Influenza epidemics and incidence of schizophrenia, affective disorders and mental retardation in Western Australia: no evidence of a major effect

Morgan, Vera; Castle, David; Page, Andrew C.; Fazio, Sam; Gurrin, Lyle C.; Burton, Paul R.; Montgomery, Philip; Jablensky, Assen

doi:10.1016/s0920-9964(97)00033-9

Cited by 86 publications

(45 citation statements)

References 37 publications

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“…No association was found for the former two, but exposure to the 1957 epidemic during the sixth month of pregnancy in Edinburgh was associated with an increased risk for schizophrenia. In contrast to the above-described replications, negative findings also exist from studies with a similar study design to that described above [14,15,16,17,18,19,20,21,22]. The majority of these studies focused on the 1957 A2 influenza epidemic in the Netherlands [14,15,16,17], Croatia [18], Australia [19], and Japan [20].…”

Section: Schizophrenia Spectrum Disordersmentioning

confidence: 99%

“…Beginning in the 1980s, most studies [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] used an ecological design and estimated the timing of the exposure to infectious agents in populations by obtaining retrospective data on epidemics from registries. Some studies [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] additionally collected exposure data by interviewing mothers during or shortly after pregnancy or using their medical records.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Inflammation, Infections and Mental Disorders

Flinkkilä

Keski‐Rahkonen

Marttunen³

et al. 2016

Psychopathology

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Background: The objective of this descriptive review is to summarize the current scientific evidence on the effect of prenatal exposure to maternal infection and immune response on the offspring's risk for mental disorders (schizophrenia spectrum disorders, autism spectrum disorders, attention-deficit hyperactivity disorder, anorexia nervosa, and mood disorders). Sampling and Methods: Studies were searched from PubMed and Ovid MEDLINE (R) databases with the following keywords: ‘prenatal exposure delayed effects' and ‘infection', and ‘inflammation' and ‘mental disorders'. A comprehensive manual search, including a search from the reference list of included articles, was also performed. Results: Prenatal exposure to maternal influenza appears to increase the offspring's risk for schizophrenia spectrum disorders, although studies are not fully consistent. Prenatal exposure to maternal fever and elevated cytokine levels seems to be related to the elevated risk for autism spectrum disorders in the offspring. No replicated findings of an association between prenatal infectious exposure and other mental disorders exist. Conclusions: Evidence for the effect of prenatal exposure to maternal infection on risk for mental disorders exists for several different infections, suggesting that common factors occurring in infections (e.g. elevated cytokine levels and fever), rather than the infectious agent itself, might be the underlying factor in increasing the risk for mental disorders. Additionally, it is likely that genetic liability to these disorders operates in conjunction with the exposure. Therefore, genetically sensitive study designs are needed in future studies.

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Section: Schizophrenia Spectrum Disordersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Inflammation, Infections and Mental Disorders

Flinkkilä

Keski‐Rahkonen

Marttunen³

et al. 2016

Psychopathology

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“…Six of the type A studies only included patients who had ever been hospitalized, while 2 included outpatients as well as inpatients. 14,18 Three ecological studies from Japan were designated type B studies. [19][20][21] We distinguished between the Japanese and other ecological studies because the course of the pandemic in Japan differed markedly from that in other countries in that it came in 2 waves, from June to July 1957 and from November to December 1957.…”

Section: Study Selectionmentioning

confidence: 99%

“…14,17 In order to apply the same method to all studies, we reclassified exposure in these 2 studies using the approach used in the other studies. Morgan et al, 18 in their study of Western Australia, increased the power of their study to find a secondtrimester effect by considering those born in the period from November 1957 until March 1958 as being exposed during this trimester. This was possible because the epidemic in Western Australia lasted from July to September 1957.…”

Section: 21mentioning

confidence: 99%

“…37 A study from Western Australia found a second-trimester effect among females exposed to the 1951 influenza epidemic but no such effect among males or females exposed to epidemics occurring in 1950, 1953, 1954, or 1959. 18 Finally, 4 studies examined the relationship between the prevalence of influenza and the risk of schizophrenia in Denmark. 8,[38][39][40] Each study used a different method and covered a different birth period (1911-1950, 1911-1965, 1915-1970, and 1950-1984, respectively).…”

Section: Studies Not Related To 1957 Pandemicmentioning

confidence: 99%

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Schizophrenia and 1957 Pandemic of Influenza: Meta-analysis

Selten

Frissen

Lensvelt-Mulders

et al. 2009

Schizophrenia Bulletin

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Maternal influenza during pregnancy is a controversial risk factor for schizophrenia in the child. We conducted a meta-analysis to examine whether birth during the 9-month period after the pandemic of 1957 was a risk factor for schizophrenia. Studies that compared the risk of schizophrenia among subjects born after the pandemic with that among those born in corresponding time periods in surrounding years were divided into those conducted in the United States, Europe, or Australia (type A studies, n 5 8) and those from Japan, where the epidemic came in 2 waves (type B studies, n 5 3). Other studies examined the risk among subjects born to mothers who were pregnant during the pandemic and reported having had influenza (type C studies, n 5 2). Relative risks (RRs) were extracted or calculated for each month and/or trimester of possible exposure by 2 independent authors. All analyses were performed using a fixed-effects model. The weighted results of the type A studies did not indicate a significantly increased risk of schizophrenia among children exposed during any trimester or month of prenatal life. Not a single study found a significant first-or second-trimester effect. The mean weighted RR for subjects who were in their first, second, or third trimester of prenatal life during the pandemic (8 effect sizes) was 0.91 (95% confidence interval [CI]: 0.85-0.98), 1.00 (95% CI: 0.93-1.07), and 1.05 (95% CI: 0.98-1.12), respectively. The pooled results of the type B and type C studies were also negative. Given high infection rates during the pandemic (about 50%), these results do not support the maternal influenza hypothesis.

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