Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study.
Identifieur interne : 000032 ( Main/Corpus ); précédent : 000031; suivant : 000033Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study.
Auteurs : Caitlin N. Dodd ; Maria De Ridder ; Wan-Ting Huang ; Daniel Weibel ; Maria Giner-Soriano ; Silvia Perez-Vilar ; Javier Diez-Domingo ; Lawrence W. Svenson ; Salahddin M. Mahmud ; Bruce Carleton ; Monika Naus ; Jeffrey C. Kwong ; Brian J. Murray ; Lisen Arnheim-Dahlstrom ; Lars Pedersen ; Rosa Morros ; Francisco Javier Puertas ; Steven Black ; Miriam SturkenboomSource :
- PloS one [ 1932-6203 ] ; 2018.
English descriptors
- KwdEn :
- Adjuvants, Immunologic (adverse effects), Adolescent, Adult, Aged, Aged, 80 and over, Canada (epidemiology), Child, Child, Preschool, Computer Simulation, Europe (epidemiology), Female, Humans, Incidence, Infant, Infant, Newborn, Influenza A Virus, H1N1 Subtype (immunology), Influenza Vaccines (adverse effects), Influenza, Human (complications), Influenza, Human (immunology), Male, Middle Aged, Models, Statistical, Narcolepsy (diagnosis), Narcolepsy (epidemiology), Narcolepsy (etiology), Risk Factors, Safety, Taiwan (epidemiology), Vaccination (adverse effects), Young Adult.
- MESH :
- chemical , adverse effects : Adjuvants, Immunologic, Influenza Vaccines.
- geographic , epidemiology : Canada, Europe, Taiwan.
- adverse effects : Vaccination.
- complications : Influenza, Human.
- diagnosis : Narcolepsy.
- epidemiology : Narcolepsy.
- etiology : Narcolepsy.
- immunology : Influenza A Virus, H1N1 Subtype, Influenza, Human.
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Computer Simulation, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Models, Statistical, Risk Factors, Safety, Young Adult.
Abstract
BACKGROUND & OBJECTIVES
Vaccine safety signals require investigation, which may be done rapidly at the population level using ecological studies, before embarking on hypothesis-testing studies. Incidence rates were used to assess a signal of narcolepsy following AS03-adjuvanted monovalent pandemic H1N1 (pH1N1) influenza vaccination among children and adolescents in Sweden and Finland in 2010. We explored the utility of ecological data to assess incidence of narcolepsy following exposure to pandemic H1N1 virus or vaccination in 10 sites that used different vaccines, adjuvants, and had varying vaccine coverage.
METHODS
We calculated incidence rates of diagnosed narcolepsy for periods defined by influenza virus circulation and vaccination campaign dates, and used Poisson regression to estimate incidence rate ratios (IRRs) comparing the periods during which wild-type virus circulated and after the start of vaccination campaigns vs. the period prior to pH1N1 virus circulation. We used electronic health care data from Sweden, Denmark, the United Kingdom, Canada (3 provinces), Taiwan, Netherlands, and Spain (2 regions) from 2003 to 2013. We investigated interactions between age group and adjuvant in European sites and conducted a simulation study to investigate how vaccine coverage, age, and the interval from onset to diagnosis may impact the ability to detect safety signals.
RESULTS
Incidence rates of narcolepsy varied by age, continent, and period. Only in Taiwan and Sweden were significant time-period-by-age-group interactions observed. Associations were found for children in Taiwan (following pH1N1 virus circulation) and Sweden (following vaccination). Simulations showed that the individual-level relative risk of narcolepsy was underestimated using ecological methods comparing post- vs. pre-vaccination periods; this effect was attenuated with higher vaccine coverage and a shorter interval from disease onset to diagnosis.
CONCLUSIONS
Ecological methods can be useful for vaccine safety assessment but the results are influenced by diagnostic delay and vaccine coverage. Because ecological methods assess risk at the population level, these methods should be treated as signal-generating methods and drawing conclusions regarding individual-level risk should be avoided.
