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Stewart J, Walker N, Jennings K, Delport C, Nuttall J, Coussens AK, Dyers R, Jolliffe DA, Tang JCY, Fraser WD, Wilkinson RJ, Bekker LG, Martineau AR, Middelkoop K. Prevalence, incidence and determinants of QuantiFERON TM positivity in South African schoolchildren. IJTLD OPEN 2024; 1:206-214. [PMID: 39022781 PMCID: PMC11249604 DOI: 10.5588/ijtldopen.24.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND TB control requires the understanding and disruption of TB transmission. We describe prevalence, incidence and risk factors associated with childhood TB infection in Cape Town, South Africa. METHODS We report cross-sectional baseline and prospective incidence data from a large trial among primary school children living in high TB burden communities. Prevalent infection was defined as QuantiFERON™-TB Gold Plus (QFT-Plus) positivity as assessed at baseline. Subsequent conversion to QFT-Plus positivity was measured 3 years later among those QFT-Plus-negative at baseline. Multivariable logistic regression models examined factors associated with TB infection. RESULTS QuantiFERON-positivity at baseline (prevalence: 22.6%, 95% CI 20.9-24.4), was independently associated with increasing age (aOR 1.24 per additional year, 95% CI 1.15-1.34) and household exposure to TB during the participant's lifetime (aOR 1.87, 95% CI 1.46-2.40). QFT-Plus conversion at year 3 (12.2%, 95% CI 10.5-14.0; annual infection rate: 3.95%) was associated with household exposure to an index TB case (aOR 2.74, 95% CI 1.05-7.18). CONCLUSION Rates of QFT-diagnosed TB infection remain high in this population. The strong association with household TB exposure reinforces the importance of contact tracing, preventative treatment and early treatment of infectious disease to reduce community transmission.
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Affiliation(s)
- J Stewart
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - N Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K Jennings
- Health Department, Cape Town Municipality, Cape Town
| | - C Delport
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - J Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town
- Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - A K Coussens
- Infectious Diseases and Immune Defence Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town
| | - R Dyers
- Western Cape Government: Health and Wellness, Cape Town
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - D A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - J C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich
- Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospitals Trust, Norwich
| | - W D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich
- Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospitals Trust, Norwich
| | - R J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town
- The Francis Crick Institute, London
- Department of Infectious Diseases, Imperial College London, London, UK
| | - L-G Bekker
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - A R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - K Middelkoop
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Middelkoop K, Micklesfield LK, Walker N, Stewart J, Delport C, Jolliffe DA, Mendham AE, Coussens AK, van Graan A, Nuttall J, Tang JCY, Fraser WD, Cooper C, Harvey NC, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on bone mineral content, bone turnover markers, and fracture risk in South African schoolchildren: multicenter double-blind randomized placebo-controlled trial (ViDiKids). J Bone Miner Res 2024; 39:211-221. [PMID: 38477739 PMCID: PMC11240149 DOI: 10.1093/jbmr/zjae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024]
Abstract
Randomized controlled trials (RCTs) to determine the influence of vitamin D on BMC and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n = 450) nested within a phase 3 RCT of weekly oral supplementation with 10 000 IU vitamin D3 vs placebo for 3 yr in HIV-uninfected Cape Town schoolchildren aged 6-11 yr. Outcomes were BMC at the whole body less head (WBLH) and LS and serum 25-hydroxyvitamin D3 (25(OH)D3), PTH, alkaline phosphatase, C-terminal telopeptide, and PINP. Incidence of fractures was a secondary outcome of the main trial (n = 1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (SD 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI, 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI, -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI, -30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI, -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomized to vitamin D vs placebo (7/755 vs 10/758 attending at least 1 follow-up; adjusted odds ratio 0.70, 95% CI, 0.27 to 1.85). In conclusion, a 3-yr course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Lisa K Micklesfield
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Amy E Mendham
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Averalda van Graan
- Biostatistics Unit, SAFOODS Division, South African Medical Research Council, Tygerberg, Cape Town 7505, Western Cape, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, Western Cape, South Africa
| | - James Nuttall
- Department of Paediatrics and Child Health, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town 7700, Western Cape, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- The Francis Crick Institute, London NW1 1AT, United Kingdom
- Imperial College London, London W12 0NN, United Kingdom
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
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Middelkoop K, Micklesfield L, Stewart J, Walker N, Jolliffe DA, Mendham AE, Coussens AK, Nuttall J, Tang J, Fraser WD, Momand W, Cooper C, Harvey NC, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on growth, body composition, pubertal development and spirometry in South African schoolchildren: a randomised controlled trial (ViDiKids). BMJ Paediatr Open 2024; 8:e002495. [PMID: 38599800 PMCID: PMC11015302 DOI: 10.1136/bmjpo-2024-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/29/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE To determine whether weekly oral vitamin D supplementation influences growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren. DESIGN Phase 3 double-blind randomised placebo-controlled trial. SETTING Socioeconomically disadvantaged peri-urban district of Cape Town, South Africa. PARTICIPANTS 1682 children of black African ancestry attending government primary schools and aged 6-11 years at baseline. INTERVENTIONS Oral vitamin D3 (10 000 IU/week) versus placebo for 3 years. MAIN OUTCOME MEASURES Height-for-age and body mass index-for-age, measured in all participants; Tanner scores for pubertal development, spirometric lung volumes and body composition, measured in a subset of 450 children who additionally took part in a nested substudy. RESULTS Mean serum 25-hydroxyvitamin D3 concentration at 3-year follow-up was higher among children randomised to receive vitamin D versus placebo (104.3 vs 64.7 nmol/L, respectively; mean difference (MD) 39.7 nmol/L, 95% CI 37.6 to 41.9 nmol/L). No statistically significant differences in height-for-age z-score (adjusted MD (aMD) -0.08, 95% CI -0.19 to 0.03) or body mass index-for-age z-score (aMD -0.04, 95% CI -0.16 to 0.07) were seen between vitamin D versus placebo groups at follow-up. Among substudy participants, allocation to vitamin D versus placebo did not influence pubertal development scores, % predicted forced expiratory volume in 1 s (FEV1), % predicted forced vital capacity (FVC), % predicted FEV1/FVC, fat mass or fat-free mass. CONCLUSIONS Weekly oral administration of 10 000 IU vitamin D3 boosted vitamin D status but did not influence growth, body composition, pubertal development or spirometric outcomes in South African schoolchildren. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov NCT02880982, South African National Clinical Trials Register DOH-27-0916-5527.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lisa Micklesfield
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amy E Mendham
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Anna K Coussens
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - James Nuttall
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Waheedullah Momand
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, UK
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian R Martineau
- Blizard Institiute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Hu X, Liu J, Shao Y, Li G, Song H, Liu Q, Chen C, Zhu L. Smoking Exposure and the Risk of Latent Tuberculosis Infection: Results from NHANES 2011-2012. TOXICS 2024; 12:94. [PMID: 38276728 PMCID: PMC10819775 DOI: 10.3390/toxics12010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
The association between smoking exposure and latent tuberculosis infection (LTBI) has been investigated in a few studies; however, further investigation is needed. In this study, the 2011-2012 NHANES population was used to evaluate smoking exposure and LTBI risk. A total of 7042 participants with available LTBI results and without active tuberculosis were included for analysis. Smoking was defined as participants who smoked at least 100 cigarettes in their life. Both univariable and multivariable analysis were adopted to evaluate smoking exposure, as well as related factors on the risk of LTBI. LTBI rates among current smokers (12.1%) and former smokers (9.9%) were higher than non-smokers (5.9%). However, current smokers and former smokers were not significantly associated with LTBI risk when compared to non-smokers after adjusting by age and sex in the multivariable analysis. Meanwhile, we found that passive smoking was not associated with LTBI (adjusted odds ratio (AOR), 0.85; 95%CI, 0.66-1.09). In multivariable analysis, current smoking was associated with LTBI (OR, 1.67; 95%CI, 1.28-2.19), while former smokers had an increased OR of LTBI, but the OR did not reach statistical significance (OR, 1.15; 95%CI, 0.90-1.48). Household tuberculosis (TB) contact was also related to LTBI (OR, 1.93; 95%CI, 1.25-2.99). However, BMI and diabetes were not found to be associated with LTBI. Smoking, especially current smoking, was significantly associated with LTBI. LTBI screening should be recommended for active smokers. Former smoking and passive smoking exposure were not found to have a significant relationship with LTBI risk. However, the high LTBI rate among quitters indicated we should pay more attention to former smokers with LTBI.
