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Hamada Y, Quartagno M, Malik F, Ntshamane K, Tisler A, Gaikwad S, Acuna-Villaorduna C, Bhavani PK, Alisjahbana B, Ronacher K, Apriani L, Becerra M, Chu AL, Creswell J, Diaz G, Ferro BE, Galea JT, Grandjean L, Grewal HMS, Gupta A, Jones-López EC, Kleynhans L, Lecca L, MacPherson P, Murray M, Marín D, Restrepo BI, Shivakumar SVBY, Shu E, Sivakumaran D, Vo LNQ, Webb EL, Copas A, Abubakar I, Rangaka MX. Prevalence of non-communicable diseases among household contacts of people with tuberculosis: A systematic review and individual participant data meta-analysis. Trop Med Int Health 2024. [PMID: 39073229 DOI: 10.1111/tmi.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To investigate the prevalence of non-communicable diseases among household contacts of people with tuberculosis. METHODS We conducted a systematic review and individual participant data meta-analysis. We searched Medline, Embase and the Global Index Medicus from inception to 16 May 2023. We included studies that assessed for at least one non-communicable disease among household contacts of people with clinical tuberculosis. We estimated the non-communicable disease prevalence through mixed effects logistic regression for studies providing individual participant data, and compared it with estimates from aggregated data meta-analyses. Furthermore, we compared age and sex-standardised non-communicable disease prevalence with national-level estimates standardised for age and sex. RESULTS We identified 39 eligible studies, of which 14 provided individual participant data (29,194 contacts). Of the remaining 25 studies, 18 studies reported aggregated data suitable for aggregated data meta-analysis. In individual participant data analysis, the pooled prevalence of diabetes in studies that undertook biochemical testing was 8.8% (95% confidence interval [CI], 5.1%-14.9%, four studies). Age-and sex-standardised prevalence was higher in two studies (10.4% vs. 6.9% and 11.5% vs. 8.4%) than the corresponding national estimates and similar in two studies. Prevalence of diabetes mellitus based on self-report or medical records was 3.4% (95% CI 2.6%-4.6%, 14 studies). Prevalence did not significantly differ compared to estimates from aggregated data meta-analysis. There were limited data for other non-communicable diseases. CONCLUSION The prevalence of diabetes mellitus among household contacts was high while that of known diabetes was substantially lower, suggesting the underdiagnosis. tuberculosis household contact investigation offers opportunities to deliver multifaceted interventions to identify tuberculosis infection and disease, screen for non-communicable diseases and address shared risk factors.
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Affiliation(s)
- Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Matteo Quartagno
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Farihah Malik
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Anna Tisler
- Institute for Global Health, University College London, London, UK
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Sanjay Gaikwad
- BJ Government Medical College and Sassoon General Hospitals, Pune, India
| | | | | | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | - Katharina Ronacher
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SA MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Molecular Biology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Mater Research Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
| | - Lika Apriani
- Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mercedes Becerra
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander L Chu
- Department of Medical Education, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Jacob Creswell
- Stop TB Partnership, Innovations and Grants, Geneva, Switzerland
| | - Gustavo Diaz
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Valle del Cauca, Colombia
- Universidad Icesi, Cali, Valle del Cauca, Colombia
| | - Beatriz E Ferro
- Departamento de Ciencias Básicas Médicas, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Louis Grandjean
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Harleen M S Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward C Jones-López
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Léanie Kleynhans
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SA MRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Molecular Biology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Mater Research Institute, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Leonid Lecca
- Socios En Salud, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Marín
- Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Blanca I Restrepo
- School of Public Health, University of Texas Health Houston, Brownsville, Texas, USA
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, Texas, USA
- Texas Biomedical Research Institute, San Antonio, Texas, USA
| | | | - Eileen Shu
- Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Dhanasekaran Sivakumaran
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi, Vietnam
- WHO Collaborating Centre for Social Medicine and Tuberculosis, Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- Division of Epidemiology and Biostatistics & CIDRI-AFRICA, University of Cape Town, Cape Town, South Africa
