tetano
Editor, Senior Moderator
Citation: Partinen M, Saarenp??-Heikkil? O, Ilveskoski I, Hublin C, Linna M, et al. (2012) Increased Incidence and Clinical Picture of Childhood Narcolepsy following the 2009 H1N1 Pandemic Vaccination Campaign in Finland. PLoS ONE 7(3): e33723. doi:10.1371/journal.pone.0033723
Markku Partinen1,2,15*, Outi Saarenp??-Heikkil?3, Ismo Ilveskoski4, Christer Hublin5, Miika Linna6, P?ivi Ols?n7, Pekka Nokelainen8, Reija Al?n9, Tiina Wallden10, Merimaaria Espo10, Harri Rusanen11, Jan Olme12, Heli S?til?13, Harri Arikka14, Pekka Kaipainen15, Ilkka Julkunen16, Turkka Kirjavainen17
1 Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Vitalmed Research Centre, Helsinki, Finland, 2 Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland, 3 Unit of Child Neurology, Department of Paediatrics, Tampere University Hospital, Tampere, Finland, 4 Department of Child Neurology, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland, 5 Finnish Institute of Occupational Health, Helsinki, Finland, 6 Department of Statistics and Registers, National Institute for Health and Welfare (THL), Helsinki, Finland, 7 Department of Child Neurology, Oulu University Hospital, Oulu, Finland, 8 Department of Child Neurology, Kuopio University Hospital, Kuopio, Finland, 9 Department of Child Neurology, Jyv?skyl? Central Hospital, Jyv?skyl?, Finland, 10 Department of Child Neurology, Central Hospital of Kymenlaakso, Kotka, Finland, 11 Department of Neurology, Oulu University Hospital, Oulu, Finland, 12 Department of Child Neurology, Vaasa Central Hospital, Vaasa, Finland, 13 Department of Child Neurology, Kanta-H?me Central Hospital, H?meenlinna, Finland, 14 Department of Child Neurology, Turku University Hospital, Turku, Finland, 15 Rinnekoti Research Centre, Espoo, Finland, 16 Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), Helsinki, Finland, 17 Department of Paediatrics, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
Abstract Top
Background
Narcolepsy is a rare neurological sleep disorder especially in children who are younger than 10 years. In the beginning of 2010, an exceptionally large number of Finnish children suffered from an abrupt onset of excessive daytime sleepiness (EDS) and cataplexy. Therefore, we carried out a systematic analysis of the incidence of narcolepsy in Finland between the years 2002?2010.
Methods
All Finnish hospitals and sleep clinics were contacted to find out the incidence of narcolepsy in 2010. The national hospital discharge register from 2002 to 2009 was used as a reference.
Findings
Altogether 335 cases (all ages) of narcolepsy were diagnosed in Finland during 2002?2009 giving an annual incidence of 0.79 per 100 000 inhabitants (95% confidence interval 0.62?0.96). The average annual incidence among subjects under 17 years of age was 0.31 (0.12?0.51) per 100 000 inhabitants. In 2010, 54 children under age 17 were diagnosed with narcolepsy (5.3/100 000; 17-fold increase). Among adults ≥20 years of age the incidence rate in 2010 was 0.87/100 000, which equals that in 2002?2009. Thirty-four of the 54 children were HLA-typed, and they were all positive for narcolepsy risk allele DQB1*0602/DRB1*15. 50/54 children had received Pandemrix vaccination 0 to 242 days (median 42) before onset. All 50 had EDS with abnormal multiple sleep latency test (sleep latency <8 min and ≥2 sleep onset REM periods). The symptoms started abruptly. Forty-seven (94%) had cataplexy, which started at the same time or soon after the onset of EDS. Psychiatric symptoms were common. Otherwise the clinical picture was similar to that described in childhood narcolepsy.
