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Precipitants of Narcolepsy: Vaccines and Infections

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Narcolepsy

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Abstract

Epidemiological studies have shown that upper airway infections and passive smoking in childhood are associated with an increased risk of developing narcolepsy with hypocretin deficiency. In particular, infection with Streptococcus pyogenes has received attention as several studies have shown increased serum titers of antistreptolysin O (ASO) antibodies in narcolepsy patients close to onset when compared to patients with longer disease duration and healthy controls. Another pathogen of particular interest is the 2009 pandemic influenza A H1N1 virus. Data from China has suggested a temporal relationship between the 2009 influenza pandemic and a marked increase in narcolepsy incidence peaking in spring 2010. Even more striking are several reports from Northern Europe of a 10–25-fold increase in narcolepsy incidence in children following vaccination with the H1N1 Pandemrix vaccine. Interestingly, the Arepanrix vaccine that contained similar antigens and the same adjuvant was not associated with an increase in narcolepsy incidence. Research is now focusing on possible smaller antigenic differences between the two vaccines as one possible explanation for the observed association between narcolepsy and Pandemrix but not other vaccines. Other factors as genetic background or co-occurring infections could also have played a role. This still remains to be discovered.

In summary, different upper airway infections are associated with the development of narcolepsy with hypocretin deficiency. This supports the hypothesis of an involvement of the immune system in disease pathogenesis. It is possible that several subsequent infections pushing the immune system toward autoreactivity are needed before narcolepsy develops in genetically susceptible individuals.

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Authors and Affiliations

  1. Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet Glostrup, Glostrup, Denmark

    Birgitte Rahbek Kornum PhD

  2. Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark

    Birgitte Rahbek Kornum PhD

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  1. Birgitte Rahbek Kornum PhD
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Correspondence to Birgitte Rahbek Kornum PhD .

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Editors and Affiliations

  1. Montefiore Medical Center Narcolepsy Institute, Bronx, New York, USA

    Meeta Goswami

  2. Montefiore Hospital Sleep-Wake Disorders Center, Bronx, New York, USA

    Michael J. Thorpy

  3. Somnogen Canada Inc, President and Chief Executive Officer, Toronto, Ontario, Canada

    S.R. Pandi-Perumal

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Kornum, B.R. (2016). Precipitants of Narcolepsy: Vaccines and Infections. In: Goswami, M., Thorpy, M., Pandi-Perumal, S. (eds) Narcolepsy. Springer, Cham. https://doi.org/10.1007/978-3-319-23739-8_3

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  • DOI: https://doi.org/10.1007/978-3-319-23739-8_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23738-1

  • Online ISBN: 978-3-319-23739-8

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