Neurological events related to influenza A (H1N1) pdm09

Authors

  • Graciela Cárdenas,

    Corresponding author
    1. Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
    • Correspondence: Graciela Cárdenas and José Luis Soto-Hernández, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Department of Neuroinfectology. Insurgentes Sur 3877, col. La fama 14269, Mexico City. E-mails: grace_goker@yahoo.de and joseluis_sotohernandez@yahoo.com

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  • José Luis Soto-Hernández,

    Corresponding author
    1. Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
    • Correspondence: Graciela Cárdenas and José Luis Soto-Hernández, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Department of Neuroinfectology. Insurgentes Sur 3877, col. La fama 14269, Mexico City. E-mails: grace_goker@yahoo.de and joseluis_sotohernandez@yahoo.com

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  • Alexandra Díaz-Alba,

    1. Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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  • Yair Ugalde,

    1. Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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  • Jorge Mérida-Puga,

    1. Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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  • Marcos Rosetti,

    1. Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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  • Edda Sciutto

    1. Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Abstract

Objectives

To review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection.

Design

A search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.”

Setting

Only papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included.

Sample

We 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 measures

Demographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection.

Results

The 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.

Conclusions

Fatal 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.

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