Interpretation
A sudden increase in the incidence of abrupt childhood narcolepsy was observed in Finland in 2010. We consider it likely that Pandemrix vaccination contributed, perhaps together with other environmental factors, to this increase in genetically susceptible children.
http://www.plosone.org/article/info...3;jsessionid=98E97B35916A771C8B2A698A03709EAB
Markku Partinen1,2,15*, Outi Saarenp??-Heikkil?3, Ismo Ilveskoski4, Christer Hublin5, Miika Linna6, P?ivi Ols?n7, Pekka Nokelainen8, Reija Al?n9, Tiina Wallden10, Merimaaria Espo10, Harri Rusanen11, Jan Olme12, Heli S?til?13, Harri Arikka14, Pekka Kaipainen15, Ilkka Julkunen16, Turkka Kirjavainen17
1 Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Vitalmed Research Centre, Helsinki, Finland, 2 Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland, 3 Unit of Child Neurology, Department of Paediatrics, Tampere University Hospital, Tampere, Finland, 4 Department of Child Neurology, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland, 5 Finnish Institute of Occupational Health, Helsinki, Finland, 6 Department of Statistics and Registers, National Institute for Health and Welfare (THL), Helsinki, Finland, 7 Department of Child Neurology, Oulu University Hospital, Oulu, Finland, 8 Department of Child Neurology, Kuopio University Hospital, Kuopio, Finland, 9 Department of Child Neurology, Jyv?skyl? Central Hospital, Jyv?skyl?, Finland, 10 Department of Child Neurology, Central Hospital of Kymenlaakso, Kotka, Finland, 11 Department of Neurology, Oulu University Hospital, Oulu, Finland, 12 Department of Child Neurology, Vaasa Central Hospital, Vaasa, Finland, 13 Department of Child Neurology, Kanta-H?me Central Hospital, H?meenlinna, Finland, 14 Department of Child Neurology, Turku University Hospital, Turku, Finland, 15 Rinnekoti Research Centre, Espoo, Finland, 16 Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), Helsinki, Finland, 17 Department of Paediatrics, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
Abstract Top
Background
Narcolepsy is a rare neurological sleep disorder especially in children who are younger than 10 years. In the beginning of 2010, an exceptionally large number of Finnish children suffered from an abrupt onset of excessive daytime sleepiness (EDS) and cataplexy. Therefore, we carried out a systematic analysis of the incidence of narcolepsy in Finland between the years 2002?2010.
Methods
All Finnish hospitals and sleep clinics were contacted to find out the incidence of narcolepsy in 2010. The national hospital discharge register from 2002 to 2009 was used as a reference.
Findings
Altogether 335 cases (all ages) of narcolepsy were diagnosed in Finland during 2002?2009 giving an annual incidence of 0.79 per 100 000 inhabitants (95% confidence interval 0.62?0.96). The average annual incidence among subjects under 17 years of age was 0.31 (0.12?0.51) per 100 000 inhabitants. In 2010, 54 children under age 17 were diagnosed with narcolepsy (5.3/100 000; 17-fold increase). Among adults ≥20 years of age the incidence rate in 2010 was 0.87/100 000, which equals that in 2002?2009. Thirty-four of the 54 children were HLA-typed, and they were all positive for narcolepsy risk allele DQB1*0602/DRB1*15. 50/54 children had received Pandemrix vaccination 0 to 242 days (median 42) before onset. All 50 had EDS with abnormal multiple sleep latency test (sleep latency <8 min and ≥2 sleep onset REM periods). The symptoms started abruptly. Forty-seven (94%) had cataplexy, which started at the same time or soon after the onset of EDS. Psychiatric symptoms were common. Otherwise the clinical picture was similar to that described in childhood narcolepsy.
Interpretation
A sudden increase in the incidence of abrupt childhood narcolepsy was observed in Finland in 2010. We consider it likely that Pandemrix vaccination contributed, perhaps together with other environmental factors, to this increase in genetically susceptible children.
http://www.plosone.org/article/info...3;jsessionid=98E97B35916A771C8B2A698A03709EAB