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Díez Galán MDM, Redondo-Bravo L, Gómez-Barroso D, Herrera L, Amillategui R, Gómez-Castellá J, Herrador Z. The impact of meteorological factors on tuberculosis incidence in Spain: a spatiotemporal analysis. Epidemiol Infect 2024; 152:e58. [PMID: 38505884 PMCID: PMC11022253 DOI: 10.1017/s0950268824000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
Tuberculosis (TB) remains a global leading cause of death, necessitating an investigation into its unequal distribution. Sun exposure, linked to vitamin D (VD) synthesis, has been proposed as a protective factor. This study aimed to analyse TB rates in Spain over time and space and explore their relationship with sunlight exposure. An ecological study examined the associations between rainfall, sunshine hours, and TB incidence in Spain. Data from the National Epidemiological Surveillance Network (RENAVE in Spanish) and the Spanish Meteorological Agency (AEMET in Spanish) from 2012 to 2020 were utilized. Correlation and spatial regression analyses were conducted. Between 2012 and 2020, 43,419 non-imported TB cases were reported. A geographic pattern (north-south) and distinct seasonality (spring peaks and autumn troughs) were observed. Sunshine hours and rainfall displayed a strong negative correlation. Spatial regression and seasonal models identified a negative correlation between TB incidence and sunshine hours, with a four-month lag. A clear spatiotemporal association between TB incidence and sunshine hours emerged in Spain from 2012 to 2020. VD levels likely mediate this relationship, being influenced by sunlight exposure and TB development. Further research is warranted to elucidate the causal pathway and inform public health strategies for improved TB control.
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Affiliation(s)
| | - Lidia Redondo-Bravo
- Health Emergencies Department, Pan American Health Organization, Washington, DC, USA
| | - Diana Gómez-Barroso
- National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Herrera
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Bacteriology, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Rocio Amillategui
- National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Gómez-Castellá
- División de control de VIH, ITS, Hepatitis virales y Tuberculosis. Ministerio de Sanidad, Madrid, Spain
| | - Zaida Herrador
- National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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2
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Wardani DWSR, Pramesona BA, Septiana T, Soemarwoto RAS. Risk factors for delayed sputum conversion: A qualitative case study from the person-in-charge of TB program's perspectives. J Public Health Res 2023; 12:22799036231208355. [PMID: 37901194 PMCID: PMC10605690 DOI: 10.1177/22799036231208355] [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: 01/28/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the indicators to determine the success of TB treatment is the conversion of sputum from smear positive to negative. However, several factors can lead to this failure of sputum conversion. Objectives To investigate the risk factors for delayed sputum conversion from the person-in-charge (PIC) of the TB program's perspective. Design and methods This qualitative case study was conducted on September 7th, 2022. Thirty-one PICs of the TB program from 31 public health centers (Puskesmas) in Bandar Lampung, Indonesia, were recruited purposively. All participants were grouped into three FGDs. Developed semi-structured interview questions were used for data collection. Thematic analysis was used to synthesize and cross-reference emerging topics. Results Three themes emerged in our study: (1) individual factors with the sub-themes of medication adherence, education, initial laboratory examination, comorbid disease, nutrition, and lifestyle; (2) environmental factors with the sub-themes of types of support, sources of support, environmental conditions and stigma; and (3) health service factors with the sub-theme of access to health service facilities. Conclusions Problems related to TB management are not only the individual's responsibility but need to strengthen support from the environment and health services.