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Hsu MS, Chung TC, Wang PH, Cheng SL, Wu YW, Hsu JC, Tzeng BH, Lin HH, Tu CM, Chu FY, Fang CT. Revisiting the association between vitamin D deficiency and active tuberculosis: A prospective case-control study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00068-9. [PMID: 38594108 DOI: 10.1016/j.jmii.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/09/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND To revisit the association between vitamin D deficiency (VDD, defined as serum 25(OH)D < 20 ng/ml) and incident active tuberculosis (TB), after two potentially underpowered randomized trials showed statistically non-significant 13%-22% decrease in TB incidence in vitamin D supplementation groups. METHODS We prospectively conducted an age/sex-matched case-control study that accounting for body-mass index (BMI), smoking, and other confounding factors to examine the association between VDD and active TB among non-HIV people in Taiwan (latitude 24°N), a high-income society which continues to have moderate TB burden. RESULTS We enrolled 62 people with incident active TB and 248 people in control group. The TB case patients had a significantly higher proportion of VDD compared to the control group (51.6% vs 29.8%, p = 0.001). The 25(OH)D level was also significantly lower in TB patients compared to control group (21.25 ± 8.93 ng/ml vs 24.45 ± 8.36 ng/ml, p = 0.008). In multivariable analysis, VDD (adjusted odds ratio [aOR]: 3.03, p = 0.002), lower BMI (aOR: 0.81, p < 0.001), liver cirrhosis (aOR: 8.99, p = 0.042), and smoking (aOR: 4.52, p = 0.001) were independent risk factors for incident active TB. CONCLUSIONS VDD is an independent risk factor for incident active TB. Future randomized trials examining the effect of vitamin D supplementation on TB incidence should focus on people with a low BMI or other risk factors to maximize the statistical power.
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Affiliation(s)
- Meng-Shiuan Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Section of Infectious Disease, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Tzu-Chien Chung
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ping-Huai Wang
- Department of Internal Medicine, Section of Chest Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Shih-Lung Cheng
- Department of Internal Medicine, Section of Chest Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yen-Wen Wu
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Jung-Cheng Hsu
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Bing-Hsiean Tzeng
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Heng-Hsu Lin
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chung-Ming Tu
- Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan; Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University School of Medicine, Taipei, Taiwan.
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Wang J, Li W, Huang W, Gao Y, Liu Y, Teng QH, Zhao Q, Chen M, Guo Y, Ma W. The associations of ambient fine particles with tuberculosis incidence and the modification effects of ambient temperature: A nationwide time-series study in China. JOURNAL OF HAZARDOUS MATERIALS 2023; 460:132448. [PMID: 37683354 DOI: 10.1016/j.jhazmat.2023.132448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
Ambient fine particulate matter (PM2.5) is a major air pollutant that poses significant risks to human health. However, little is known about the association of PM2.5 with tuberculosis (TB) incidence, and whether temperature modifies the association.This study aimed to explore the association between ambient PM2.5 exposure and TB incidence in China and the modification effects of temperature. Weekly meteorological data, PM2.5 concentrations, and TB incidence numbers were collected for 22 cities across Mainland China, from 2011 to 2020. A quasi-Poisson regression with the distributed lag non-linear model was used to assess city-specific PM2.5-TB associations. A multivariate meta-regression model was then used to pool the city-specific effect estimates, at the national and regional levels. A J-shaped PM2.5-TB relationship was observed at the national level for China. Compared to those with minimum PM2.5-TB risk, people who were exposed to the highest PM2.5 concentrations had a 26 % (RR:1.26, 95 % confidence interval [CI]: 1.05, 1.52) higher risk for TB incidence. J-shaped PM2.5-TB associations were also observed for most sub-groups, however, no significant modifying effects were found. While a trend was observed between low temperatures and increased exposure-response associations, these results were not significant. Overall, approximately 20 % of TB cases in the 22 study cities, over the period 2011-2020, could be attributed to PM2.5 exposure. Strengthening the monitoring and emission control of PM2.5 could aid the prevention and control of TB incidence.
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Affiliation(s)
- Jia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen Li
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Shandong University Climate Change and Health Center, Jinan, Shandong, China; Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuan Gao
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yanming Liu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Qian Hui Teng
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Shandong University Climate Change and Health Center, Jinan, Shandong, China
| | - Mingting Chen
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Shandong University Climate Change and Health Center, Jinan, Shandong, China.