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Affiliation(s)
- Xinsong Hu
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (X.H.); (J.L.)
| | - Jiongya Liu
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (X.H.); (J.L.)
| | - Yan Shao
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
| | - Guoli Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
| | - Honghuan Song
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
| | - Limei Zhu
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (X.H.); (J.L.)
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing 210009, China; (Y.S.); (G.L.); (H.S.); (Q.L.)
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Rieder HL. Global epidemiologic aspects of tuberculosis in children. Indian J Tuberc 2023; 70 Suppl 1:S1-S5. [PMID: 38110250 DOI: 10.1016/j.ijtb.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Hans L Rieder
- Tuberculosis Consultant Services, Kirchlindach, Switzerland.
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6
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Middelkoop K, Stewart J, Walker N, Delport C, Jolliffe DA, Coussens AK, Nuttall J, Tang JCY, Fraser WD, Griffiths CJ, Kumar GT, Filteau S, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Vitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicenter phase 3 double-blind randomized placebo-controlled trial (ViDiKids). Int J Infect Dis 2023; 134:63-70. [PMID: 37211272 DOI: 10.1016/j.ijid.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES To determine whether weekly oral supplementation with 10,000 IU vitamin D3 for 3 years reduces the risk of sensitization to M. tuberculosis in South African schoolchildren aged 6-11 years with negative QuantiFERON-tuberculosis (TB) Gold Plus (QFT-Plus) assay results at baseline. METHODS We conducted a phase 3 randomized placebo-controlled trial in 1682 children attending 23 primary schools in Cape Town. The primary outcome was a positive end-trial QFT-Plus result, analyzed using a mixed effects logistic regression model with the school of attendance included as a random effect. RESULTS 829 vs. 853 QFT-Plus-negative children were randomized to receive vitamin D3 vs. placebo, respectively. Mean end-study 25(OH)D concentrations in participants randomized to vitamin D vs. placebo were 104.3 vs 64.7 nmol/l, respectively (95% confidence interval for difference, 37.6 to 41.9 nmol/l). A total of 76/667 (11.4%) participants allocated to vitamin D vs. 89/687 (13.0%) participants allocated to placebo tested QFT-Plus positive at 3-year follow-up (adjusted odds ratio 0.86, 95% confidence interval 0.62-1.19, P = 0.35). CONCLUSION Weekly oral supplementation with 10,000 IU vitamin D3 for 3 years elevated serum 25(OH)D concentrations among QFT-Plus-negative Cape Town schoolchildren but did not reduce their risk of QFT-Plus conversion.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Infectious Diseases and Immune Defense Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK; Departments of Laboratory Medicine, Clinical Biochemistry, and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK; Departments of Laboratory Medicine, Clinical Biochemistry, and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Christopher J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geeta Trilok Kumar
- Delhi School of Public Health, Institute of Eminence, University of Delhi, Delhi, India; Trivedi School of Biosciences, Ashoka University, Sonipat, India
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; The Francis Crick Institute, London, UK; Imperial College London, London, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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7
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Yu J, Liu M, Mijiti X, Liu H, Wang Q, Yin C, Anwaierjiang A, Xu M, Li M, Deng L, Xiao H, Zhao X, Wan K, Li G, Yuan X. Association of Single-Nucleotide Polymorphisms in the VDR Gene with Tuberculosis and Infection of Beijing Genotype Mycobacterium tuberculosis. Infect Drug Resist 2023; 16:3157-3169. [PMID: 37235072 PMCID: PMC10208660 DOI: 10.2147/idr.s407595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Background The aim of the present study was to investigate the association between vitamin D receptor (VDR) gene polymorphism and tuberculosis susceptibility, as well as the potential interaction of host genetic factors with the heterogeneity of Mycobacterium tuberculosis in the population from Xinjiang, China. Methods From January 2019 to January 2020, we enrolled 221 tuberculosis patients as the case group and 363 staff with no clinical symptoms as the control group from four designated tuberculosis hospitals in southern Xinjiang, China. The polymorphisms of Fok I, Taq I, Apa I, Bsm I, rs3847987 and rs739837 in the VDR were detected by sequencing. M. tuberculosis isolates were collected from the case group and identified as Beijing or non-Beijing lineage by multiplex PCR. Propensity score (PS), univariate analysis and multivariable logistic regression models were used to perform the analysis. Results Our results showed that the allele and genotype frequencies of Fok I, Taq I, Apa I, Bsm I, rs3847987 and rs739837 in VDR were not correlated with tuberculosis susceptibility or lineages of M. tuberculosis. Two out of six loci of the VDR gene formed one haplotype block, and none of the haplotypes was found to correlate with tuberculosis susceptibility or lineages of M. tuberculosis infected. Conclusion Polymorphisms in the VDR gene may not indicate susceptibility to tuberculosis. There was also no evidence on the interaction between the VDR gene of host and the lineages of M. tuberculosis in the population from Xinjiang, China. Further studies are nonetheless required to prove our conclusions.
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Affiliation(s)
- Jinjie Yu
- School of Public Health, University of South China, Hengyang, 421001, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Mengwen Liu
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Xiaokaiti Mijiti
- The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830049, People’s Republic of China
| | - Haican Liu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Quan Wang
- The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830049, People’s Republic of China
| | - Chunjie Yin
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | | | - Miao Xu
- The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830049, People’s Republic of China
| | - Machao Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Lele Deng
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Hui Xiao
- School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Xiuqin Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Kanglin Wan
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Guilian Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Xiuqin Yuan
- School of Public Health, University of South China, Hengyang, 421001, People’s Republic of China
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8
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Zavala MJ, Becker GL, Blount RJ. Interrelationships between tuberculosis and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:104-111. [PMID: 36647566 PMCID: PMC9877200 DOI: 10.1097/mcp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Our objective was to review the current literature regarding socioeconomic, environmental, clinical, and immunologic factors common to chronic obstructive pulmonary disease (COPD) and tuberculosis (TB). RECENT FINDINGS Recent studies suggest that TB patients might be at increased risk for developing COPD. Conversely, additional prospective cohort studies have determined that COPD patients are at increased risk for active TB: a risk that appears to be partially mediated through inhaled corticosteroid use. Tobacco smoking, poverty, air pollution, and malnutrition are associated with COPD and TB. Vitamin D has been shown to prevent COPD exacerbations, but its use for preventing TB infection remains unclear. Surfactant deficiency, elevated matrix metalloproteinases, and toll-like receptor 4 polymorphisms play key roles in the pathogenesis of both diseases. SUMMARY Recent studies have elucidated interrelationships between COPD and TB. Future research is needed to optimize clinical and public health approaches that could mitigate risk factors contributing to both diseases.