DOI: 10.1371/journal.pone.0204799
PubMed: 30332477
Links to Exploration step
pubmed:30332477Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study.</title><author><name sortKey="Dodd, Caitlin N" sort="Dodd, Caitlin N" uniqKey="Dodd C" first="Caitlin N" last="Dodd">Caitlin N. Dodd</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="De Ridder, Maria" sort="De Ridder, Maria" uniqKey="De Ridder M" first="Maria" last="De Ridder">Maria De Ridder</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Huang, Wan Ting" sort="Huang, Wan Ting" uniqKey="Huang W" first="Wan-Ting" last="Huang">Wan-Ting Huang</name><affiliation><nlm:affiliation>Taiwan Centers for Disease Control, Taipei, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Weibel, Daniel" sort="Weibel, Daniel" uniqKey="Weibel D" first="Daniel" last="Weibel">Daniel Weibel</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Giner Soriano, Maria" sort="Giner Soriano, Maria" uniqKey="Giner Soriano M" first="Maria" last="Giner-Soriano">Maria Giner-Soriano</name><affiliation><nlm:affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Perez Vilar, Silvia" sort="Perez Vilar, Silvia" uniqKey="Perez Vilar S" first="Silvia" last="Perez-Vilar">Silvia Perez-Vilar</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Diez Domingo, Javier" sort="Diez Domingo, Javier" uniqKey="Diez Domingo J" first="Javier" last="Diez-Domingo">Javier Diez-Domingo</name><affiliation><nlm:affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Svenson, Lawrence W" sort="Svenson, Lawrence W" uniqKey="Svenson L" first="Lawrence W" last="Svenson">Lawrence W. Svenson</name><affiliation><nlm:affiliation>University of Alberta, Division of Preventative Medicine, Alberta, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Mahmud, Salahddin M" sort="Mahmud, Salahddin M" uniqKey="Mahmud S" first="Salahddin M" last="Mahmud">Salahddin M. Mahmud</name><affiliation><nlm:affiliation>University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Carleton, Bruce" sort="Carleton, Bruce" uniqKey="Carleton B" first="Bruce" last="Carleton">Bruce Carleton</name><affiliation><nlm:affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Naus, Monika" sort="Naus, Monika" uniqKey="Naus M" first="Monika" last="Naus">Monika Naus</name><affiliation><nlm:affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Kwong, Jeffrey C" sort="Kwong, Jeffrey C" uniqKey="Kwong J" first="Jeffrey C" last="Kwong">Jeffrey C. Kwong</name><affiliation><nlm:affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Public Health Ontario, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>University Health Network, Toronto, Ontario, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Murray, Brian J" sort="Murray, Brian J" uniqKey="Murray B" first="Brian J" last="Murray">Brian J. Murray</name><affiliation><nlm:affiliation>Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Arnheim Dahlstrom, Lisen" sort="Arnheim Dahlstrom, Lisen" uniqKey="Arnheim Dahlstrom L" first="Lisen" last="Arnheim-Dahlstrom">Lisen Arnheim-Dahlstrom</name><affiliation><nlm:affiliation>Karolinska Institut, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.</nlm:affiliation></affiliation></author><author><name sortKey="Pedersen, Lars" sort="Pedersen, Lars" uniqKey="Pedersen L" first="Lars" last="Pedersen">Lars Pedersen</name><affiliation><nlm:affiliation>Aarhus University, Department of Clinical Epidemiology, Aarhus, Denmark.</nlm:affiliation></affiliation></author><author><name sortKey="Morros, Rosa" sort="Morros, Rosa" uniqKey="Morros R" first="Rosa" last="Morros">Rosa Morros</name><affiliation><nlm:affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Puertas, Francisco Javier" sort="Puertas, Francisco Javier" uniqKey="Puertas F" first="Francisco Javier" last="Puertas">Francisco Javier Puertas</name><affiliation><nlm:affiliation>Sleep Unit, Neurophysiology Department, La Ribera University Hospital, Valencia, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Physiology Department, University of Valencia, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Black, Steven" sort="Black, Steven" uniqKey="Black S" first="Steven" last="Black">Steven Black</name><affiliation><nlm:affiliation>Cincinnati Children's Hospital, Center for Global Health, Cincinnati, Ohio, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Sturkenboom, Miriam" sort="Sturkenboom, Miriam" uniqKey="Sturkenboom M" first="Miriam" last="Sturkenboom">Miriam Sturkenboom</name><affiliation><nlm:affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:30332477</idno><idno type="pmid">30332477</idno><idno type="doi">10.1371/journal.pone.0204799</idno><idno type="wicri:Area/Main/Corpus">000032</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000032</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study.