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Affiliation(s)
| | - Bayu Anggileo Pramesona
- Department of Public Health, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia
| | - Trisya Septiana
- Department of Informatics Engineering, Faculty of Engineering, Universitas Lampung, Bandar Lampung, Indonesia
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3
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Zhao JW, Wang XQ, Li ZH, Mao YC, Zhang S, Huang K, Hu CY, Zhang XJ, Kan XH. Effect of gaseous pollutant and greenness exposure on mortality during treatment of newly treated tuberculosis patients: a provincial population-based cohort study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:98195-98210. [PMID: 37608175 DOI: 10.1007/s11356-023-29256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Previous studies addressing the impact of environmental factors on TB prognosis are scarce, with only some studies examining the effect of particulate pollutants on TB mortality. Moreover, few studies have evaluated the effects of multiple gaseous pollutants and greenness exposures on newly treated TB patients on a large population scale. METHODS Through the Centers for Disease Control and Prevention, data were collected from January 1, 2015 to December 31, 2020 for newly treated TB patients in Anhui Province, China. Data on gaseous pollutants sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were collected through the National Earth System Science Data Center of China. Normalized vegetation index data were obtained through NASA. The Cox proportional risk model was also applied to calculate the hazard ratios of SO2, NO2, CO, O3, and NDVI with 95% confidence intervals for mortality among newly treated TB patients. RESULTS Multifactorial Cox regression analysis showed that for every 0.10 μg/m3 increase in SO2, the risk of death among newly treated TB patients increased by 13.2% (HR = 1.132, 95% CI: 1.045-1.1.225), for every 10 μg/m3 increase in NO2, the risk of death among newly treated TB patients increased by 11.4%, and for each 0.1 mg/m3 increase in CO, the risk of death among newly treated TB patients increased by 5.8%. For each 0.1 increase in NDVI 250m-buffer and 500m-buffer, the risk of death among newly treated TB patients decreased by 8.5% and 6.4%, respectively. The effect of gaseous pollutants on mortality decreased progressively with elevated greenness exposure when greenness exposure was grouped from low to high. CONCLUSION Gaseous pollutants are a risk factor during the treatment of newly treated TB patients and greenness exposure is a protective factor. Higher greenness exposure reduces the risk of death due to exposure to gaseous pollutants.
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Affiliation(s)
- Jia-Wen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhen-Hua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yi-Cheng Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Sun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kai Huang
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiao-Hong Kan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022, China.
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4
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Corbett S, Cho JG, Ulbricht E, Sintchenko V. Migration and descent, adaptations to altitude and tuberculosis in Nepalis and Tibetans. Evol Med Public Health 2022; 10:189-201. [PMID: 35528702 PMCID: PMC9071402 DOI: 10.1093/emph/eoac008] [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: 07/11/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High rates of tuberculosis (TB) in migrants from Tibet and Nepal have been documented for over 120 years and were previously ascribed to poor living conditions in the places of settlement. Adaptations to altitude involving genes in the Hypoxia-Inducible Factor pathway are present in 90–95% of Tibetans and in Nepalis these allele frequencies increase by 17% with each 1000 m increase in altitude.
Methods
We calculated the incidence of TB by country of origin in immigrants from South and East Asia in New South Wales (NSW), Australia between 2004 and 2018, and compared disease severity, site of infection, evidence of local transmission and prevalence of latent TB, among these groups.
Results
The incidence of active TB was consistently higher among 30 000 Nepalese and 1000 Tibetans than among all other immigrants to NSW. Nepal was the only country of origin where TB incidence in immigrants was not significantly lower than the reported TB incidence in the country of origin.
Conclusions and implications
High rates of TB among Nepalese and Tibetan immigrants in Australia are unlikely to be attributable to pre-existing disease or local acquisition. Phenotypic effects of high-altitude adaptations may include a dampening of inflammatory responses to hypoxia, an effect unmasked by descent to a normoxic environment. A corollary of these findings may be that hypoxia-induced inflammation limits TB progression, reconfirming previous explanations for the apparent efficacy of high-altitude sanatoria. If vindicated by subsequent research, these provisional findings could open new avenues into preventive and host-directed interventions for tuberculosis.
Lay Summary
The incidence of tuberculosis among Nepalese immigrants to Australia and other people of Tibetan heritage who migrate to lower altitudes is very high. In these screened populations, pre-existing active TB or locally acquired infection are unlikely explanations. We suggest that adaptations to altitude combined with descent to higher oxygen levels in air at sea level may be contributing factors.
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Affiliation(s)
- Stephen Corbett
- Centre for Population Health, Western Sydney Local Health District, Sydney, New South Wales 2151, Australia
- Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Jin-Gun Cho
- Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, New South Wales 2006, Australia
- Parramatta Chest Clinic, Parramatta, Sydney, New South Wales 2150, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Wentworthville, New South Wales 2145, Australia
| | - Evan Ulbricht
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Wentworthville, New South Wales 2145, Australia
| | - Vitali Sintchenko
- Sydney Institute for Infectious Diseases and Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Institute of Clinical Pathology and Medical Research, Westmead Hospital and NSW Health Pathology, Sydney, New South Wales 2145, Australia
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5
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Maharjan B, Gopali RS, Zhang Y. A scoping review on climate change and tuberculosis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1579-1595. [PMID: 33728507 DOI: 10.1007/s00484-021-02117-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Climate change is a global public health challenge. The changes in climatic factors affect the pattern and burden of tuberculosis, which is a worldwide public health problem affecting low and middle-income countries. However, the evidence related to the impact of climate change on tuberculosis is few and far between. This study is a scoping review following a five-stage version of Arksey and O'Malley's method. We searched the literature using the keywords and their combination in Google scholar, and PubMed. Climate change affects tuberculosis through diverse pathways: changes in climatic factors like temperature, humidity, and precipitation influence host response through alterations in vitamin D distribution, ultraviolet radiation, malnutrition, and other risk factors. The rise in extreme climatic events induces population displacement resulting in a greater number of vulnerable and risk populations of tuberculosis. It creates a conducive environment of tuberculosis transmission and development of active tuberculosis and disrupts tuberculosis diagnosis and treatment services. Therefore, it stands to reasons that climate change affects tuberculosis, particularly in highly vulnerable countries and areas. However, further studies and novel methodologies are required to address such a complex relationship and better understand the occurrence of tuberculosis attributable to climate change.
