{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T01:30:10Z","timestamp":1772155810897,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"EU-NN"},{"name":"UCB Pharma Brussels"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Increased incidence rates of narcolepsy type-1 (NT1) have been reported worldwide after the 2009\u20132010 H1N1 influenza pandemic (pH1N1). While some European countries found an association between the NT1 incidence increase and the H1N1 vaccination Pandemrix, reports from Asian countries suggested the H1N1 virus itself to be linked to the increased NT1 incidence. Using robust data-driven modeling approaches, that is, locally estimated scatterplot smoothing methods, we analyzed the number of de novo NT1 cases (n = 508) in the last two decades using the European Narcolepsy Network database. We confirmed the peak of NT1 incidence in 2010, that is, 2.54-fold (95% confidence interval [CI]: [2.11, 3.19]) increase in NT1 onset following 2009\u20132010 pH1N1. This peak in 2010 was found in both childhood NT1 (2.75-fold increase, 95% CI: [1.95, 4.69]) and adulthood NT1 (2.43-fold increase, 95% CI: [2.05, 2.97]). In addition, we identified a new peak in 2013 that is age-specific for children\/adolescents (i.e. 2.09-fold increase, 95% CI: [1.52, 3.32]). Most of these children\/adolescents were HLA DQB1*06:02 positive and showed a subacute disease onset consistent with an immune-mediated type of narcolepsy. The new 2013 incidence peak is likely not related to Pandemrix as it was not used after 2010. Our results suggest that the increased NT1 incidence after 2009\u20132010 pH1N1 is not unique and our study provides an opportunity to develop new hypotheses, for example, considering other (influenza) viruses or epidemiological events to further investigate the pathophysiology of immune-mediated narcolepsy.<\/jats:p>","DOI":"10.1093\/sleep\/zsaa172","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T02:24:39Z","timestamp":1599704679000},"source":"Crossref","is-referenced-by-count":18,"title":["New 2013 incidence peak in childhood narcolepsy: more than vaccination?"],"prefix":"10.1093","volume":"44","author":[{"given":"Zhongxing","family":"Zhang","sequence":"first","affiliation":[{"name":"Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7480-7841","authenticated-orcid":false,"given":"Jari K","family":"Gool","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands"},{"name":"Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1935-7603","authenticated-orcid":false,"given":"Rolf","family":"Fronczek","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0683-6506","authenticated-orcid":false,"given":"Yves","family":"Dauvilliers","sequence":"additional","affiliation":[{"name":"Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, H\u00f4pital Gui-de-Chauliac, INSERM U1061, Universit\u00e9 de Montpellier, Montpellier, France"}]},{"given":"Claudio L A","family":"Bassetti","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"},{"name":"Department of Neurology, Sechenov University, Moscow, Russian Federation"}]},{"given":"Geert","family":"Mayer","sequence":"additional","affiliation":[{"name":"Neurology Department, Hephata Klinik, Schwalmstadt, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-3065","authenticated-orcid":false,"given":"Giuseppe","family":"Plazzi","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy"},{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy"}]},{"given":"Fabio","family":"Pizza","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy"},{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy"}]},{"given":"Joan","family":"Santamaria","sequence":"additional","affiliation":[{"name":"Neurology Service, Multidisciplinary Sleep Unit, Hospital Cl\u00ednic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain"}]},{"given":"Markku","family":"Partinen","sequence":"additional","affiliation":[{"name":"Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland"}]},{"given":"Sebastiaan","family":"Overeem","sequence":"additional","affiliation":[{"name":"Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands"},{"name":"Eindhoven University of Technology, Eindhoven, The Netherlands"}]},{"given":"Rosa","family":"Peraita-Adrados","sequence":"additional","affiliation":[{"name":"Sleep and Epilepsy Unit\u2013Clinical Neurophysiology Service, University General Hospital Gregorio Mara\u00f1\u00f3n, Research Institute Gregorio Mara\u00f1\u00f3n, University Complutense of Madrid, Madrid, Spain"}]},{"given":"Antonio Martins","family":"da Silva","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Neurofisiologia, Hospital Santo Ant\u00f3nio\/Centro Hospitalar Universit\u00e1rio do Porto and UMIB-Instituto Ci\u00eancias Biom\u00e9dicas Abel Salazar, Universidade do Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5773-9656","authenticated-orcid":false,"given":"Karel","family":"Sonka","sequence":"additional","affiliation":[{"name":"Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1652-4215","authenticated-orcid":false,"given":"Rafael","family":"del Rio-Villegas","sequence":"additional","affiliation":[{"name":"Unidad de Neurofisiolog\u00eda y Trastornos del Sue\u00f1o, Hospital Vithas Internacional Madrid, Madrid, Spain"}]},{"given":"Raphael","family":"Heinzer","sequence":"additional","affiliation":[{"name":"Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland"}]},{"given":"Aleksandra","family":"Wierzbicka","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland"}]},{"given":"Peter","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine and Neuromuscular Disorders, University of M\u00fcnster, M\u00fcnster, Germany"}]},{"given":"Birgit","family":"H\u00f6gl","sequence":"additional","affiliation":[{"name":"Neurology Department, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria"}]},{"given":"Mauro","family":"Manconi","sequence":"additional","affiliation":[{"name":"Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland"}]},{"given":"Eva","family":"Feketeova","sequence":"additional","affiliation":[{"name":"Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic"}]},{"given":"Johannes","family":"Mathis","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"}]},{"given":"Teresa","family":"Paiva","sequence":"additional","affiliation":[{"name":"Institute of Molecular Medicine Portugal, Medical Faculty Lisbon University, Lisbon, Portugal"}]},{"given":"Francesca","family":"Canellas","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Institut d\u2019Investigaci\u00f3 Sanit\u00e0ria Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain"}]},{"given":"Michel","family":"Lecendreux","sequence":"additional","affiliation":[{"name":"AP-HP, Pediatric Sleep Center, CHU Robert-Debr\u00e9, Paris, France"},{"name":"National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France"}]},{"given":"Christian R","family":"Baumann","sequence":"additional","affiliation":[{"name":"Neurology Department, University Hospital Zurich, Zurich, Switzerland"}]},{"given":"Gert Jan","family":"Lammers","sequence":"additional","affiliation":[{"name":"Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands"}]},{"given":"Ramin","family":"Khatami","sequence":"additional","affiliation":[{"name":"Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland"},{"name":"Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, 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