</title><author><name sortKey="Dodd, Caitlin N" sort="Dodd, Caitlin N" uniqKey="Dodd C" first="Caitlin N" last="Dodd">Caitlin N. Dodd</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="De Ridder, Maria" sort="De Ridder, Maria" uniqKey="De Ridder M" first="Maria" last="De Ridder">Maria De Ridder</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Huang, Wan Ting" sort="Huang, Wan Ting" uniqKey="Huang W" first="Wan-Ting" last="Huang">Wan-Ting Huang</name><affiliation><nlm:affiliation>Taiwan Centers for Disease Control, Taipei, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Weibel, Daniel" sort="Weibel, Daniel" uniqKey="Weibel D" first="Daniel" last="Weibel">Daniel Weibel</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Giner Soriano, Maria" sort="Giner Soriano, Maria" uniqKey="Giner Soriano M" first="Maria" last="Giner-Soriano">Maria Giner-Soriano</name><affiliation><nlm:affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Perez Vilar, Silvia" sort="Perez Vilar, Silvia" uniqKey="Perez Vilar S" first="Silvia" last="Perez-Vilar">Silvia Perez-Vilar</name><affiliation><nlm:affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Diez Domingo, Javier" sort="Diez Domingo, Javier" uniqKey="Diez Domingo J" first="Javier" last="Diez-Domingo">Javier Diez-Domingo</name><affiliation><nlm:affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Svenson, Lawrence W" sort="Svenson, Lawrence W" uniqKey="Svenson L" first="Lawrence W" last="Svenson">Lawrence W. Svenson</name><affiliation><nlm:affiliation>University of Alberta, Division of Preventative Medicine, Alberta, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Mahmud, Salahddin M" sort="Mahmud, Salahddin M" uniqKey="Mahmud S" first="Salahddin M" last="Mahmud">Salahddin M. Mahmud</name><affiliation><nlm:affiliation>University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Carleton, Bruce" sort="Carleton, Bruce" uniqKey="Carleton B" first="Bruce" last="Carleton">Bruce Carleton</name><affiliation><nlm:affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Naus, Monika" sort="Naus, Monika" uniqKey="Naus M" first="Monika" last="Naus">Monika Naus</name><affiliation><nlm:affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Kwong, Jeffrey C" sort="Kwong, Jeffrey C" uniqKey="Kwong J" first="Jeffrey C" last="Kwong">Jeffrey C. Kwong</name><affiliation><nlm:affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Public Health Ontario, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>University Health Network, Toronto, Ontario, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Murray, Brian J" sort="Murray, Brian J" uniqKey="Murray B" first="Brian J" last="Murray">Brian J. Murray</name><affiliation><nlm:affiliation>Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Arnheim Dahlstrom, Lisen" sort="Arnheim Dahlstrom, Lisen" uniqKey="Arnheim Dahlstrom L" first="Lisen" last="Arnheim-Dahlstrom">Lisen Arnheim-Dahlstrom</name><affiliation><nlm:affiliation>Karolinska Institut, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.</nlm:affiliation></affiliation></author><author><name sortKey="Pedersen, Lars" sort="Pedersen, Lars" uniqKey="Pedersen L" first="Lars" last="Pedersen">Lars Pedersen</name><affiliation><nlm:affiliation>Aarhus University, Department of Clinical Epidemiology, Aarhus, Denmark.</nlm:affiliation></affiliation></author><author><name sortKey="Morros, Rosa" sort="Morros, Rosa" uniqKey="Morros R" first="Rosa" last="Morros">Rosa Morros</name><affiliation><nlm:affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Puertas, Francisco Javier" sort="Puertas, Francisco Javier" uniqKey="Puertas F" first="Francisco Javier" last="Puertas">Francisco Javier Puertas</name><affiliation><nlm:affiliation>Sleep Unit, Neurophysiology Department, La Ribera University Hospital, Valencia, Spain.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Physiology Department, University of Valencia, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Black, Steven" sort="Black, Steven" uniqKey="Black S" first="Steven" last="Black">Steven Black</name><affiliation><nlm:affiliation>Cincinnati Children's Hospital, Center for Global Health, Cincinnati, Ohio, United States of America.