W112 - Influenza Antibody Titers in Recent Onset Narcolepsy

ling Lin, PhD – Scientist, Center for narcolepsy, Psychiatry and behavioral science, Stanford University; Pauline Dodet, MD – Physician, Sorbonne Universites, Sorbonne Universites; Emmanuel Mignot, MD, PhD – Professor, Center for narcolepsy, Psychiatry and behavioral science, Stanford University

Abstract Text:

Objective: Epidemiological studies have shown associations between pandemic H1N1 2009 Influenza-A infection and vaccination (only using Pandemrix®) and the onset of narcolepsy, an autoimmune disease associated with HLA-DQB1*0602. We tested whether patients with recent onset have increased flu antibodies versus matched DQ0602 controls.

Methods: Serum samples of 82 recent onset type-1 narcolepsy patients (12 [1-25] months) and 84 healthy controls matched by sex, age, and year and season of sample collection were used. Samples were tested for Influenza-A and B antibodies using HAI assays against the dominant strains known to circulate at time of collection. HAI assays against H1N1 2009 were also tested independently in all subjects. Titers were log2 transformed, with zero being < 1/10 dilution, 1 being 1/20, 2 1/40 etc., so that every dilution represents an increment of 1 unit.

Results: pH1N1 2009 titers were increased in 25/63 (39.7%) subjects collected after 2009. Increasing titers (doubling rate) of H1N1 2009 [OR=1.2962(1.0513, 1.5984), p=0.015], all H1N1 [OR=1.13(1.03-1.24), p=0.023] and Influenza-B Victoria [1.37 (1.16-1.61) p=0.001] were associated with narcolepsy, whereas no association was found with H3N2 and Influenza-B Yamagata.

Conclusion: Both Influenza-A H1N1 and Influenza-B Victoria, but not other strains, may trigger narcolepsy onset. This result is in line with a recent epidemiological study in Europe that reported a strong increase in narcolepsy onset in 2010 (following 2009 H1N1) and a secondary peak in 2013 following a season with primary Influenza-B Victoria infections.