116 Chapter 4 Infection history An infection before the onset of narcolepsy type 1 symptoms was reported in 37/136 (27.2%; Supplementary Figure 1A). Reported infections included flu (9/136, 6.6% of total sample), EBV (10/136, 7.4%), other respiratory infections (8/136, 5.9%) and other non-respiratory infections (10/136, 7.4% of total sample). Other reported respiratory infections included pharyngitis (N = 3), pneumonia (N = 3), rhinitis (N = 1), tonsilitis (N = 1), and other types of nonrespiratory infections included fever of unknown origin (N = 2), erysipelas (N = 1), enterovirus (N = 1), hip infection (N = 1), toxoplasmosis (N = 1), otitis (N=1), dengue (N = 1), not further specified (N = 2). Rapid onset of narcolepsy type 1 within one year of the infection was seen in 29/33 (87.9%) of all people who had reported infection and was most common for flu (9/9, 100%), followed by other respiratory infections (7/8, 87.5%), EBV (7/10, 70.0%) and other nonrespiratory infections (6/10, 60.0%). Narcolepsy type 1 progression (latency between EDS and cataplexy onset) was short in people with a reported flu infection (7/9, 77.8%) and less pronounced for other respiratory (5/8, 62.5%), other non-respiratory (3/10, 30.0%) and EBV infections (2/10, 20.0%). Influenza vaccination history Influenza vaccination was reported in 43/132 (32.6%) people with narcolepsy type 1 with a known influenza vaccination history. H1N1 influenza vaccination in 2009-2010 was reported in 33/132 (25.0%) of the total sample and 33/43 of all reported influenza vaccinations (76.7%). Ten people received influenza vaccination in other years or yearly without specification of which exact years (7.6% of total sample and 23.3% of all influenza vaccinations). Eight of the people with H1N1 influenza vaccination reported receiving Pandemrix vaccination and two Focetria. Rapid onset of narcolepsy within one year of the influenza vaccination was reported in 15/43 (34.9%) of all vaccinated individuals, in 15/33 (45.5%) for those with H1N1 vaccination in 2009-2010 and in 0/10 (0.0%) for other years/unspecified. Development of cataplexy in less than one year after the onset of EDS was frequently seen in the H1N1 influenza vaccination group (25/33, 75.8%) compared to influenza vaccination in other or unspecified years (4/10, 40.0%). Onset of narcolepsy type 1 within one month after an immunological event The exact timing of the immunological events and onset of narcolepsy type 1 were not known in all individuals. Still, the latency between the immunological event and narcolepsy type 1 onset was often much shorter than one year. For people reporting an infection these exact timings were known in 23 individuals,
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