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April 02, 2013; 80 (14) Article

Increased childhood incidence of narcolepsy in western Sweden after H1N1 influenza vaccination

Attila Szakács, Niklas Darin, Tove Hallböök
First published March 13, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31828ab26f
Attila Szakács
From the Department of Children (A.S.), County Hospital, Halmstad; 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.
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Niklas Darin
From the Department of Children (A.S.), County Hospital, Halmstad; 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.
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Tove Hallböök
From the Department of Children (A.S.), County Hospital, Halmstad; 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.
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Citation
Increased childhood incidence of narcolepsy in western Sweden after H1N1 influenza vaccination
Attila Szakács, Niklas Darin, Tove Hallböök
Neurology Apr 2013, 80 (14) 1315-1321; DOI: 10.1212/WNL.0b013e31828ab26f

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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.

GLOSSARY

CI=
confidence interval;
HLA=
human leukocyte antigen;
MSLT=
multiple sleep latency test;
OSA=
obstructive sleep apnea;
PLMS=
periodic limb movements during sleep;
PSG=
polysomnography

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1276

  • Received April 4, 2012.
  • Accepted November 16, 2012.
  • © 2013 American Academy of Neurology
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