In 2011, the Irish Medicines Board received reports of onset of
narcolepsy following vaccination against influenza A(H1N1)pdm09 with
Pandemrix. A national steering committee was convened to examine the association between
narcolepsy and pandemic vaccination. We conducted a retrospective population-based cohort study.
Narcolepsy cases with onset from 1 April 2009 to 31 December 2010 were identified through active case finding.
Narcolepsy history was gathered from medical records. Pandemic vaccination status was obtained from vaccination databases. Two independent experts classified cases using the Brighton case definition. Date of onset was defined as date of first healthcare contact for
narcolepsy symptoms. Incidence of
narcolepsy in vaccinated and non-vaccinated individuals was compared. Of 32
narcolepsy cases identified, 28 occurred in children/adolescents and for 24 first healthcare contact was between April 2009 and December 2010.
Narcolepsy incidence was 5.7 (95% confidence interval (CI): 3.4–8.9) per 100,000 children/adolescents vaccinated with
Pandemrix and 0.4 (95% CI: 0.1–1.0) per 100,000 unvaccinated children/adolescents (relative risk: 13.9; absolute attributable risk: 5.3 cases per 100,000 vaccinated children/adolescents). This study confirms the crude association between
Pandemrix vaccination and
narcolepsy as observed in Finland and Sweden. The
vaccine is no longer in use in Ireland. Further studies are needed to explore the immunogenetic mechanism of
narcolepsy.