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Affiliation(s)
- Michael J Zavala
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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9
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Ganmaa D, Bromage S, Khudyakov P, Erdenenbaatar S, Delgererekh B, Martineau AR. Influence of Vitamin D Supplementation on Growth, Body Composition, and Pubertal Development Among School-aged Children in an Area With a High Prevalence of Vitamin D Deficiency: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:32-41. [PMID: 36441522 PMCID: PMC9706398 DOI: 10.1001/jamapediatrics.2022.4581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
Importance Vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] <20 ng/mL) is prevalent among children living in temperate climates and has been reported to associate independently with stunting, obesity, and early activation of the hypothalamic-pituitary-gonadal axis. Phase 3 randomized clinical trials to investigate the influence of long-term vitamin D replacement on growth, body composition, and pubertal development of school-aged children with vitamin D deficiency are lacking. Objective To determine whether weekly oral vitamin D supplementation influences linear growth, body composition, or pubertal development in school-aged children living in a setting where vitamin D deficiency is highly prevalent. Design, Setting, and Participants This secondary analysis of a double-blind, placebo-controlled randomized clinical trial was conducted from June 2016 to June 2019 at 18 grade schools in Ulaanbaatar, Mongolia. School-aged children (6 to 13 years at baseline) attending participating schools were included. Exclusion criteria included a positive QuantiFERON-TB Gold in-tube assay result, conditions or medications associated with altered vitamin D metabolism, use of vitamin D supplements, signs of rickets, or intention to move from Ulaanbaatar within 4 years. Of 11 475 children invited to participate in the study, 9814 underwent QFT testing, and 8851 with negative results were included in the study. All but 1 participant in the placebo group completed follow-up and were included in the present analysis. Data were analyzed from November 2021 to February 2022. Interventions Weekly oral doses of vitamin D3, 14 000 IU, (n = 4418), or placebo (n = 4433) for 3 years. Main Outcomes and Measures Mean z scores for height for age, body mass index for age, and waist-to-height ratio; mean percentage body fat, fat mass, and fat-free mass; and mean Tanner scores for pubertal development. Results Of 8851 participants, 4366 (49.3%) were female, and 8165 (92.2%) were of Khalkh ethnicity; the mean (SD) age was 9.4 (1.6) years. A total of 8453 participants (95.5%) were vitamin D deficient at baseline, and mean end-of-study 25(OH)D concentrations among participants randomized to vitamin D vs placebo were 31.0 vs 10.7 ng/mL (mean difference, 20.3; 95% CI; 19.9-20.6). However, vitamin D supplementation did not influence mean height for age, body mass index for age, waist-to-height ratio, percentage body fat, fat mass, fat-free mass, or Tanner scores, either overall or within subgroups defined by baseline 25(OH)D concentration less than 10 ng/mL vs 10 ng/mL or greater, estimated calcium intake less than 500 mg/d vs 500 mg/d or greater, or male vs female sex. Conclusions and Relevance In school-aged children in this study with low baseline vitamin D status, oral vitamin D3 supplementation at a dose of 14 000 IU per week for 3 years was effective in elevating 25(OH)D concentrations but did not influence growth, body composition, or pubertal development. Trial Registration ClinicalTrials.gov Identifier: NCT02276755.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Sumiya Erdenenbaatar
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Baigal Delgererekh
- Global Laboratory, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Adrian R. Martineau
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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10
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Bromage S. Integrated Spreadsheets for Nutritional Analysis of Population Diet Surveys. J Vis Exp 2022. [PMID: 36342153 PMCID: PMC10892476 DOI: 10.3791/64327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
It can be challenging to calculate nutrient intakes in population diet surveys because existing nutritional analysis software is generally oriented toward analyzing intakes of individuals and may not allow users to input or easily modify the food composition data used in the analysis. These are drawbacks that are more problematic in low- and middle-income country settings. While there are numerous software-assisted dietary assessment platforms that conduct onboard nutritional analysis and are appropriate for use in large surveys, they are often similarly limited, and further restrict users to specific assessment modalities. This paper presents a multifunctional system of integrated spreadsheets for nutritional analysis of population diet surveys (ISNAPDS) that provides a solution for situations in which data have been collected but cannot be adequately analyzed with existing software. The protocol involves supplying the system with fully customizable data on food composition, food group classifications, and food intake (food intake in g/day may be entered directly or calculated based on user-supplied intake frequencies and either standard or variable serving sizes). Following data entry, the user modifies a set of simple pre-populated formulas to match them to the structure of the input data and the system applies these formulas to calculate nutrient and food group intakes, and the contributions of food groups to nutrient intakes for all members of the survey population. The flexibility of the ISNAPDS system allows it to accommodate the global diversity of foods consumed and analyze quantitative, semiquantitative, and nonquantitative food consumption data collected using prospective and retrospective assessment methods employing different reference periods and portion size estimation methods. To date, the system has been applied in published and ongoing analyses of 24 h recall, diet record, food frequency, and disaggregated household consumption data from population surveys in China, Ethiopia, India, Mongolia, Thailand, and a multi-country analysis of 10 sub-Saharan African countries.
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Affiliation(s)
- Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health;
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11
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Zanaa A, Paramita SA, Erdenee O, Tsolmon B, Purevdagva A, Yamazaki C, Uchida M, Hamazaki K. Childhood Tuberculosis in Mongolia: Trends and Estimates, 2010-2030. TOHOKU J EXP MED 2022; 257:193-203. [PMID: 35491122 DOI: 10.1620/tjem.2022.j034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mongolia was listed among the 30 countries with a high tuberculosis burden in 2021. Approximately 10-11% of the tuberculosis cases are of children, which is higher than the global average (6.0%). As children are a vulnerable population, it is important to understand the current situation and prioritize the development of tuberculosis prevention strategies. However, only few studies have addressed childhood tuberculosis in Mongolia. Therefore, we aimed to describe the characteristics of childhood tuberculosis and to show its trends and estimates in Mongolia. We performed descriptive and trend analyses on secondary data from the National Center for Communicable Diseases from 2010 to 2020. A total of 4,242 childhood tuberculosis cases, compiled from nine districts of the capital city and 21 provinces, were analyzed. We found that tuberculosis occurred more frequently in school-age children, and 71.8% of the all cases were an extrapulmonary tuberculosis. Trend analysis revealed that childhood tuberculosis continuously increased with fluctuations from 2018 onwards. The central region, including the capital city of Ulaanbaatar, is the most tuberculosis-burdened. Childhood tuberculosis is estimated to increase in the central region and decrease in the others from 2021 to 2030. Our findings showed that the national childhood tuberculosis trend is increasing, although there are differences in the pattern between regions. Further studies are needed to identify the determinant factors of regional differences, and age-specific public health interventions, such as scale-up screening and preventive treatment, are in demand in high-prevalence areas.