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Affiliation(s)
- Bijay Maharjan
- Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal.
| | - Ram Sharan Gopali
- Japan-Nepal Health and Tuberculosis Research Association, Kathmandu, Nepal
| | - Ying Zhang
- School of Public Health, University of Sydney, Sydney, Australia
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6
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Ganmaa D, Khudyakov P, Buyanjargal U, Jargalsaikhan B, Baigal D, Munkhjargal O, Yansan N, Bolormaa S, Lkhagvasuren E, Sempos CT, Bromage S, Wu Z, Ochirbat B, Gunchin B, Martineau AR. Prevalence and Determinants of QuantiFERON-Diagnosed Tuberculosis Infection in 9810 Mongolian Schoolchildren. Clin Infect Dis 2019; 69:813-819. [PMID: 30481273 PMCID: PMC6695506 DOI: 10.1093/cid/ciy975] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is controversy regarding the potential influence of vitamin D deficiency, exposure to environmental tobacco smoke, BCG vaccination, season, and body habitus on susceptibility to Mycobacterium tuberculosis (MTB) infection. METHODS We conducted a cross-sectional analysis to identify determinants of a positive QuantiFERON-TB Gold (QFT) assay result in children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Data relating to potential risk factors for MTB infection were collected by questionnaire, physical examination, and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios (RRs) were calculated with adjustment for potential confounders, and population attributable fractions (PAFs) were calculated for modifiable risk factors identified. RESULTS Nine hundred forty-six of 9810 (9.6%) participants had a positive QFT result. QFT positivity was independently associated with household exposure to pulmonary tuberculosis (adjusted RR [aRR], 4.75 [95% confidence interval {CI}, 4.13-5.46, P < .001]; PAF, 13.1% [95% CI, 11.1%-15.0%]), vitamin D deficiency (aRR, 1.23 [95% CI, 1.08-1.40], P = .002; PAF, 5.7% [95% CI, 1.9%-9.3%]), exposure to environmental tobacco smoke (1 indoor smoker, aRR, 1.19 [95% CI, 1.04-1.35]; ≥2 indoor smokers, aRR, 1.30 [95% CI, 1.02-1.64]; P for trend = .006; PAF, 7.2% [95% CI, 2.2%-12.0%]), and increasing age (aRR per additional year, 1.14 [95% CI, 1.10-1.19], P < .001). No statistically significant independent association was seen for presence of a BCG scar, season of sampling, or body mass index. CONCLUSIONS Vitamin D deficiency and exposure to environmental tobacco smoke are potentially modifiable risk factors for MTB infection.
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Affiliation(s)
- Davaasambuu Ganmaa
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Mongolian Health Initiative, Ulaanbaatar
| | - Polyna Khudyakov
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Uyanga Buyanjargal
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Enkhsaikhan Lkhagvasuren
- Mongolian Health Initiative, Ulaanbaatar
- Mongolian National Health Sciences University, Ulaanbaatar
| | - Christopher T Sempos
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland
| | | | - Zhenqiang Wu
- School of Population Health, University of Auckland, New Zealand
| | | | - Batbaatar Gunchin
- Mongolian Health Initiative, Ulaanbaatar
- Mongolian National Health Sciences University, Ulaanbaatar
| | - Adrian R Martineau
- Blizard Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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7
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Bernard JJ, Gallo RL, Krutmann J. Photoimmunology: how ultraviolet radiation affects the immune system. Nat Rev Immunol 2019; 19:688-701. [PMID: 31213673 DOI: 10.1038/s41577-019-0185-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 02/07/2023]
Abstract
Ultraviolet (UV) radiation is a ubiquitous component of the environment that has important effects on a wide range of cell functions. Short-wavelength UVB radiation induces sunburn and is a potent immunomodulator, yet longer-wavelength, lower-energy UVA radiation also has effects on mammalian immunity. This Review discusses current knowledge regarding the mechanisms by which UV radiation can modify innate and adaptive immune responses and how this immunomodulatory capacity can be both beneficial in the case of inflammatory and autoimmune diseases, and detrimental in the case of skin cancer and the response to several infectious agents.