</nlm:affiliation></affiliation></author><author><name sortKey="Sturkenboom, Miriam" sort="Sturkenboom, Miriam" uniqKey="Sturkenboom M" first="Miriam" last="Sturkenboom">Miriam Sturkenboom</name><affiliation><nlm:affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</nlm:affiliation></affiliation></author></analytic><series><title level="j">PloS one</title><idno type="eISSN">1932-6203</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adjuvants, Immunologic (adverse effects)</term><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Canada (epidemiology)</term><term>Child</term><term>Child, Preschool</term><term>Computer Simulation</term><term>Europe (epidemiology)</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Infant</term><term>Infant, Newborn</term><term>Influenza A Virus, H1N1 Subtype (immunology)</term><term>Influenza Vaccines (adverse effects)</term><term>Influenza, Human (complications)</term><term>Influenza, Human (immunology)</term><term>Male</term><term>Middle Aged</term><term>Models, Statistical</term><term>Narcolepsy (diagnosis)</term><term>Narcolepsy (epidemiology)</term><term>Narcolepsy (etiology)</term><term>Risk Factors</term><term>Safety</term><term>Taiwan (epidemiology)</term><term>Vaccination (adverse effects)</term><term>Young Adult</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Adjuvants, Immunologic</term><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Canada</term><term>Europe</term><term>Taiwan</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Vaccination</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Narcolepsy</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Narcolepsy</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Narcolepsy</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Influenza A Virus, H1N1 Subtype</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Child</term><term>Child, Preschool</term><term>Computer Simulation</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Infant</term><term>Infant, Newborn</term><term>Male</term><term>Middle Aged</term><term>Models, Statistical</term><term>Risk Factors</term><term>Safety</term><term>Young Adult</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND & OBJECTIVES</b></p><p>Vaccine safety signals require investigation, which may be done rapidly at the population level using ecological studies, before embarking on hypothesis-testing studies. Incidence rates were used to assess a signal of narcolepsy following AS03-adjuvanted monovalent pandemic H1N1 (pH1N1) influenza vaccination among children and adolescents in Sweden and Finland in 2010. We explored the utility of ecological data to assess incidence of narcolepsy following exposure to pandemic H1N1 virus or vaccination in 10 sites that used different vaccines, adjuvants, and had varying vaccine coverage.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We calculated incidence rates of diagnosed narcolepsy for periods defined by influenza virus circulation and vaccination campaign dates, and used Poisson regression to estimate incidence rate ratios (IRRs) comparing the periods during which wild-type virus circulated and after the start of vaccination campaigns vs. the period prior to pH1N1 virus circulation. We used electronic health care data from Sweden, Denmark, the United Kingdom, Canada (3 provinces), Taiwan, Netherlands, and Spain (2 regions) from 2003 to 2013. We investigated interactions between age group and adjuvant in European sites and conducted a simulation study to investigate how vaccine coverage, age, and the interval from onset to diagnosis may impact the ability to detect safety signals.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Incidence rates of narcolepsy varied by age, continent, and period. Only in Taiwan and Sweden were significant time-period-by-age-group interactions observed. Associations were found for children in Taiwan (following pH1N1 virus circulation) and Sweden (following vaccination). Simulations showed that the individual-level relative risk of narcolepsy was underestimated using ecological methods comparing post- vs. pre-vaccination periods; this effect was attenuated with higher vaccine coverage and a shorter interval from disease onset to diagnosis.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Ecological methods can be useful for vaccine safety assessment but the results are influenced by diagnostic delay and vaccine coverage. Because ecological methods assess risk at the population level, these methods should be treated as signal-generating methods and drawing conclusions regarding individual-level risk should be avoided.