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Affiliation(s)
- Ankhjargal Zanaa
- Department of Public Health, Gunma University Graduate School of Medicine
| | - Sekar Ayu Paramita
- Department of Public Health, Gunma University Graduate School of Medicine
| | | | | | | | - Chiho Yamazaki
- Department of Public Health, Gunma University Graduate School of Medicine
| | - Mitsuo Uchida
- Department of Public Health, Gunma University Graduate School of Medicine
| | - Kei Hamazaki
- Department of Public Health, Gunma University Graduate School of Medicine
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12
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Serial T-SPOT.TB responses in Tanzanian adolescents: Transient, persistent and irregular conversions. PLoS One 2022; 17:e0268685. [PMID: 35749397 PMCID: PMC9231806 DOI: 10.1371/journal.pone.0268685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Prospective studies of interferon-gamma release assays (IGRA) on healthy subjects in tuberculosis-endemic regions have not examined the long-term variability of serial assays. This issue is relevant to the interpretation of tuberculosis (TB) vaccine trials based on prevention of infection. Methods T-SPOT.TB assays were performed manually on healthy adolescents during a tuberculosis vaccine trial in Tanzania at 5 intervals over 3 years. Assay results were defined as negative, positive, borderline or invalid. Subsequently, microtiter plates were analyzed by an automated reader to obtain quantitative counts of spot forming cells (SFCs) for the present analysis. Results 3387 T-SPOT.TB samples were analyzed from 928 adolescents; manual and automated assay results were 97% concordant. Based on the quantitative results 143 (15%) participants were prevalent IGRA-positives at baseline, were ineligible for further study. Among the remaining IGRA-negative participants, the annual rate of IGRA conversion was 2·9%. Among 43 IGRA converters with repeat assays 12 (28%) were persistent converters, 16 (37%) were transient converters, and 15 (35%) comprised a new category defined as irregular converters (≥2 different subsequent results). ESAT-6 and CFP-10 responses were higher in prevalent than incident positives: 53 vs 36 for CFP-10 (p < 0·007); 44 vs 34 for ESAT-6 (p = 0·12). Conclusions Definitions of IGRA conversion, reversion, and persistence depend critically on the frequency of testing. Multiple shifts in categories among adolescents in a TB-endemic country may represent multiple infections, variable host responses in subclinical infection, or assay variation. These findings should to be considered in the design and interpretation of TB vaccine trials based on prevention of infection. Household contact studies could determine whether even transient IGRA conversion might represent exposure to an active case of M. tuberculosis disease.
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13
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Altet N, Latorre I, Jiménez-Fuentes MÁ, Soriano-Arandes A, Villar-Hernández R, Milà C, Rodríguez-Fernández P, Muriel-Moreno B, Comella-del-Barrio P, Godoy P, Millet JP, de Souza-Galvão ML, Jiménez-Ruiz CA, Domínguez J. Tobacco Smoking and Second-Hand Smoke Exposure Impact on Tuberculosis in Children. J Clin Med 2022; 11:jcm11072000. [PMID: 35407608 PMCID: PMC8999260 DOI: 10.3390/jcm11072000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Little is known about whether second-hand smoke (SHS) exposure affects tuberculosis (TB). Here, we investigate the association of cigarette smoke exposure with active TB and latent TB infection (LTBI) in children, analyzing Interferon-Gamma Release Assays’ (IGRAs) performance and cytokine immune responses. A total of 616 children from contact-tracing studies were included and classified regarding their smoking habits [unexposed, SHS, or smokers]. Risk factors for positive IGRAs, LTBI, and active TB were defined. GM-CSF, IFN-γ, IL-2, IL-5, IL-10, IL-13, IL-22, IL-17, TNF-α, IL-1RA and IP-10 cytokines were detected in a subgroup of patients. Being SHS exposed was associated with a positive IGRA [aOR (95% CI): 8.7 (5.9–12.8)] and was a main factor related with LTBI [aOR (95% CI): 7.57 (4.79–11.94)] and active TB [aOR (95% CI): 3.40 (1.45–7.98)]. Moreover, IGRAs’ sensitivity was reduced in active TB patients exposed to tobacco. IL-22, GM-CSF, IL-5, TNF-α, IP-10, and IL-13 were less secreted in LTBI children exposed to SHS. In conclusion, SHS is associated with LTBI and active TB in children. In addition, false-negative IGRAs obtained on active TB patients exposed to SHS, together with the decrease of specific cytokines released, suggest that tobacco may alter the immune response.
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Affiliation(s)
- Neus Altet
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
- Serveis Clínics, Unitat Clínica de Tractament Directament Observat de la Tuberculosi, 08022 Barcelona, Spain;
| | - Irene Latorre
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
- Correspondence: ; Tel.: +34-93-033-0537
| | - María Ángeles Jiménez-Fuentes
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Antoni Soriano-Arandes
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Raquel Villar-Hernández
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Celia Milà
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | - Pablo Rodríguez-Fernández
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
- Institut de Biotecnologia i Biomedicina, 08193 Cerdanyola del Vallès, Spain
| | - Beatriz Muriel-Moreno
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Patricia Comella-del-Barrio
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
| | - Pere Godoy
- Departament de Salut, Generalitat de Catalunya, 08028 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain
- IRB-Lleida, Universitat de Lleida, 25198 Lleida, Spain
| | - Joan-Pau Millet
- Serveis Clínics, Unitat Clínica de Tractament Directament Observat de la Tuberculosi, 08022 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain
| | - Maria Luiza de Souza-Galvão
- Unitat de Tuberculosi Vall d’Hebron-Drassanes, Hospital Universitari Vall d’Hebron, 08001 Barcelona, Spain; (N.A.); (M.Á.J.-F.); (A.S.-A.); (C.M.); (M.L.d.S.-G.)
| | | | - Jose Domínguez
- Institut d’Investigació Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (R.V.-H.); (P.R.-F.); (B.M.-M.); (P.C.-d.-B.); (J.D.)
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14
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Middelkoop K, Walker N, Stewart J, Delport C, Jolliffe DA, Nuttall J, Coussens AK, Naude CE, Tang JCY, Fraser WD, Wilkinson RJ, Bekker LG, Martineau AR. Prevalence and Determinants of Vitamin D Deficiency in 1825 Cape Town Primary Schoolchildren: A Cross-Sectional Study. Nutrients 2022; 14:nu14061263. [PMID: 35334921 PMCID: PMC8952729 DOI: 10.3390/nu14061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin D deficiency (25-hydroxyvitamin D[25(OH)D] <50 nmol/L) is common among adults in Cape Town, South Africa, but studies investigating vitamin D status of children in this setting are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 1825 Cape Town schoolchildren aged 6−11 years. Prevalence of vitamin D deficiency was 7.6% (95% Confidence Interval [CI] 6.5% to 8.9%). Determinants of vitamin D deficiency included month of sampling (adjusted odds ratio [aOR] for July−September vs. January−March 10.69, 95% CI 5.02 to 22.77; aOR for October−December vs. January−March 6.73, 95% CI 2.82 to 16.08), older age (aOR 1.25 per increasing year, 95% CI: 1.01−1.53) and higher body mass index (BMI; aOR 1.24 per unit increase in BMI-for-age Z-score, 95% CI: 1.03−1.49). In a subset of 370 participants in whom parathyroid hormone (PTH) concentrations were measured; these were inversely related to serum 25(OH)D concentrations (p < 0.001). However, no association between participants with hyperparathyroidism (PTH >6.9 pmol/L) and vitamin D deficiency was seen (p = 0.42). In conclusion, we report that season is the major determinant of vitamin D status among Cape Town primary schoolchildren, with prevalence of vitamin D deficiency ranging from 1.4% in January−March to 22.8% in July−September.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
- Correspondence: (K.M.); (A.R.M.)
| | - Neil Walker
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - David A. Jolliffe
- Wolfson Institute of Population Health, Queen Mary University of London, London E1 2AB, UK; (N.W.); (D.A.J.)