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Ruiz-Tagle C, Romero F, Naves R, Balcells ME. Vitamin D and cathelicidin levels and susceptibility to Mycobacterium tuberculosis infection acquisition in household contacts. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:489-493. [PMID: 36707289 DOI: 10.1016/j.eimce.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/27/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Vitamin D deficiency has been proposed to confer susceptibility to acquiring tuberculosis infection by impairing the innate immune response. METHODS In an exploratory study, we examined whether the levels of 25-hydroxyvitamin D3 (25(OH)D3) in serum, and cathelicidin - an antimicrobial peptide-induced under calcitriol - in the nasal fluid, would associate with the risk of acquiring tuberculosis infection. RESULTS Within a prospective cohort of 231 tuberculosis household contacts tested with repeated interferon-gamma release assays, we serially analyzed all the uninfected contacts acquiring tuberculosis infection at follow-up ("converters", n=18), and an age and sex-matched control group of contacts not acquiring tuberculosis infection ("non-converters", n=36). The median levels of serum 25(OH)D3 did not differ between convertors and non-converters at baseline (14.9 vs. 13.2 ng/ml, p=0.41), nor at follow-up (19.0 vs 18.6ng/ml, p=0.83). Similarly, cathelicidin levels did not differ between both groups. CONCLUSION These data argue against a major role for hypovitaminosis D in tuberculosis infection susceptibility.
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Affiliation(s)
- Cinthya Ruiz-Tagle
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Romero
- Facultad de Ciencias Biológicas, Universidad Andrés Bello, Santiago, Chile
| | - Rodrigo Naves
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - María Elvira Balcells
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Huang YL, Pham TTM, Chen YC, Chang JS, Chao JCJ, Bai CH. Effects of Climate, Sun Exposure, and Dietary Intake on Vitamin D Concentrations in Pregnant Women: A Population-Based Study. Nutrients 2023; 15:nu15051182. [PMID: 36904183 PMCID: PMC10005797 DOI: 10.3390/nu15051182] [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: 02/01/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) is a global micronutrient issue that commonly occurs in pregnant women, leading to adverse health outcomes. We examined the role of sunlight-related factors and dietary vitamin D intake on vitamin D concentrations among pregnant women in different climate zones. METHODS We conducted a nationwide cross-sectional survey in Taiwan between June 2017 and February 2019. The data of 1502 pregnant women were collected, including sociodemographic information and characteristics related to pregnancy, diet, and sun exposure. Serum 25-hydroxyvitamin D concentrations were measured, and VDD was assessed as a concentration of less than 20 ng/mL. Logistic regression analyses were used to explore the factors associated with VDD. Furthermore, the area under the receiver operating characteristic (AUROC) curve was used to analyze the contribution of sunlight-related factors and dietary vitamin D intake to vitamin D status stratified by climate zones. RESULTS The prevalence of VDD was 30.1% and was the highest in the north. Sufficient intake of red meat (odds ratio (OR): 0.50, 95% confidence interval (CI): 0.32-0.75; p = 0.002), vitamin D and/or calcium supplements (OR: 0.51, 95% CI: 0.39-0.66; p < 0.001), sun exposure (OR: 0.75, 95% CI: 0.57-0.98; p = 0.034), and blood draw during sunny months (OR: 0.59, 95% CI: 0.46-0.77; p < 0.001) were associated with a lower likelihood of VDD. Additionally, in northern Taiwan, which is characterized by a subtropical climate, dietary vitamin D intake (AUROC: 0.580, 95% CI: 0.528-0.633) had a greater influence on vitamin D status than did sunlight-related factors (AUROC: 0.536, 95% CI: 0.508-0.589) with a z value = 51.98, p < 0.001. By contrast, sunlight-related factors (AUROC: 0.659, 95% CI: 0.618-0.700) were more important than dietary vitamin D intake (AUROC: 0.617, 95% CI, 0.575-0.660) among women living in tropical areas of Taiwan (z value = 54.02, p < 0.001). CONCLUSIONS Dietary vitamin D intake was essential to alleviate VDD in the tropical region, whereas sunlight-related factors played a greater role in subtropical areas. Safe sunlight exposure and adequate dietary vitamin D intake should be promoted appropriately as a strategic healthcare program.
