Clinical features of narcolepsy in children vaccinated with AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine in England

Anne Marie Winstone*, Lesley Stellitano, Christopher Verity, Nick Andrews, Elizabeth Miller, Julia Stowe, John Shneerson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)


Aim: The aim of this study was to investigate whether children in England with narcolepsy who received the ASO3 adjuvanted pandemic A/H1N1 2009 influenza vaccine (Pandemrix) differed clinically from unvaccinated patients. Method: A retrospective review was conducted in children with narcolepsy diagnosed by sleep centres and paediatric neurologists in 16 English hospitals. The inclusion criteria were patient age 4 to 18 years, onset of narcolepsy after January 2008, and diagnosis by the time of the key data-gathering visit in 2011. Clinical data came from hospital notes and general practitioner questionnaires. An expert panel validated the diagnoses. Results: Seventy-five patients with narcolepsy were identified (43 males, 32 females; mean age at onset 10y 4mo, range 3-18y). Of these patients, 11 received the Pandemrix vaccine before narcolepsy onset. On first presentation, there were more frequent reports of cataplexy, among other features, in vaccinated than in unvaccinated patients (82% vs 55%), but only excessive weight gain (55% vs 20%) was significantly more frequent (p=0.03). Facial hypotonia (p=0.03) and tongue protrusion (p=0.01) were eventually seen more frequently in vaccinated children. When considering patients diagnosed within a year of onset, vaccinated children were not diagnosed more rapidly than unvaccinated children. Interpretation: Some symptoms and signs of narcolepsy were more frequently reported in Pandemrix-vaccinated patients. There was no evidence of the more rapid diagnosis in vaccinated patients that has been reported in Finland and Sweden. What this paper adds: The incidence of narcolepsy in children aged 4 to 18 years in 2008 was 0.42/100 000 in England.In England, 1 in 75 patients with narcolepsy had suspected swine flu infection.Weight gain, facial hypotonia, and tongue protrusion were significantly more frequent in Pandemrix-vaccinated patients.There was no evidence of quicker diagnosis in patients who were vaccinated. This article is commented on by Johansen on pages 1041-1042 of this issue.

Original languageEnglish
Pages (from-to)1117-1123
Number of pages7
JournalDevelopmental Medicine and Child Neurology
Issue number11
Publication statusPublished - 1 Nov 2014

Bibliographical note

Publisher Copyright:
©2014 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.


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