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town 7700, South Africa;
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7700, South Africa
| | - Anna K. Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute, Parkville, VIC 3052, Australia
| | - Celeste E. Naude
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Jonathan C. Y. Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
| | - William D. Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (J.C.Y.T.); (W.D.F.)
- Departments of Clinical Biochemistry and Endocrinology, Norfolk and Norwich University Hospitals Trust, Norwich NR4 7UY, UK
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (A.K.C.); (R.J.W.)
- The Francis Crick Institute, Midland Road, London NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London W12 0NN, UK
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; (J.S.); (C.D.); (L.-G.B.)
- Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Adrian R. Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
- Correspondence: (K.M.); (A.R.M.)
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Stockdale L, Sambou B, Sissoko M, Egere U, Sillah AK, Kampmann B, Basu Roy R. Vitamin D in Gambian children with discordant tuberculosis (TB) infection status despite matched TB exposure: a case control study. Eur J Pediatr 2022; 181:1263-1267. [PMID: 34643785 PMCID: PMC8897383 DOI: 10.1007/s00431-021-04272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Using a matched case control design conducted at MRC Gambia in 2015, we measured vitamin D levels in pairs of asymptomatic children with discordant tuberculin skin test status despite the same sleeping proximity to the same adult TB index case. Median ages of groups (infected; 10.0 years, uninfected 8.8 years) were not significantly different (p = 0.13). Mean vitamin D levels were 2.05 ng/mL (95% CI - 0.288 to 4.38) higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-exposed infected children (p = 0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case.
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Affiliation(s)
- Lisa Stockdale
- Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Basil Sambou
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Muhamed Sissoko
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Uzochukwu Egere
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK
| | - Abdou K. Sillah
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Robin Basu Roy
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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16
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Blount RJ, Phan H, Trinh T, Dang H, Merrifield C, Zavala M, Zabner J, Comellas AP, Stapleton EM, Segal MR, Balmes J, Nhung NV, Nahid P. Indoor Air Pollution and Susceptibility to Tuberculosis Infection in Urban Vietnamese Children. Am J Respir Crit Care Med 2021; 204:1211-1221. [PMID: 34343025 DOI: 10.1164/rccm.202101-0136oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic. OBJECTIVES To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia. METHODS We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, July 2017-December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations. MEASUREMENTS AND MAIN RESULTS We enrolled 72 tuberculosis patients (27% with cavitary disease) and 109 of their child household contacts. Of household contacts, 58 (53%) were diagnosed with latent tuberculosis at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95%CI 1.27-5.16). Odds were highest among children exposed to indoor smokers and children under five years old exposed to household smokers. Each residential floor above street-level pollution decreased the odds of latent tuberculosis by 36% (aOR 0.64, 95%CI 0.42-0.96). Motorcycles parked inside children's homes and cooking with liquid petroleum gas compared to electricity increased the odds of latent tuberculosis while kitchen ventilation decreased the effect, but these findings were not statistically significant. CONCLUSION Common urban indoor air pollution sources were associated with increased odds of latent tuberculosis infection in child household contacts of active tuberculosis patients.
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Affiliation(s)
- Robert J Blount
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States;
| | - Ha Phan
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Trang Trinh
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Hai Dang
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Cindy Merrifield
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Tuberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, California, United States
| | - Michael Zavala
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Joseph Zabner
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Alejandro P Comellas
- University of Iowa, 4083, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Emma M Stapleton
- UI Carver College of Medicine, 12243, Iowa City, Iowa, United States
| | - Mark R Segal
- University of California San Francisco, 8785, Department of Epidemiology and Biostatistics, San Francisco, California, United States
| | - John Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Nguyen Viet Nhung
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Vietnam National Tuberculosis Program, Hanoi, Viet Nam
| | - Payam Nahid
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Turberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, United States
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17
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Mistry N, Hemler EC, Dholakia Y, Bromage S, Shukla A, Dev P, Govekar L, Tipre P, Shah D, Keshavjee SA, Fawzi WW. Protocol for a case-control study of vitamin D status, adult multidrug-resistant tuberculosis disease and tuberculosis infection in Mumbai, India. BMJ Open 2020; 10:e039935. [PMID: 33184081 PMCID: PMC7662534 DOI: 10.1136/bmjopen-2020-039935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Vitamin D status may be an important determinant of multidrug-resistant tuberculosis (MDR-TB) infection, progression to disease and treatment outcomes. Novel and potentially cost-effective therapies such as vitamin D supplementation are needed to stem the tide of TB and MDR-TB globally, particularly in India, a country that accounts for the largest fraction of the world's TB incidence and MDR-TB incidence, and where vitamin D deficiency is endemic. While vitamin D has shown some promise in the treatment of MDR-TB, its role in the context of MDR-TB infection and progression to disease is largely unknown. METHODS AND ANALYSIS Through a case-control study in Mumbai, India, we aim to examine associations between vitamin D status and active MDR-TB and to investigate vitamin D status and TB infection among controls. Cases are adult outpatient pulmonary patients with MDR-TB recruited from two public TB clinics. Controls are recruited from the cases' household contacts and from non-respiratory departments of the facilities where cases were recruited. Cases and controls are assessed for serum 25-hydroxyvitamin D concentration, nutrient intake, diet quality, anthropometry and other relevant clinical and sociodemographic parameters. Controls undergo additional clinical assessments to rule out active TB and laboratory assessments to determine presence of TB infection. Statistical analysis investigates associations between vitamin D status and active MDR-TB and between vitamin D status and TB infection among controls, accounting for potential confounding effects of diet, anthropometry and other covariates. ETHICS AND DISSEMINATION This study has been approved by Harvard T.H. Chan School of Public Health Institutional Review Board; Foundation for Medical Research Institutional Research Ethics Committee and Health Ministry's Screening Committee of the Indian Council for Medical Research. Permission was granted by the Municipal Corporation of Greater Mumbai, India, a collaborating partner on this research. Outcomes will be disseminated through publication and scientific presentation. TRIAL REGISTRATION NUMBER NCT04342598.