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Affiliation(s)
- Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Thu T. M. Pham
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Yi-Chun Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
- Chinese Taipei Society for the Study of Obesity, Taipei 110-31, Taiwan
| | - Jane C.-J. Chao
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Correspondence:
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Huang K, Hu CY, Yang XY, Zhang Y, Wang XQ, Zhang KD, Li YQ, Wang J, Yu WJ, Cheng X, Cao JY, Zhang T, Kan XH, Zhang XJ. Contributions of ambient temperature and relative humidity to the risk of tuberculosis admissions: A multicity study in Central China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156272. [PMID: 35644395 DOI: 10.1016/j.scitotenv.2022.156272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND As a communicable disease and major public health issue, many studies have quantified the associations between tuberculosis (TB) and meteorological factors with inconsistent results. The purpose of this multicenter study was to characterize the associations between ambient temperature, humidity and the risk of TB hospitalizations and to investigate potential heterogeneity. METHOD Data on daily hospitalizations for TB, meteorological factors and ambient air pollutants for 16 cities in Anhui Province were collected from 2015 to 2020. A distributed lag nonlinear model (DLNM) was performed to obtain the estimates of meteorological-TB relationships by cities. Then, we used the multivariate meta-regression model to pool the city-specific estimates with air pollution, demographic indicators, medical resource and latitude as potential modifiers to explore the sources of heterogeneity. Finally, we divided the whole province into three regions to validate the meteorological-TB relationships by regions. RESULTS The overall pooled temperature-TB association presented an approximate S-shaped curve, with relative risk (RR) peaking at 5 °C (RR = 1.536, 95% CI: 1.303-1.811) compared to the reference temperature (27 °C). Lag-response curve suggested that low temperature exposure increased the risk of TB hospitalizations at lag 0 and 1 day (lag0 day: RR = 1.136, 95% CI: 1.048-1.231, lag1 day: RR = 1.052, 95% CI: 1.023-1.082). However, the overall exposure-response curve between relative humidity and TB showed almost horizontal line with reference relative humidity to 78%. The residual heterogeneity ranged from 27.1% to 36.9%, with air pollution, latitude and medical resource explained the largest proportion. CONCLUSION We found that low temperature exposure is associated with an acute increased risk of TB hospitalizations in Anhui Province. The association between temperature and TB admission varies depending on air pollution, latitude, and medical resources. Since the effect of short-term exposure to humidity is not significant, further studies are supposed to focus on the long-term effect of humidity.
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Affiliation(s)
- Kai Huang
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei 230601, China; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Xi-Yao Yang
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei 230601, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Kang-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Ying-Qing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Jie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Wen-Jie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Xin Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China
| | - Ji-Yu Cao
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China
| | - Tao Zhang
- Anhui Chest Hospital, 397 Jixi Road, Hefei 230022, China
| | - Xiao-Hong Kan
- Anhui Chest Hospital, 397 Jixi Road, Hefei 230022, China; Anhui Medical University Clinical College of Chest, 397 Jixi Road, Hefei 230022, China.
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, China.
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Paz LC, Saavedra CAPB, Braga JU, Kimura H, Evangelista MDSN. [Analysis of the seasonality of tuberculosis in Brazilian capitals and the Federal District from 2001 to 2019]. CAD SAUDE PUBLICA 2022; 38:e00291321. [PMID: 35894370 DOI: 10.1590/0102-311xpt291321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
The literature has few studies on the seasonality of tuberculosis (TB) in the southern hemisphere, entailing the fill of this knowledge gap. This study aims to analyze whether TB incidence in Brazilian capitals and the Federal District is seasonal. This is an ecological study of a time series (2001-2019) of TB cases, conducted with 26 capitals and the Federal District. The Ministry of Health database, with 516,524 TB cases, was used. Capitals and the Federal District were divided into five groups based on social indicators, disease burden, and the Koppen climate classification. The seasonal variation of TB notifications and group amplitude were evaluated. We found TB seasonality in Brazil with a 1% significance in all capital groups (Stability assumption and Krusall-Wallis tests, p < 0.01). In the combined seasonality test, capital groups A, D, and E showed seasonality, whereas groups B and C, its probability. Our findings showed that health service supply and/or demand - rather than climate - may be the most relevant underlying factor in TB seasonality. It is challenging to raise the other seasonal factors underlying TB seasonality in tropical regions in the Southern Hemisphere.
