tetano
Editor, Senior Moderator
Sleep Med. 2018 Nov 26. pii: S1389-9457(18)30567-7. doi: 10.1016/j.sleep.2018.10.036. [Epub ahead of print]
[h=1]Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan.[/h] Huang WT[SUP]1[/SUP], Huang YS[SUP]2[/SUP], Hsu CY[SUP]3[/SUP], Chen HC[SUP]4[/SUP], Lee HC[SUP]5[/SUP], Lin HC[SUP]5[/SUP], Hsieh CF[SUP]3[/SUP], Wu MN[SUP]3[/SUP], Yang CH[SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Several European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03[SUP]?[/SUP] adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59[SUP]?[/SUP] adjuvant to 67% of children and 12% of adults.
[h=4]METHODS:[/h] For those registered in the 2000-2012 National Health Insurance (NHI) databases, we compared age-stratified (0-4, 5-18, 19-59, and ≥60 years) incidence of first referral for a diagnostic MSLT for the pre-pandemic, pandemic/pre-vaccination, and vaccination/post-pandemic period. We also compared the odds of H1N1 vaccination in each chart-ascertained narcolepsy patient, whoever had an onset of excessive daytime sleepiness between April 2009 and December 2012, with 10 population-based controls from the NHI databases on year of birth, sex, and index date, using conditional logistic regressions.
[h=4]RESULTS:[/h] Incidence of MSLT referral for narcolepsy was highest and significantly increased in the pandemic/pre-vaccination period in the age group 5-18 (IRR 3.40, 95% confidence intervals (CI) 2.12-5.45) and 19-59 (IRR 2.90, 95% CI 1.62-5.02) years. Among 137 confirmed narcolepsy cases (86 adults and 51 children), the odds ratios (ORs) were 1.67 (95% CI 0.81-3.45) (adults) and 1.22 (95% CI 0.62-2.39) (children) for H1N1 vaccination without adjuvant, and 1.39 (95% CI 0.17-11.48) (adults) and 3.66 (95% CI 0.37-36.02) (children) with MF59[SUP]?[/SUP] adjuvant.
[h=4]CONCLUSION:[/h] No substantial association between the use of H1N1 vaccines and narcolepsy was identified in Taiwan. Instead, the H1N1 infection itself could have played a role in triggering narcolepsy in children and young adults.
Copyright ? 2018 Elsevier B.V. All rights reserved.
[h=4]KEYWORDS:[/h] Epidemiology; H1N1; Influenza vaccine; MF59; Narcolepsy; Taiwan
PMID: 30579702 DOI: 10.1016/j.sleep.2018.10.036
[h=1]Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan.[/h] Huang WT[SUP]1[/SUP], Huang YS[SUP]2[/SUP], Hsu CY[SUP]3[/SUP], Chen HC[SUP]4[/SUP], Lee HC[SUP]5[/SUP], Lin HC[SUP]5[/SUP], Hsieh CF[SUP]3[/SUP], Wu MN[SUP]3[/SUP], Yang CH[SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Several European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03[SUP]?[/SUP] adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59[SUP]?[/SUP] adjuvant to 67% of children and 12% of adults.
[h=4]METHODS:[/h] For those registered in the 2000-2012 National Health Insurance (NHI) databases, we compared age-stratified (0-4, 5-18, 19-59, and ≥60 years) incidence of first referral for a diagnostic MSLT for the pre-pandemic, pandemic/pre-vaccination, and vaccination/post-pandemic period. We also compared the odds of H1N1 vaccination in each chart-ascertained narcolepsy patient, whoever had an onset of excessive daytime sleepiness between April 2009 and December 2012, with 10 population-based controls from the NHI databases on year of birth, sex, and index date, using conditional logistic regressions.
[h=4]RESULTS:[/h] Incidence of MSLT referral for narcolepsy was highest and significantly increased in the pandemic/pre-vaccination period in the age group 5-18 (IRR 3.40, 95% confidence intervals (CI) 2.12-5.45) and 19-59 (IRR 2.90, 95% CI 1.62-5.02) years. Among 137 confirmed narcolepsy cases (86 adults and 51 children), the odds ratios (ORs) were 1.67 (95% CI 0.81-3.45) (adults) and 1.22 (95% CI 0.62-2.39) (children) for H1N1 vaccination without adjuvant, and 1.39 (95% CI 0.17-11.48) (adults) and 3.66 (95% CI 0.37-36.02) (children) with MF59[SUP]?[/SUP] adjuvant.
[h=4]CONCLUSION:[/h] No substantial association between the use of H1N1 vaccines and narcolepsy was identified in Taiwan. Instead, the H1N1 infection itself could have played a role in triggering narcolepsy in children and young adults.
Copyright ? 2018 Elsevier B.V. All rights reserved.
[h=4]KEYWORDS:[/h] Epidemiology; H1N1; Influenza vaccine; MF59; Narcolepsy; Taiwan
PMID: 30579702 DOI: 10.1016/j.sleep.2018.10.036