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Affiliation(s)
- Nerges Mistry
- Department of Tuberculosis Research, Foundation for Medical Research, Mumbai, India
| | - Elena C Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yatin Dholakia
- Department of Tuberculosis Research, Foundation for Medical Research, Mumbai, India
| | - Sabri Bromage
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anupam Shukla
- Department of Tuberculosis Research, Foundation for Medical Research, Mumbai, India
| | - Prachi Dev
- Department of Tuberculosis Research, Foundation for Medical Research, Mumbai, India
| | - Laxmi Govekar
- Department of Tuberculosis Research, Foundation for Medical Research, Mumbai, India
| | - Pranita Tipre
- Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Daksha Shah
- Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Salmaan A Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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18
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Corbett C, Kulzhabaeva A, Toichkina T, Kalmambetova G, Ahmedov S, Antonenka U, Iskakova A, Kosimova D, Migunov D, Myrzaliev B, Sahalchyk E, Umetalieva N, Vogel M, Kadyrov A, Hoffmann H. Implementing contact tracing for tuberculosis in Kyrgyz Republic and risk factors for positivity using QuantiFERON-TB Gold plus. BMC Infect Dis 2020; 20:746. [PMID: 33046016 PMCID: PMC7552456 DOI: 10.1186/s12879-020-05465-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Effective active case finding (ACF) activities are essential for early identification of new cases of active tuberculosis (TB) and latent TB infection (LTBI). Accurate diagnostics as well as the ability to identify contacts at high risk of infection are essential for ACF, and have not been systematically reported from Central Asia. The objective was to implement a pilot ACF program to determine the prevalence and risk factors for LTBI and active TB among contacts of individuals with TB in Kyrgyz Republic using Quantiferon-TB Gold plus (QuantiFERON). METHODS An enhanced ACF project in the Kyrgyz Republic was implemented in which close and household (home) contacts of TB patients from the Issyk-Kul Oblast TB Center were visited at home. QuantiFERON and the tuberculin skin test (TST) alongside clinical and bacteriological examination were used to identify LTBI and active TB cases among contacts. The association for QuantiFERON positivity and risk factors were analysed and compared to TST results. RESULTS Implementation of ACF with QuantiFERON involved close collaboration with the national sanitary and epidemiological services (SES) and laboratories in the Kyrgyz Republic. From 67 index cases, 296 contacts were enrolled of whom 253 had QuantiFERON or TST results; of those 103 contacts had LTBI (positive TST or IGRA), and four (1.4%) active TB cases were detected. Index case smear microscopy (OR 1.76) and high household density (OR 1.97) were significant risk factors for QuantiFERON positivity for all contacts. When stratified by age, association with smear positivity disappeared for children below 15 years. TST was not associated with any risk factor. CONCLUSIONS This is the first time that ACF activities have been reported for Central Asia, and provide insight for implementation of effective ACF in the region. These ACF activities using QuantiFERON led to increase in the detection of LTBI and active cases, prior to patients seeking treatment. Household density should be taken into consideration as an important risk factor for the stratification of future ACF activities.
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Affiliation(s)
- Caroline Corbett
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany.
| | | | | | | | | | - Uladzimir Antonenka
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Altyn Iskakova
- Republican Tuberculosis Reference Laboratory, Bishkek, Kyrgyz Republic
| | | | | | - Bakyt Myrzaliev
- KNCV Branch Office in the Kyrgyz Republic, Bishkek, Kyrgyz Republic
| | - Evgeni Sahalchyk
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Nagira Umetalieva
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Monica Vogel
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
| | - Abdylat Kadyrov
- Republican Tuberculosis Center, National TB Program, Bishkek, Kyrgyz Republic
| | - Harald Hoffmann
- Departments SYNLAB Gauting & IML red GmbH, WHO - Supranational Tuberculosis Reference Laboratory Munich-Gauting, Institute of Microbiology and Laboratory Medicine, Robert-Koch-Allee 2, D-82131, Gauting, Germany
- SYNLAB Gauting, SYNLAB Human Genetics, Munich, Germany
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19
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Ganmaa D, Uyanga B, Zhou X, Gantsetseg G, Delgerekh B, Enkhmaa D, Khulan D, Ariunzaya S, Sumiya E, Bolortuya B, Yanjmaa J, Enkhtsetseg T, Munkhzaya A, Tunsag M, Khudyakov P, Seddon JA, Marais BJ, Batbayar O, Erdenetuya G, Amarsaikhan B, Spiegelman D, Tsolmon J, Martineau AR. Vitamin D Supplements for Prevention of Tuberculosis Infection and Disease. N Engl J Med 2020; 383:359-368. [PMID: 32706534 PMCID: PMC7476371 DOI: 10.1056/nejmoa1915176] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vitamin D metabolites support innate immune responses to Mycobacterium tuberculosis. Data from phase 3, randomized, controlled trials of vitamin D supplementation to prevent tuberculosis infection are lacking. METHODS We randomly assigned children who had negative results for M. tuberculosis infection according to the QuantiFERON-TB Gold In-Tube assay (QFT) to receive a weekly oral dose of either 14,000 IU of vitamin D3 or placebo for 3 years. The primary outcome was a positive QFT result at the 3-year follow-up, expressed as a proportion of children. Secondary outcomes included the serum 25-hydroxyvitamin D (25[OH]D) level at the end of the trial and the incidence of tuberculosis disease, acute respiratory infection, and adverse events. RESULTS A total of 8851 children underwent randomization: 4418 were assigned to the vitamin D group, and 4433 to the placebo group; 95.6% of children had a baseline serum 25(OH)D level of less than 20 ng per milliliter. Among children with a valid QFT result at the end of the trial, the percentage with a positive result was 3.6% (147 of 4074 children) in the vitamin D group and 3.3% (134 of 4043) in the placebo group (adjusted risk ratio, 1.10; 95% confidence interval [CI], 0.87 to 1.38; P = 0.42). The mean 25(OH)D level at the end of the trial was 31.0 ng per milliliter in the vitamin D group and 10.7 ng per milliliter in the placebo group (mean between-group difference, 20.3 ng per milliliter; 95% CI, 19.9 to 20.6). Tuberculosis disease was diagnosed in 21 children in the vitamin D group and in 25 children in the placebo group (adjusted risk ratio, 0.87; 95% CI, 0.49 to 1.55). A total of 29 children in the vitamin D group and 34 in the placebo group were hospitalized for treatment of acute respiratory infection (adjusted risk ratio, 0.86; 95% CI, 0.52 to 1.40). The incidence of adverse events did not differ significantly between the two groups. CONCLUSIONS Vitamin D supplementation did not result in a lower risk of tuberculosis infection, tuberculosis disease, or acute respiratory infection than placebo among vitamin D-deficient schoolchildren in Mongolia. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02276755.).
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Affiliation(s)
- Davaasambuu Ganmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Buyanjargal Uyanga
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Xin Zhou
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Garmaa Gantsetseg
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Baigali Delgerekh
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Davaasambuu Enkhmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Dorjnamjil Khulan
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Saranjav Ariunzaya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Erdenebaatar Sumiya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Batbileg Bolortuya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Jutmaan Yanjmaa
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Tserenkhuu Enkhtsetseg
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ankhbat Munkhzaya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Murneren Tunsag
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Polyna Khudyakov
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - James A Seddon
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ben J Marais
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ochirbat Batbayar
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Ganbaatar Erdenetuya
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Bazarsaikhan Amarsaikhan
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Donna Spiegelman
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Jadambaa Tsolmon
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
| | - Adrian R Martineau
- From the Harvard T.H. Chan School of Public Health (D.G., P.K., D.S.) and the Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (D.G.) - all in Boston; the Mongolian Health Initiative (D.G., B.U., G.G., D.E., D.K., S.A., E.S., B.B., J.Y., T.E., O.B.) and Global Laboratory (B.D., A.M.), Royal Plaza, Bayanzurkh District, the National Center for Communicable Diseases (M.T.), and the Mongolian National University of Medical Sciences (G.E., B.A., J.T.) - all in Ulaanbaatar, Mongolia; Yale School of Public Health, New Haven, CT (X.Z., D.S.); the Faculty of Medicine, Imperial College (J.A.S.), and the Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (A.R.M.) - all in London; the Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa (J.A.S.); and the Faculty of Medicine and Health, University of Sydney, Sydney (B.J.M.)