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Affiliation(s)
- Leidijany Costa Paz
- Centro Especializado em Doenças Infecciosas, Secretaria de Estado da Saúde do Distrito Federal, Brasília, Brasil.,Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brasil
| | | | - José Ueleres Braga
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Herbert Kimura
- Faculdade de Economia, Administração, Contabilidade e Gestão de Políticas Públicas, Universidade de Brasília, Brasília, Brasil
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Vitamin D and cathelicidin levels and susceptibility to Mycobacterium tuberculosis infection acquisition in household contacts. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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An influence of dew point temperature on the occurrence of Mycobacterium tuberculosis disease in Chennai, India. Sci Rep 2022; 12:6147. [PMID: 35413979 PMCID: PMC9005621 DOI: 10.1038/s41598-022-10111-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Climate factors such as dew point temperature, relative humidity and atmospheric temperature may be crucial for the spread of tuberculosis. This study was conducted for the first time to investigate the relationship of climatic factors with TB occurrence in an Indian setting. Daily tuberculosis notification data during 2008–2015 were generated from the National Treatment Elimination Program, and analogous daily climatic data were obtained from the Regional Meteorological Centre at Chennai city, Tamil Nadu, India. The decomposition method was adopted to split the series into deterministic and non-deterministic components, such as seasonal, non-seasonal, trend and cyclical, and non-deterministic climate factors. A generalized linear model was used to assess the relation independently. TB disease progression from latent stage infection to active was supported by higher dew point temperature and moderate temperature. It had a significant association with TB progression in the summer and monsoon seasons. The relative humidity may be favored in the winter and post-monsoon. The water tiny dew droplets may support the TB bacterium to recuperate in the environment.
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10
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Hypovitaminosis D among newly diagnosed pulmonary TB patients and their household contacts in Uganda. Sci Rep 2022; 12:5296. [PMID: 35351933 PMCID: PMC8964708 DOI: 10.1038/s41598-022-09375-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
An estimated one billion people globally live with hypovitaminosis D. Studies have indicated that vitamin D deficiency is a risk factor for active tuberculosis (TB) disease. The aim of this study was to determine the association between vitamin D deficiency and TB status among patients with active TB, latent TB infection (LTBI) and those without TB infection. In a cross-sectional study of active TB patients, LTBI, QuantiFERON GOLD testpositive and (QFN+TST+) household contact and controls QuantiFERON GOLD testnegative (QFN−TST−) samples vitamin D levels were compared. Vitamin D status was determined by measurement of total vitamin D levels with 56 samples of active TB patients, 17 with LTBI, and 22 without TB infection using electrochemiluminescence. The median interquartile range (IQR) age of the study participants was 28 (20–35) years, and the majority (63%) were females. The median (IQR) vitamin D levels were 18 ng/ml (14–24). All groups had vitamin D hypovitaminosis with significantly lower levels among active TB patients (17 ng/ml, 13, 2) than among LTBI individuals (23 ng/ml 16–29) and those without TB infection (22 ng/ml, 17–28).
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Cao Y, Wang X, Liu P, Su Y, Yu H, Du J. Vitamin D and the risk of latent tuberculosis infection: a systematic review and meta-analysis. BMC Pulm Med 2022; 22:39. [PMID: 35045861 PMCID: PMC8772077 DOI: 10.1186/s12890-022-01830-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Latent tuberculosis infection (LTBI) may be a risk of developing tuberculosis (TB) and thus a health hazard. The aim of this meta-analysis is to explore the association between vitamin D and LTBI. Methods Databases including PubMed, Embase, Scopus, and ProQuest were electronically searched to identify observational or interventional studies that reported the association between vitamin D and LTBI. The retrieval time is limited from inception to 30 September 2021. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using STATA 12.0 software. Results A total of 5 studies involving 2 case–control studies and 3 cohort studies were included. The meta-analysis result showed that the risk of LTBI among individuals was not associated with high vitamin D level (OR 0.51, 95% CI 0.05–5.65, P = 0.58). The result from cohort studies also suggested that relatively high vitamin D level was not a protective factor for LTBI (RR = 0.56, 95%CI 0.19–1.67, P = 0.300). Conclusions Our meta-analysis suggested that serum vitamin D levels were not associated with incidence of LTBI, and relatively high serum vitamin D level was not a protective factor for LTBI. Further RCTs are needed to verify whether sufficient vitamin D levels and vitamin D supplementation reduces the risk of LTBI. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01830-5.
