RESUMEN
In response to the 2009-2010 influenza A(H1N1)pdm09 pandemic, a mass vaccination programme with the AS03-adjuvanted influenza A(H1N1) vaccine Pandemrix was initiated in Sweden. Unexpectedly, there were a number of narcolepsy cases amongst vaccinated children and adolescents reported. In this review, we summarize the results of a joint cross-disciplinary national research effort to investigate the adverse reaction signal from the spontaneous reporting system and to better understand possible causative mechanisms. A three- to fourfold increased risk of narcolepsy in vaccinated children and adolescents was verified by epidemiological studies. Of importance, no risk increase was observed for the other neurological and autoimmune diseases studied. Genetic studies confirmed the association with the allele HLA-DQB1*06:02, which is known to be related to sporadic narcolepsy. Furthermore, a number of studies using cellular and molecular experimental models investigated possible links between influenza vaccination and narcolepsy. Serum analysis, using a peptide microarray platform, showed that individuals who received Pandemrix exhibited a different epitope reactivity pattern to neuraminidase and haemagglutinin, as compared to individuals who were infected with H1N1. Patients with narcolepsy were also found to have increased levels of interferon-gamma production in response to streptococcus-associated antigens. The chain of patient-related events and the study results emerging over time were subjected to intense nationwide media attention. The importance of transparent communication and collaboration with patient representatives to maintain public trust in vaccination programmes is also discussed in the review. Organizational challenges due to this unexpected event delayed the initiation of some of the research projects, still the main objectives of this joint, cross-disciplinary research effort were reached, and important insights were acquired for future, similar situations in which a fast and effective task force may be required to evaluate vaccination-related adverse events.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A , Vacunas contra la Influenza/efectos adversos , Gripe Humana/prevención & control , Narcolepsia/etiología , Vacunación/efectos adversos , Adolescente , Niño , Epítopos/inmunología , Hemaglutininas/inmunología , Humanos , Inmunohistoquímica , Interferón gamma/biosíntesis , Relaciones Interprofesionales , Narcolepsia/genética , Narcolepsia/inmunología , Neuraminidasa/inmunología , Fragmentos de Péptidos/biosíntesis , Investigación , Streptococcus/inmunología , SueciaRESUMEN
The prevalence of breathing obstruction was determined in a cohort of 4-year-old children. Craniofacial morphology was studied in obstructed children and compared with data from a control group of 4-year-old children with ideal occlusion. Dental arch morphology was compared in obstructed and non-obstructed children in the group. Parents of 95.5 per cent of the study base of 644 children answered a questionnaire concerning their child's nocturnal behaviour and related questions. The 48 children who, based on parental report, snored every night or stopped breathing when snoring (the 'snoring group'), showed a higher rate of disturbed sleep, mouth-breathing, and a history of throat infections as compared with the rest of the cohort. These children were examined by both an orthodontist and an otorhinolaryngologist and, when indicated, they were also monitored in a sleep laboratory. Twenty-eight of the children were diagnosed as having a breathing obstruction (4.3 per cent of the cohort) and six children (0.9 per cent) had sleep apnoea (mean apnoea-hypopnoea index of 17.3), using the same definition as that for adults. Cephalometric values among the obstructed children differed from those of a Swedish sample of the same age with ideal occlusion. Thy had a smaller cranial base angle and a lower ratio of posterior/anterior total face height. Small, but not significant differences were seen for NSL-ML and NL-ML. Compared with 48 asymptomatic children from the same cohort, the obstructed children had a narrower maxilla, a deeper palatal height, and a shorter lower dental arch. In addition, the prevalence of lateral crossbite was significantly higher among the obstructed children.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Trastornos Respiratorios/etiología , Adolescente , Adulto , Apnea/etiología , Niño , Preescolar , Estudios de Cohortes , Trastornos Craneomandibulares/complicaciones , Trastornos Craneomandibulares/fisiopatología , Arco Dental/anatomía & histología , Humanos , Polisomnografía , Trastornos Respiratorios/fisiopatología , Cráneo/anatomía & histología , Ronquido , Encuestas y CuestionariosRESUMEN
Severe airway obstruction caused by tonsillar enlargement can result in disturbances in body growth. The effect of this interference and of tonsillectomy in the child with only moderate symptoms have been less satisfactoril evaluated. In this study, 122 children with symptoms and signs of tonsillar obstruction were investigated concerning the height and weight before and after tonsillectomy. None of the individuals demonstrated cardiopulmonary complications of tonsillar obstruction. Altogether 10% of the children exhibited abnormalities in body weight and/or length prior to surgery. Especially during the first postoperative year, the weight and height gain exceeded the expected in 75% of the patients. The accelerated weight gain increased with tonsil size, but there was no relation to the extent of difficulties in swallowing or sleeping disruptions. The results support the hypothesis that tonsillar hypertrophy frequently is associated with disturbances in body growth and that this is seldom demonstrable prior to tonsillectomy.
Asunto(s)
Estatura , Peso Corporal , Crecimiento , Tonsila Palatina/patología , Tonsilectomía , Adolescente , Niño , Preescolar , Estudios de Seguimiento , Humanos , Hipertrofia , Lactante , Tonsila Palatina/cirugía , Periodo Posoperatorio , Cuidados Preoperatorios , Aumento de PesoRESUMEN
One hundred and twenty-two children between 1 1/2 and 14 years of age with symptoms suggesting tonsillar obstruction have been investigated. Each patient's history was analysed and the symptoms scored according to their incidence and severity. In addition, the size of the tonsils was evaluated. Eighty-five patients were chosen for tonsillectomy. The children with signs and symptoms of tonsillar obstruction improved greatly immediately after tonsillectomy. Severe symptoms of obstruction were observed in children with nearly normal tonsil size, as well as in those with very large tonsils. It is therefore just as important to obtain a careful history as it is to evaluate the size of the tonsils before deciding about surgery.
Asunto(s)
Tonsila Palatina/patología , Tonsilectomía , Adolescente , Niño , Preescolar , Trastornos de Deglución/etiología , Humanos , Hipertrofia , Lactante , Tonsila Palatina/fisiopatología , Respiración , Síndromes de la Apnea del Sueño/etiología , Ronquido/etiología , Trastornos del Habla/etiologíaRESUMEN
Two 12-year-old boys with severe sleep apnea syndrome but normal-sized tonsils were satisfactorily corrected by tonsillectomy and uvulopalatopharyngoplasty. One of the boys had muscular hypotony as contributing cause of the condition. The other had mandibular hypoplasia in combination with a long soft palate. Thorough preoperative anamnesis and examination in a sleep laboratory are necessary to determine which cases will benefit from surgery in spite of normal-sized tonsils and which surgical procedure will be most helpful.