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Affiliation(s)
- Jamie J Bernard
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI, USA. .,Division of Dermatology, Department of Medicine, Michigan State University, East Lansing, MI, USA.
| | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, CA, USA
| | - Jean Krutmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
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8
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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9
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Gelaw YA, Yu W, Magalhães RJS, Assefa Y, Williams G. Effect of Temperature and Altitude Difference on Tuberculosis Notification: A Systematic Review. J Glob Infect Dis 2019; 11:63-68. [PMID: 31198309 PMCID: PMC6555232 DOI: 10.4103/jgid.jgid_95_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Ecological factors are important indicators for tuberculosis (TB) notification. However, consolidation of evidence on the effect of altitude and temperature on TB notification rate has not yet been done. The aim of this review is to illustrate the effect of altitude and temperature on TB notification rate. Methods: Electronic searches were undertaken from PubMed, EMBASE, and Scopus databases. Hand searches of bibliographies of retrieved papers provided additional references. A review was performed using the Meta-analysis Of Observational Studies in Epidemiology guideline. Results: Nine articles from various geographic regions were included in the study. Five out of nine studies showed the effect of altitude and four articles identified temperature effects. Results showed that TB notification rates were lower at higher altitude and higher at a higher temperature. Conclusion: This review provides qualitative evidence that TB notification rates increase with temperature and decrease with altitude. The findings of this review will encourage policymakers and program managers to consider seasonality and altitude differences in the design and implementation of TB prevention and control strategies.
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Affiliation(s)
- Yalemzewod Assefa Gelaw
- Epidemiology and Biostatistics Division, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Weiwei Yu
- Epidemiology and Biostatistics Division, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, Australia.,Children's Health and Environment Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yibeltal Assefa
- Health Systems and Policy Division, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gail Williams
- Epidemiology and Biostatistics Division, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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10
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Hart PH, Norval M, Byrne SN, Rhodes LE. Exposure to Ultraviolet Radiation in the Modulation of Human Diseases. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:55-81. [PMID: 30125148 DOI: 10.1146/annurev-pathmechdis-012418-012809] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This review focuses primarily on the beneficial effects for human health of exposure to ultraviolet radiation (UVR). UVR stimulates anti-inflammatory and immunosuppressive pathways in skin that modulate psoriasis, atopic dermatitis, and vitiligo; suppresses cutaneous lesions of graft-versus-host disease; and regulates some infection and vaccination outcomes. While polymorphic light eruption and the cutaneous photosensitivity of systemic lupus erythematosus are triggered by UVR, polymorphic light eruption also frequently benefits from UVR-induced immunomodulation. For systemic diseases such as multiple sclerosis, type 1 diabetes, asthma, schizophrenia, autism, and cardiovascular disease, any positive consequences of UVR exposure are more speculative, but could occur through the actions of UVR-induced regulatory cells and mediators, including 1,25-dihydroxy vitamin D3, interleukin-10, and nitric oxide. Reduced UVR exposure is a risk factor for the development of several inflammatory, allergic, and autoimmune conditions, including diseases initiated in early life. This suggests that UVR-induced molecules can regulate cell maturation in developing organs.
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Affiliation(s)
- Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia 6008, Australia;
| | - Mary Norval
- University of Edinburgh Medical School, Edinburgh EH8 9AG, United Kingdom;
| | - Scott N Byrne
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia; .,Westmead Institute for Medical Research, Westmead, New South Wales 2145, Australia
| | - Lesley E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, and Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom;
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11
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Korthals Altes H, Kloet S, Cobelens F, Bootsma M. Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling. PLoS One 2018; 13:e0192282. [PMID: 29444122 PMCID: PMC5812587 DOI: 10.1371/journal.pone.0192282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/19/2018] [Indexed: 11/18/2022] Open
Abstract
While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation-either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995-2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting returning travelers might be less effective at preventing LTBI than immigrants upon entry in the country.
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Affiliation(s)
- Hester Korthals Altes
- Epidemiology and Surveillance, Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- * E-mail:
| | - Serieke Kloet
- Epidemiology and Surveillance, Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands
| | - Martin Bootsma
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Sciences, Department of Mathematics, Utrecht University, Utrecht, The Netherlands
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