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30332477</PMID><DateCompleted><Year>2019</Year><Month>03</Month><Day>14</Day></DateCompleted><DateRevised><Year>2019</Year><Month>03</Month><Day>14</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN><JournalIssue CitedMedium="Internet"><Volume>13</Volume><Issue>10</Issue><PubDate><Year>2018</Year></PubDate></JournalIssue><Title>PloS one</Title><ISOAbbreviation>PLoS ONE</ISOAbbreviation></Journal><ArticleTitle>Incidence rates of narcolepsy diagnoses in Taiwan, Canada, and Europe: The use of statistical simulation to evaluate methods for the rapid assessment of potential safety issues on a population level in the SOMNIA study.</ArticleTitle><Pagination><MedlinePgn>e0204799</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0204799</ELocationID><Abstract><AbstractText Label="BACKGROUND & OBJECTIVES">Vaccine safety signals require investigation, which may be done rapidly at the population level using ecological studies, before embarking on hypothesis-testing studies. Incidence rates were used to assess a signal of narcolepsy following AS03-adjuvanted monovalent pandemic H1N1 (pH1N1) influenza vaccination among children and adolescents in Sweden and Finland in 2010. We explored the utility of ecological data to assess incidence of narcolepsy following exposure to pandemic H1N1 virus or vaccination in 10 sites that used different vaccines, adjuvants, and had varying vaccine coverage.</AbstractText><AbstractText Label="METHODS">We calculated incidence rates of diagnosed narcolepsy for periods defined by influenza virus circulation and vaccination campaign dates, and used Poisson regression to estimate incidence rate ratios (IRRs) comparing the periods during which wild-type virus circulated and after the start of vaccination campaigns vs. the period prior to pH1N1 virus circulation. We used electronic health care data from Sweden, Denmark, the United Kingdom, Canada (3 provinces), Taiwan, Netherlands, and Spain (2 regions) from 2003 to 2013. We investigated interactions between age group and adjuvant in European sites and conducted a simulation study to investigate how vaccine coverage, age, and the interval from onset to diagnosis may impact the ability to detect safety signals.</AbstractText><AbstractText Label="RESULTS">Incidence rates of narcolepsy varied by age, continent, and period. Only in Taiwan and Sweden were significant time-period-by-age-group interactions observed. Associations were found for children in Taiwan (following pH1N1 virus circulation) and Sweden (following vaccination). Simulations showed that the individual-level relative risk of narcolepsy was underestimated using ecological methods comparing post- vs. pre-vaccination periods; this effect was attenuated with higher vaccine coverage and a shorter interval from disease onset to diagnosis.</AbstractText><AbstractText Label="CONCLUSIONS">Ecological methods can be useful for vaccine safety assessment but the results are influenced by diagnostic delay and vaccine coverage. Because ecological methods assess risk at the population level, these methods should be treated as signal-generating methods and drawing conclusions regarding individual-level risk should be avoided.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Dodd</LastName><ForeName>Caitlin N</ForeName><Initials>CN</Initials><Identifier Source="ORCID">0000-0002-8784-696X</Identifier><AffiliationInfo><Affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>de Ridder</LastName><ForeName>Maria</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Huang</LastName><ForeName>Wan-Ting</ForeName><Initials>WT</Initials><AffiliationInfo><Affiliation>Taiwan Centers for Disease Control, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Weibel</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Giner-Soriano</LastName><ForeName>Maria</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Perez-Vilar</LastName><ForeName>Silvia</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Erasmus Medical Center, Rotterdam, The Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Diez-Domingo</LastName><ForeName>Javier</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat (FISABIO), Vaccine Research, Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Svenson</LastName><ForeName>Lawrence W</ForeName><Initials>LW</Initials><AffiliationInfo><Affiliation>University of Alberta, Division of Preventative Medicine, Alberta, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mahmud</LastName><ForeName>Salahddin M</ForeName><Initials>SM</Initials><AffiliationInfo><Affiliation>University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Carleton</LastName><ForeName>Bruce</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Naus</LastName><ForeName>Monika</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kwong</LastName><ForeName>Jeffrey C</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Public Health Ontario, Toronto, Ontario, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>University Health Network, Toronto, Ontario, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Murray</LastName><ForeName>Brian J</ForeName><Initials>BJ</Initials><AffiliationInfo><Affiliation>Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Arnheim-Dahlstrom</LastName><ForeName>Lisen</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Karolinska Institut, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pedersen</LastName><ForeName>Lars</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Aarhus University, Department of Clinical Epidemiology, Aarhus, Denmark.