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Narcolepsy and Pandemic Influenza Vaccination: What We Need to Know to be Ready for the Next Pandemic

tetano

Editor, Senior Moderator
Pediatr Infect Dis J. 2019 Aug;38(8):873-876. doi: 10.1097/INF.0000000000002398.
[h=1]Narcolepsy and Pandemic Influenza Vaccination: What We Need to Know to be Ready for the Next Pandemic.[/h] Edwards K[SUP]1[/SUP], Lambert PH[SUP]2[/SUP], Black S[SUP]3[/SUP].
[h=3]Author information[/h]

[h=3]Abstract[/h] After the initial identification of the H1N1 pandemic influenza strain in Mexico in April 2009 and its subsequent global spread, several monovalent influenza vaccines were developed as part of the pandemic response. Three of these vaccines, Pandemrix, Arepanrix and Focetria were adjuvanted. One of these, the AS03-adjuvanted Pandemrix vaccine, was primarily used in Europe. Following widespread Pandemrix vaccine administration in Scandinavia, an increased risk of narcolepsy was noted in observational studies. Subsequently, this increased risk was also reported in other European countries as well. In contrast, studies from Canada of a similar AS03-adjuvanted vaccine, Arepanrix, did not demonstrate a similar increased risk of narcolepsy. No studies have identified an increased risk of narcolepsy following the MF59-adjuvanted Focetria vaccine. For many potential pandemic influenza strains, adjuvants might be required to solicit a protective immune response. Thus, it is critical that we understand the nature of the association between adjuvanted vaccine receipt and narcolepsy. Here, we present a potential hypothesis for narcolepsy seen during the 2009 H1N1 pandemic in AS03-adjuvanted influenza vaccine recipients.


PMID: 31306400 DOI: 10.1097/INF.0000000000002398
 
The “double-hit hypothesis,” meaning natural infection
closely followed by vaccination, should be further explored in
both animal models and human studies. Findings of such studies
are essential to inform the optimal public health response during
the next pandemic. If the double hit hypothesis is confirmed,
adjuvanted vaccines might be withheld in populations especially
susceptible to narcolepsy, such as adolescents and young adults,
during the period following wild-type virus circulation, particularly
when this virus is causing a relatively mild disease."
 
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