Incidence of narcolepsy after H1N1 influenza and vaccinations : Systematic review and meta-analysis

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http://hdl.handle.net/10138/300884

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Sarkanen , T O , Alakuijala , A P E , Dauvilliers , Y A & Partinen , M M 2018 , ' Incidence of narcolepsy after H1N1 influenza and vaccinations : Systematic review and meta-analysis ' , Sleep Medicine Reviews , vol. 38 , pp. 177-186 . https://doi.org/10.1016/j.smrv.2017.06.006

Title: Incidence of narcolepsy after H1N1 influenza and vaccinations : Systematic review and meta-analysis
Author: Sarkanen, Tomi O.; Alakuijala, Anniina P. E.; Dauvilliers, Yves A.; Partinen, Markku M.
Contributor: University of Helsinki, Department of Neurosciences
University of Helsinki, Neurologian yksikkö
University of Helsinki, Department of Neurosciences
Date: 2018-04
Language: eng
Number of pages: 10
Belongs to series: Sleep Medicine Reviews
ISSN: 1087-0792
URI: http://hdl.handle.net/10138/300884
Abstract: An increased incidence of narcolepsy was seen in many countries after the pandemic H1N1 influenza vaccination campaign in 2009-2010. The H1N1 vaccine - narcolepsy connection is based on observational studies that are prone to various biases, e.g., confounding by H1N1 infection, and ascertainment, recall and selection biases. A direct pathogenic link has, however, remained elusive. We conducted a systematic review and meta-analysis to analyze the magnitude of H1N1 vaccination related risk and to examine if there was any association with H1N1 infection itself. We searched all articles from PubMed, Web of Science and Scopus, and other relevant sources reporting the incidence and risk of post-vaccine narcolepsy. In our paper, we show that the risk appears to be limited to only one vaccine (Pandemrix (R)). During the first year after vaccination, the relative risk of narcolepsy was increased 5 to 14-fold in children and adolescents and 2 to 7-fold in adults. The vaccine attributable risk in children and adolescents was around 1 per 18,400 vaccine doses. Studies from Finland and Sweden also appear to demonstrate an extended risk of narcolepsy into the second year following vaccination, but such conclusions should be interpreted with a word of caution due to possible biases. Benefits of immunization outweigh the risk of vaccination-associated narcolepsy, which remains a rare disease. (C) 2017 Elsevier Ltd. All rights reserved.
Subject: Narcolepsy
Cataplexy
H1N1
Influenza
Pandemrix
Vaccination
Autoimmune diseases
UNITED-STATES
A(H1N1)PDM09 VACCINATION
A H1N1
CHILDREN
CATAPLEXY
SAFETY
RISK
EPIDEMIOLOGY
ASSOCIATION
VACCINES
3112 Neurosciences
3124 Neurology and psychiatry
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