Neurological events related to influenza A (H1N1) pdm09

Abstract

ObjectivesTo review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection.DesignA search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.”SettingOnly papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included.SampleWe included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine-related neurological events from our neurological care center, arising during the period of study, were also included.Main outcome measuresDemographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection.ResultsThe retrieved cases were divided into two groups: the post-vaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain-Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed.ConclusionsFatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post-vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long-term clinical and imaging follow-up of infection and post-vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.

Neurological Complications of Novel Influenza A (H1N1) pdm09 Infection: Report of Two Cases and a Systematic Review of the Literature

“…Other neurologic manifestations of influenza are now known to include acute disseminated encephalomyelitis (ADEM), and acute necrotizing encephalopathy (ANE) [8]. According to a study done be Cardenas et al, fatal cases and permanent neurological sequelea were reported in 11% of patients with influenza related neurological complications [4]. This number includes also post-vaccination complications and occurred in all age groups.…”

“…In March 2010, almost all countries reported cases of influenza A (H1N1) and more than 17,700 deaths (laboratory confirmed cases) had been documented [1]. Up to date, there are no accurate data regarding the global frequency of neurological complications related to this disease [4]. The incidence of neurological complications in influenza A (H1N1) pdm09 was estimated to be 3.7% of the total number of patients confirmed to have influenza A (H1N1) pdm09 [5].…”

On vaccine's adjuvants and autoimmunity: Current evidence and future perspectives

“…Vaccines reported to be associated with ASIA syndrome include several adjuvants among which AS04 [29,30,143], Alum [105,144], AS03 and MF59 [145][146][147][148][149]. This indicates that, despite the different mechanism of actions, all adjuvants may determine the ASIA syndrome.…”

Influenza

“…Zum Ausschluss einer Influenza-assoziierten Myokarditis empfehlen sich bei Patienten mit schwerer Erkrankung oder gleichzeitig bestehenden kardialen Beschwerden (Brustschmerz, Rhythmusstörungen, neu aufgetretene Herzinsuffizienz) die Durchführung eines EKG sowie die Bestimmung kardialer Biomarker (Troponin). Die relative Häufigkeit anderer, insbesondere neurologischer Komplikationen, ist vergleichsweise schlecht untersucht [6]. ▶ Tab.…”