H1N1 influenza A. AU - Heier,M S, AU - Gautvik,K M, AU - Wannag,E, AU - Bronder,K H, AU - Midtlyng,E, AU - Kamaleri,Y, AU - Storsaeter,J, Y1 - 2013/06/14/ PY - 2012/12/06/received PY - 2013/03/20/revised PY - 2013/03/25/accepted PY - 2013/6/19/entrez PY - 2013/6/19/pubmed PY - 2014/5/13/medline KW - Cataplexy KW - Children KW - EDS KW - Influenza KW - Narcolepsy KW - Vaccination SP - 867 EP - 71 JF - Sleep medicine JO - Sleep Med VL - 14 IS - 9 N2 - BACKGROUND: From October 2009 to January 2010, approximately 470,000 children and adolescents in Norway ages 4-19 years were vaccinated with Pandemrix® against influenza A (H1N1 subtype). The vaccination coverage in this age cohort was approximately 50%. OBJECTIVES: Our study was performed to evaluate the possible association between Pandemrix® vaccination and narcolepsy in Norway. METHODS: Children and adolescents with sudden onset of excessive daytime sleepiness (EDS) and cataplexy occurring after the 2009-2010 vaccination period were registered by the National Institute of Public Health in cooperation with the Norwegian Resource Center for AD/HD, Tourette Syndrome, and Narcolepsy. RESULTS: Fifty-eight vaccinated children and adolescents (35 girls, 23 boys) ages 4-19 years (mean age, 10.5 years) were diagnosed as new cases of confirmed narcolepsy and were included in our study during 2010 and 2011. Forty-two children had onset of symptoms within 6 months after vaccination, with 12 of them having symptoms within the first 6 weeks. All had EDS, 46 had documented cataplexy, 47 had mean sleep latency less than 8 min, and 43 had two or more sleep-onset rapid eye movement sleep (SOREM) periods in multiple sleep latency tests (MSLT). Cerebrospinal fluid (CSF) hypocretin levels were measured in 41 patients, with low levels in all. Thirty seven patients that were analyzed had tissue type HLADQB1*0602. During the same period, 10 unvaccinated cases were reported (mean age, 12.5 years). CONCLUSION: The data collected during 3 years following vaccination showed a significantly increased risk for narcolepsy with cataplexy (P<.0001) and reduced CSF hypocretin levels in vaccinated children ages 4-19 years the first year after Pandemrix® vaccination, with a minimum incidence of 10 of 100,000 individuals per year. The second year after vaccination, the incidence was 1.1 of 100,000 individuals per year, which was not significantly different from the incidence of 0.5-1 of 100,000 per year in unvaccinated children during the same period. SN - 1878-5506 UR - https://www.unboundmedicine.com/medline/citation/23773727/Incidence_of_narcolepsy_in_Norwegian_children_and_adolescents_after_vaccination_against_H1N1_influenza_A_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1389-9457(13)00154-8 DB - PRIME DP - Unbound Medicine ER -