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Giustina A, Adler RA, Binkley N, Bollerslev J, Bouillon R, Dawson-Hughes B, Ebeling PR, Feldman D, Formenti AM, Lazaretti-Castro M, Marcocci C, Rizzoli R, Sempos CT, Bilezikian JP. Consensus statement from 2 nd International Conference on Controversies in Vitamin D. Rev Endocr Metab Disord 2020; 21:89-116. [PMID: 32180081 PMCID: PMC7113202 DOI: 10.1007/s11154-019-09532-w] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The 2nd International Conference on Controversies in Vitamin D was held in Monteriggioni (Siena), Italy, September 11-14, 2018. The aim of this meeting was to address ongoing controversies and timely topics in vitamin D research, to review available data related to these topics and controversies, to promote discussion to help resolve lingering issues and ultimately to suggest a research agenda to clarify areas of uncertainty. Several issues from the first conference, held in 2017, were revisited, such as assays used to determine serum 25-hydroxyvitamin D [25(OH)D] concentration, which remains a critical and controversial issue for defining vitamin D status. Definitions of vitamin D nutritional status (i.e. sufficiency, insufficiency and deficiency) were also revisited. New areas were reviewed, including vitamin D threshold values and how they should be defined in the context of specific diseases, sources of vitamin D and risk factors associated with vitamin D deficiency. Non-skeletal aspects related to vitamin D were also discussed, including the reproductive system, neurology, chronic kidney disease and falls. The therapeutic role of vitamin D and findings from recent clinical trials were also addressed. The topics were considered by 3 focus groups and divided into three main areas: 1) "Laboratory": assays and threshold values to define vitamin D status; 2) "Clinical": sources of vitamin D and risk factors and role of vitamin D in non-skeletal disease and 3) "Therapeutics": controversial issues on observational studies and recent randomized controlled trials. In this report, we present a summary of our findings.
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Affiliation(s)
- A Giustina
- Chair of Endocrinology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Endocrinology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - R A Adler
- McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - N Binkley
- Osteoporosis Clinical Research Program and Institute on Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - J Bollerslev
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - R Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, Leuven, KU, Belgium
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - D Feldman
- Department of Medicine, Endocrinology Division, Stanford University School of Medicine, Stanford, CA, USA
| | - A M Formenti
- Chair of Endocrinology, School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Endocrinology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Rizzoli
- Divison of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C T Sempos
- Vitamin D Standardization Program LLC, Havre de Grace, MD, USA
| | - J P Bilezikian
- Department of Medicine, Endocrinology Division, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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21
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Genotype-independent association between vitamin D deficiency and polycystic ovarian syndrome in Lahore, Pakistan. Sci Rep 2020; 10:2290. [PMID: 32042037 PMCID: PMC7010676 DOI: 10.1038/s41598-020-59228-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/27/2020] [Indexed: 11/08/2022] Open
Abstract
Both vitamin D deficiency and single nucleotide polymorphisms (SNPs) in the gene encoding the vitamin D receptor (VDR) have been widely reported to associate with susceptibility to polycystic ovarian syndrome (PCOS). A case-control study was conducted to study the influence of vitamin D status and genotpye for 24 SNPs in four genes in the vitamin D pathway (VDR, DBP, CYP27B1, CYP24A1) on PCOS. Statistical analyses were conducted to identify phenotypic and genotypic factors associated with risk of PCOS and to test for interactions between genotype and vitamin D status. PCOS was independently associated with lower age, higher body mass index, lower waist-hip ratio, vitamin D deficiency (serum 25-hydroxyvitamin D concentration <10 ng/mL), lack of outdoor exercise, increased fasting glucose and a family history of PCOS in at least one first degree relative. No statistically significant association was observed between the genotype of any SNP investigated and risk of PCOS, either as a main effect or in interaction with vitamin D status. We report a strong and independent association between vitamin D deficiency and risk of PCOS in Pakistan, that was not modified by genetic variation in the vitamin D pathway.
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Martineau AR, Thummel KE, Wang Z, Jolliffe DA, Boucher BJ, Griffin SJ, Forouhi NG, Hitman GA. Differential Effects of Oral Boluses of Vitamin D2 vs Vitamin D3 on Vitamin D Metabolism: A Randomized Controlled Trial. J Clin Endocrinol Metab 2019; 104:5831-5839. [PMID: 31199458 PMCID: PMC6797055 DOI: 10.1210/jc.2019-00207] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/07/2019] [Indexed: 01/02/2023]
Abstract
CONTEXT Vitamin D2 and vitamin D3 have been hypothesized to exert differential effects on vitamin D metabolism. OBJECTIVE To compare the influence of administering vitamin D2 vs vitamin D3 on metabolism of vitamin D3. METHODS We measured baseline and 4-month serum concentrations of vitamin D3, 25-hydroxyvitamin D3 [25(OH)D3], 25-hydroxyvitamin D2, 24R,25-dihydroxyvitamin D3 [24R,25(OH)2D3], 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3], and 4β,25-dihydroxyvitamin D3 [4β,25(OH)2D3] in 52 adults randomized to receive a total of four oral bolus doses of 2.5 mg vitamin D2 (n = 28) or vitamin D3 (n = 24) over four months. Metabolite-to-parent compound ratios were calculated to estimate hydroxylase activity. Pairwise before vs after comparisons were made to evaluate effects of vitamin D2 and vitamin D3 on metabolism of vitamin D. Mean postsupplementation metabolite-to-parent ratios were then compared between groups. RESULTS Vitamin D2 was less effective than vitamin D3 in elevating total serum 25(OH)D concentration. Vitamin D2 suppressed mean four-month serum concentrations of 25(OH)D3, 24R,25(OH)2D3, 1α,25(OH)2D3, and 4β,25(OH)2D3 and mean ratios of 25(OH)D3 to D3 and 1α,25(OH)2D3 to 25(OH)D3, while increasing the mean ratio of 24R,25(OH)2D3 to 25(OH)D3. Vitamin D3 increased mean four-month serum concentrations of 25(OH)D3, 24R,25(OH)2D3, 1α,25(OH)2D3, and 4β,25(OH)2D3 and the mean ratio of 24R,25(OH)2D3 to 25(OH)D3. Participants receiving vitamin D2 had lower mean postsupplementation ratios of 25(OH)D3 to vitamin D3 and 1α,25(OH)2D3 to 25(OH)D3 than those receiving vitamin D3. Mean postsupplementation ratios of 24R,25(OH)2D3 to 25(OH)D3 and 4β,25(OH)2D3 to 25(OH)D3 did not differ between groups. CONCLUSIONS Bolus-dose vitamin D2 is less effective than bolus-dose vitamin D3 in elevating total serum 25(OH)D concentration. Administration of vitamin D2 reduces 25-hydroxylation of vitamin D3 and 1-α hydroxylation of 25(OH)D3, while increasing 24R-hydroxylation of 25(OH)D3.
