Sensitivity analyses of the risk ratio of Pandemrix vaccination and narcolepsy using different definitions of the onset dates of narcolepsy and follow-up time periods.

<p>The two intervals in the top left panel are missing because of infinite estimates (i.e. no cases among unvaccinated).</p

The prioritization order of the pandemic influenza vaccinations in Finland during the A(H1N1) pandemic recommended by the National Advisory Committee on Vaccinations.

<p>The prioritization order of the pandemic influenza vaccinations in Finland during the A(H1N1) pandemic recommended by the National Advisory Committee on Vaccinations.</p

The different time intervals from the vaccination to the onset of narcolepsy depending on the definition of the onset time point, i.e. a) estimated onset time based on the extensive review of the patient records by a sleep and/or narcolepsy specialist, and closest to the parental/patient recall; b) first recorded contact to health care because of excessive sleepiness; c) date of referral to paediatrician or pediatric neurologist; and d) date of setting the diagnosis of narcolepsy, ICD-10 G47.4.

<p>The different time intervals from the vaccination to the onset of narcolepsy depending on the definition of the onset time point, i.e. a) estimated onset time based on the extensive review of the patient records by a sleep and/or narcolepsy specialist, and closest to the parental/patient recall; b) first recorded contact to health care because of excessive sleepiness; c) date of referral to paediatrician or pediatric neurologist; and d) date of setting the diagnosis of narcolepsy, ICD-10 G47.4.</p

The age-specific Pandemic vaccination coverage in Finland during the influenza pandemic season in 2009–10.

<p>Sources:</p>1<p>Electronic patient records in Finnish health care centres.</p>2<p>Population register of Finland;</p

Column charts showing antibody titers against H1N1pdm09 subtype and H3N2 subtype influenza A virus NS1 proteins in serum specimens obtained from narcoleptic patients.

<p>The relative antibody levels against N1N1pdm09 and H3N2 virus NS1 proteins were determined as the last serum dilution showing a positive signal in Western blot analysis. Blue columns show antibody titers against H1N1pdm09 subtype, and yellow columns show antibody titers against H3N2 subtype influenza A virus NS1 proteins in serum specimens obtained from 45 narcoleptic patients. Sera 2 and 27 (red arrows) show equally high titer levels against both NS1 protein subtypes.</p

A phylogram of influenza A virus NS1 amino acid sequences from 113 human isolates representing strains circulating in human population from 1918 to 2012.

<p>The phylogram was constructed by maximum parsimony method using MEGA 3.1 software. Branch lengths represent number of amino acid changes as indicated by the scale bar. GenBank accession number and the generic name of the virus subtype are shown. Viral NS1 sequences are grouped in different subtypes as indicated in the figure.</p

Statistical analyses of serum specimens for each patient group.

<p>Geometric mean antibody titers and 95% confidence interval against H1N1pdm09 subtype and H3N2 subtype NS1 proteins in serum specimens for each patient group.</p><p>Significance of the differences between the mean anti-NS1 H1/H3 virus protein antibody titers of narcoleptic patients and other patient groups.</p><p>Significance of the differences was calculated with Student’s t-test (two tailed, unequal variance).</p

The results of association analyses between <i>CACNA1C</i> variants and TST, night awakenings and sleep latency, N = 1086.

<p>The results of association analyses between <i>CACNA1C</i> variants and TST, night awakenings and sleep latency, N = 1086.</p