Wan-Ting Huang1, Yu-Shu Huang2, Chung-Yao Hsu3, Hsi-Chung Chen4, Hsin-Chun Lee5, Hui-Chen Lin5, Cheng-Fang Hsieh3, Meng-Ni Wu3, Chin-Hui Yang5. 1. Taiwan Centers for Disease Control, Taipei, Taiwan. Electronic address: huangwt@ntu.edu.tw. 2. Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan. 3. Department of Neurology and Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 4. Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan. 5. Taiwan Centers for Disease Control, Taipei, Taiwan.
Abstract
BACKGROUND: Several European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03® adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59® adjuvant to 67% of children and 12% of adults. METHODS: 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. RESULTS: 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® adjuvant. CONCLUSION: 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.
BACKGROUND: Several European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03® adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59® adjuvant to 67% of children and 12% of adults. METHODS: 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 narcolepsypatient, 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. RESULTS: 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® adjuvant. CONCLUSION: No substantial association between the use of H1N1 vaccines and narcolepsy was identified in Taiwan. Instead, the H1N1infection itself could have played a role in triggering narcolepsy in children and young adults.
Authors: Daniel A Salmon; Paul Henri Lambert; Hanna M Nohynek; Julianne Gee; Umesh D Parashar; Jacqueline E Tate; Annelies Wilder-Smith; Kenneth Y Hartigan-Go; Peter G Smith; Patrick Louis F Zuber Journal: BMJ Glob Health Date: 2021-05
Authors: Julia Stowe; Nick Andrews; Paul Gringras; Timothy Quinnell; Zenobia Zaiwalla; John Shneerson; Elizabeth Miller Journal: PLoS Med Date: 2020-09-14 Impact factor: 11.069