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Morros</LastName><ForeName>Rosa</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Puertas</LastName><ForeName>Francisco Javier</ForeName><Initials>FJ</Initials><AffiliationInfo><Affiliation>Sleep Unit, Neurophysiology Department, La Ribera University Hospital, Valencia, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Physiology Department, University of Valencia, Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Black</LastName><ForeName>Steven</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Cincinnati Children's Hospital, Center for Global Health, Cincinnati, Ohio, United States of America.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sturkenboom</LastName><ForeName>Miriam</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Julius Center Global Health, University Medical Center Utrecht, Utrecht, The Netherlands.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D013487">Research Support, U.S. Gov't, P.H.S.</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2018</Year><Month>10</Month><Day>17</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000276">Adjuvants, Immunologic</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007252">Influenza Vaccines</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000276" MajorTopicYN="N">Adjuvants, Immunologic</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002170" MajorTopicYN="N" Type="Geographic">Canada</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002675" MajorTopicYN="N">Child, Preschool</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003198" MajorTopicYN="N">Computer Simulation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005060" MajorTopicYN="N" Type="Geographic">Europe</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007223" MajorTopicYN="N">Infant</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007231" MajorTopicYN="N">Infant, Newborn</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053118" MajorTopicYN="N">Influenza A Virus, H1N1 Subtype</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007252" MajorTopicYN="N">Influenza Vaccines</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000276" MajorTopicYN="N">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015233" MajorTopicYN="N">Models, Statistical</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009290" MajorTopicYN="N">Narcolepsy</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012449" MajorTopicYN="N">Safety</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013624" MajorTopicYN="N" Type="Geographic">Taiwan</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014611" MajorTopicYN="N">Vaccination</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><CoiStatement>MGS, as an employee of IDIAP Jordi Gol, worked on projects funded by pharmaceutical companies unrelated to this study. RM, as an employee of IDIAP Jordi Gol, worked on projects funded by pharmaceutical companies unrelated to this study. SB is a consultant for GSK Vaccines and chairs a data monitoring committee for GSK. SMM has received funding for unrelated projects from GSK, Merck, Pfizer and Sanofi and sat on advisory boards for GSK and Sanofi. LAD has received funding from MSD Sanofi Pasteur, Merck Sharp & Dome and GlaxoSmithKline for studies other than the study presented here. MS has led a research unit that occasionally conducted research for pharmaceutical companies, including Novartis, Boehringer, Lilly, and Pfizer. None of this work is related to these activities. All other authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>05</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>09</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>10</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>10</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>3</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">30332477</ArticleId><ArticleId IdType="doi">10.1371/journal.pone.0204799</ArticleId><ArticleId IdType="pii">PONE-D-17-18787</ArticleId><ArticleId IdType="pmc">PMC6192586</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Int J Epidemiol. 