title: Increased childhood incidence of narcolepsy in western Sweden after H1N1 influenza vaccination.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Children, County Hospital, Halmstad, Sweden.
authors.forename: Attila
authors.initials: A
authors.lastname: Szakács
authors.forename: Niklas
authors.initials: N
authors.lastname: Darin
authors.forename: Tove
authors.initials: T
authors.lastname: Hallböök
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001426:Bacterial Proteins / Q000276:immunology; D017871:Calcium-Calmodulin-Dependent Protein Kinases; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000276:immunology*; D047908:Intracellular Signaling Peptides and Proteins / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D009290:Narcolepsy / Q000097:blood / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000209:etiology*; D011110:Polymorphism, Genetic / Q000235:genetics; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000235:genetics; D018048:Receptors, Purinergic P2 / Q000235:genetics; D012189:Retrospective Studies; D013301:Streptolysins / Q000276:immunology; D013548:Sweden / Q000453:epidemiology; D015898:Tomography Scanners, X-Ray Computed; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D001323:Autoantibodies; D001426:Bacterial Proteins; D047908:Intracellular Signaling Peptides and Proteins; C109734:P2RY11 protein, human; D016693:Receptors, Antigen, T-Cell, alpha-beta; D018048:Receptors, Purinergic P2; D013301:Streptolysins; C025964:streptolysin O; D017871:Calcium-Calmodulin-Dependent Protein Kinases; C489044:TRIB2 protein, human