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Affiliation(s)
- Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Correspondence and Reprint Requests: Adrian R. Martineau, PhD, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London E1 2AB, United Kingdom. E-mail:
| | - Kenneth E Thummel
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Zhican Wang
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Barbara J Boucher
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simon J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Graham A Hitman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens) 2019; 18:353-363. [PMID: 31768940 PMCID: PMC7092025 DOI: 10.1007/s42000-019-00155-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Respiratory tract infections (RTIs) are a major cause of illness worldwide and the most common cause of hospitalization for pneumonia and bronchiolitis. These two diseases are the leading causes of morbidity and mortality among children under 5 years of age. Vitamin D is believed to have immunomodulatory effects on the innate and adaptive immune systems by modulating the expression of antimicrobial peptides, like cathelicidin, in response to both viral and bacterial stimuli. The aim of this review is to summarize the more recently published data with regard to potential associations of 25-hydroxyvitamin D [25(OH)D] with infectious respiratory tract diseases of childhood and the possible health benefits from vitamin D supplementation. METHODS The literature search was conducted by using the PubMed, Scopus, and Google Scholar databases, with the following keywords: vitamin D, respiratory tract infection, tuberculosis, influenza, infancy, and childhood. RESULTS Several studies have identified links between inadequate 25(OH)D concentrations and the development of upper or lower respiratory tract infections in infants and young children. Some of them also suggest that intervention with vitamin D supplements could decrease both child morbidity and mortality from such causes. CONCLUSIONS Most studies agree in that decreased vitamin D concentrations are prevalent among most infants and children with RTIs. Also, normal to high-serum 25(OH)D appears to have some beneficial influence on the incidence and severity of some, but not all, types of these infections. However, studies with vitamin D supplementation revealed conflicting results as to whether supplementation may be of benefit, and at what doses.
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Affiliation(s)
- Dimitra Zisi
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Anna Challa
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Alexandros Makis
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece.
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Ganmaa D, Khudyakov P, Buyanjargal U, Baigal D, Baatar M, Enkhamgalan N, Erdenebaatar S, Ochirbat B, Burneebaatar B, Purevdorj E, Purevsuren Y, Garmaa G, Ganbaatar E, Martineau AR. Risk factors for active tuberculosis in 938 QuantiFERON-positive schoolchildren in Mongolia: a community-based cross-sectional study. BMC Infect Dis 2019; 19:532. [PMID: 31208362 PMCID: PMC6580591 DOI: 10.1186/s12879-019-4160-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is controversy regarding the relative influence of 'exogenous' versus 'endogenous' factors on the risk of progression from latent tuberculosis infection to active tuberculosis (TB) disease in children. METHODS We conducted a cross-sectional analysis to identify risk factors for active tuberculosis in QuantiFERON®-TB Gold (QFT-G)-positive children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Children underwent clinical and radiological screening for active tuberculosis, and data relating to potential risk factors for disease progression were collected by questionnaire and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios were calculated using generalized estimating equations with adjustment for potential confounders. RESULTS 129/938 (13.8%) QFT-positive children were diagnosed with active tuberculosis. Risk of active tuberculosis was independently associated with household exposure to pulmonary TB (adjusted risk ratio [aRR] 2.40, 95% CI 1.74 to 3.30, P < 0.001), month of sampling (adjusted risk ratio [aRR] for March-May vs. June-November 3.31, 95% CI 1.63 to 6.74, P < 0.001; aRR for December-February vs. June-November 2.53, 95% CI 1.23 to 5.19, P = 0.01) and active smoking by the child (aRR 5.23, 95% CI 2.70 to 10.12, P < 0.001). No statistically significant independent association was seen for age, sex, socio-economic factors, presence of a Bacillus Calmette-Guérin (BCG) scar, tobacco exposure or vitamin D status. CONCLUSIONS Household exposure to active TB, winter or spring season and active smoking were independently associated with risk of active tuberculosis in QFT-positive children. Our findings highlight the potentially high yield of screening child household contacts of infectious index cases for active tuberculosis in low- and middle-income countries.
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Affiliation(s)
- Davaasambuu Ganmaa
- Harvard T.H. Chan School of Public Health, Building 2, Room 211, 655 Huntington Ave, Boston, MA 02115 USA
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Polyna Khudyakov
- Harvard T.H. Chan School of Public Health, Building 2, Room 211, 655 Huntington Ave, Boston, MA 02115 USA
| | - Uyanga Buyanjargal
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Delgerekh Baigal
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Munkhzul Baatar
- National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Nomin Enkhamgalan
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Sumiya Erdenebaatar
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Batbayar Ochirbat
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | | | | | | | - Gantsetseg Garmaa
- Mongolian Health Initiative, Royal Plaza, Bayanzurkh District, Ulaanbaatar, Mongolia
| | | | - Adrian R. Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AB, London, UK
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25
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Martinez L, Lo NC, Cords O, Hill PC, Khan P, Hatherill M, Mandalakas A, Kay A, Croda J, Horsburgh CR, Zar HJ, Andrews JR. Paediatric tuberculosis transmission outside the household: challenging historical paradigms to inform future public health strategies. THE LANCET RESPIRATORY MEDICINE 2019; 7:544-552. [PMID: 31078497 DOI: 10.1016/s2213-2600(19)30137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Tuberculosis is a major cause of death and disability among children globally, yet children have been neglected in global tuberculosis control efforts. Historically, tuberculosis in children has been thought of as a family disease, and because of this, household contact tracing of children after identification of an adult tuberculosis case has been emphasised as the principal public health intervention. However, the population-level effect of household contact tracing is predicated on the assumption that most paediatric tuberculosis infections are acquired within the household. In this Personal View, we focus on accumulating scientific evidence indicating that the majority of Mycobacterium tuberculosis transmission to children in high-burden settings occurs in the community, outside of households in which a person has tuberculosis. We estimate the population-attributable fraction of M tuberculosis transmission to children due to household exposures to be between 10% and 30%. M tuberculosis transmission from the household was low (<30%) even in children younger than age 5 years. We propose that an effective public health response to childhood tuberculosis requires comprehensive, community-based interventions, such as active surveillance in select settings, rather than contact tracing alone. Importantly, the historical paradigm that most paediatric transmission occurs in households should be reconsidered on the basis of the scientific knowledge presented.
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Affiliation(s)
- Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Olivia Cords
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - Palwasha Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Anna Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Alexander Kay
- The Global Tuberculosis Program, Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; The Baylor Children's Foundation, Mbabane, Swaziland
| | - Julio Croda
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil; Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - C Robert Horsburgh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South Africa Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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26
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Jolliffe DA, Ganmaa D, Wejse C, Raqib R, Haq MA, Salahuddin N, Daley PK, Ralph AP, Ziegler TR, Martineau AR. Adjunctive vitamin D in tuberculosis treatment: meta-analysis of individual participant data. Eur Respir J 2019; 53:13993003.02003-2018. [DOI: 10.1183/13993003.02003-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
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