1989 Mar;18(1):269-74</Citation><ArticleIdList><ArticleId IdType="pubmed">2656561</ArticleId></ArticleIdList></Reference><Reference><Citation>Sci Transl Med. 2015 Jul 1;7(294):294ra105</Citation><ArticleIdList><ArticleId IdType="pubmed">26136476</ArticleId></ArticleIdList></Reference><Reference><Citation>Annu Rev Public Health. 1995;16:61-81</Citation><ArticleIdList><ArticleId IdType="pubmed">7639884</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2012;7(3):e33536</Citation><ArticleIdList><ArticleId IdType="pubmed">22470453</ArticleId></ArticleIdList></Reference><Reference><Citation>Hum Vaccin Immunother. 2016;12(1):187-93</Citation><ArticleIdList><ArticleId IdType="pubmed">26379011</ArticleId></ArticleIdList></Reference><Reference><Citation>Sleep. 2014 Jan 01;37(1):19-25</Citation><ArticleIdList><ArticleId IdType="pubmed">24381371</ArticleId></ArticleIdList></Reference><Reference><Citation>Tissue Antigens. 2002 Oct;60(4):282-91</Citation><ArticleIdList><ArticleId IdType="pubmed">12472657</ArticleId></ArticleIdList></Reference><Reference><Citation>J Autoimmun. 2014 May;50:1-11</Citation><ArticleIdList><ArticleId IdType="pubmed">24559657</ArticleId></ArticleIdList></Reference><Reference><Citation>Expert Rev Vaccines. 2016 May;15(5):573-84</Citation><ArticleIdList><ArticleId IdType="pubmed">26967200</ArticleId></ArticleIdList></Reference><Reference><Citation>Tissue Antigens. 2011 Jan;77(1):45-53</Citation><ArticleIdList><ArticleId IdType="pubmed">21155721</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 1997 Jan 4;349(9044):14-6</Citation><ArticleIdList><ArticleId IdType="pubmed">8988116</ArticleId></ArticleIdList></Reference><Reference><Citation>J Paediatr Child Health. 2002 Dec;38(6):618-21</Citation><ArticleIdList><ArticleId IdType="pubmed">12410881</ArticleId></ArticleIdList></Reference><Reference><Citation>Ann Neurol. 2011 Sep;70(3):410-7</Citation><ArticleIdList><ArticleId IdType="pubmed">21866560</ArticleId></ArticleIdList></Reference><Reference><Citation>J Pediatr. 1988 Nov;113(5):801-5</Citation><ArticleIdList><ArticleId IdType="pubmed">3263484</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2015 Sep;175(9):1527-9</Citation><ArticleIdList><ArticleId IdType="pubmed">26192815</ArticleId></ArticleIdList></Reference><Reference><Citation>BMJ. 2013 Feb 26;346:f794</Citation><ArticleIdList><ArticleId IdType="pubmed">23444425</ArticleId></ArticleIdList></Reference><Reference><Citation>Nat Med. 2002 Dec;8(12):1398-404</Citation><ArticleIdList><ArticleId IdType="pubmed">12436116</ArticleId></ArticleIdList></Reference><Reference><Citation>J Intern Med. 2014 Jun;275(6):551-61</Citation><ArticleIdList><ArticleId IdType="pubmed">24635221</ArticleId></ArticleIdList></Reference><Reference><Citation>Vaccine. 2015 Jun 8;33 Suppl 2:B6-B13</Citation><ArticleIdList><ArticleId IdType="pubmed">26022571</ArticleId></ArticleIdList></Reference><Reference><Citation>J Sleep Res. 2016 Dec;25(6):709-715</Citation><ArticleIdList><ArticleId IdType="pubmed">27149919</ArticleId></ArticleIdList></Reference><Reference><Citation>Vaccine. 2013 Feb 6;31(8):1246-54</Citation><ArticleIdList><ArticleId IdType="pubmed">23246544</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2011 Jan 28;6(1):e16635</Citation><ArticleIdList><ArticleId IdType="pubmed">21307958</ArticleId></ArticleIdList></Reference><Reference><Citation>Sleep. 2002 Mar 15;25(2):197-202</Citation><ArticleIdList><ArticleId IdType="pubmed">11902429</ArticleId></ArticleIdList></Reference><Reference><Citation>Vaccine. 2004 May 7;22(15-16):2064-70</Citation><ArticleIdList><ArticleId IdType="pubmed">15121324</ArticleId></ArticleIdList></Reference><Reference><Citation>Drugs Aging. 2003;20(5):361-76</Citation><ArticleIdList><ArticleId IdType="pubmed">12696996</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2012;7(4):e36120</Citation><ArticleIdList><ArticleId IdType="pubmed">22545158</ArticleId></ArticleIdList></Reference><Reference><Citation>Vaccine. 2010 Oct 18;28(44):7161-6</Citation><ArticleIdList><ArticleId IdType="pubmed">20804804</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2014 Dec 15;9(12):e114361</Citation><ArticleIdList><ArticleId IdType="pubmed">25501681</ArticleId></ArticleIdList></Reference><Reference><Citation>PLoS One. 2016 Feb 22;11(2):e0149289</Citation><ArticleIdList><ArticleId IdType="pubmed">26901063</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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