75 Incidence Peaks and the Role of Influenza Figure 4. Narcolepsy type 1 and preceding influenza season severity correlations per country. The three panels respectively represent the correlations between annual incidence rates of each influenza strain incidence and narcolepsy type 1 (NT1) incidence in the following year for all individuals (A), children (B) and adults (C). Top values and circle sizes represent the correlation coefficients. Bottom values and circle colours represent the level of significance of the correlation. NT2/IH incidence and preceding influenza season severity A significantly positive relationship was seen for type A H1N1 influenza severity and paediatric NT2 and IH incidence when combining data from all countries (Table 2). A similar significantly negative correlation was seen for type A H3N2 and children with NT2/IH. Significant associations between influenza season severity and NT2/IH incidence were not present for adults. Similar results were found when excluding NT2/IH with a clinical diagnosis. Discussion We replicated the 2010 and 2013 NT1 incidence peaks in complete datasets from multiple European countries. Both peaks in 2010 and 2013 were reported in children and adults. Similar incidence peaks were seen for NT2 and IH in 2010 with a smaller peak in 2013. These peaks were driven by children in 2010 and by adults in 2013. Regression analyses showed that the NT1 incidence in children had a significantly positive association with type A H1N1 influenza season severity but a negative association with type A H3N2 influenza season 3
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