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Kashyap B, Gupta N, Dewan P, Hyanki P, Singh N. Hypovitaminosis D in pediatric tuberculosis: a clinicomicrobiological study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2022. [DOI: 10.4103/ejcdt.ejcdt_42_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kafle S, Basnet AK, Karki K, Thapa Magar M, Shrestha S, Yadav RS. Association of Vitamin D Deficiency With Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17883. [PMID: 34660082 PMCID: PMC8504877 DOI: 10.7759/cureus.17883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Pulmonary tuberculosis, caused by Mycobacterium tuberculosis, is a significant public health issue, especially in developing countries, affecting millions of people every year. Despite the development of many antitubercular antibiotics and increased awareness of preventive methods, it is still a major cause of mortality worldwide. Vitamin D, a micronutrient known to have a major role in bone and calcium metabolism, has also shown its immunomodulatory effects to suppress mycobacterial growth. We conducted a systematic review and meta-analysis of the available evidence to explore the association between vitamin D levels and tuberculosis. We performed a systematic search for articles from inception to May 2021 in multiple databases. We included 26 studies in our qualitative synthesis and 12 studies in meta-analysis or quantitative synthesis. In our meta-analysis, we used a random-effect model to calculate the odds ratio (OR) of vitamin D deficiency in tuberculosis patients compared to the healthy controls. On pooled analysis, we found that the odds of the participants having vitamin D deficiency was 3.23 times more in tuberculosis patients compared to the healthy group (OR=3.23, CI = 1.91-5.45, p<0.0001). Thus, we concluded that there is an association between low levels of vitamin D and tuberculosis infections. We suggest conducting long-term prospective cohort studies in tuberculosis endemic countries to better understand the causal relationship between vitamin D deficiency and tuberculosis.
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Affiliation(s)
- Sunam Kafle
- Internal Medicine, College of Medical Sciences, Bharatpur, NPL
| | | | - Kumar Karki
- Internal Medicine, National Medical College, Birgunj, NPL
| | | | - Shumneva Shrestha
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, NPL
| | - Randhir S Yadav
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, NPL
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Sari DK, Sari LM, Laksmi LI, Farhat F. The Use of 25-hydroxyvitamin D Saliva Test to Replace Vitamin D Serum Blood Test in Healthy People. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Routine examination of Vitamin D levels is carried out by checking serum 25-hydroxyvitamin D (25[OH]D) levels which indicate circulating Vitamin D levels. While serum 1.25(OH)D levels are less frequently performed, although serum 1.25(OH)D levels represent the active form of Vitamin D be a substitute for checking Vitamin D levels.
AIMS: This study aims to see the correlation between Vitamin D levels, namely, 25(OH)D and 1.25(OH)D saliva, which correlate with serum 25(OH)D and 1.25(OH)D levels so that the examination of salivary Vitamin D levels can be a substitute for checking serum Vitamin D levels.
MATERIAL AND METHODS: This study is a cross-sectional study involving healthy men and women, aged 20–50 years, sampling in Lima Puluh Village, Batubara District, North Sumatra Province, Indonesia. The parameters studied were 25(OH)D and 1.25(OH)D levels of saliva and serum.
RESULTS: This study involved 56 study subjects, male and female, with a percentage of deficiencies of 78.6% by examining 25(OH)D saliva and 76.8% by examining 25(OH)D serum. As for the 1.25(OH)D examination of saliva and serum, all were within normal limits. The analysis showed that a moderate correlation was obtained for levels of 25(OH)D saliva with serum 25(OH)D (p = 0.424) and a weak correlation for levels of 1.25(OH)D saliva with serum 25(OH)D (p = 0.339).
CONCLUSIONS: Salivary 25(OH)D assay can be used to replace serum 25(OH)D assay in healthy people as a non-invasive alternative.
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Sari DK, Sari LM, Laksmi LI, Farhat. The Moderate Correlation Between 25(OH)D Serum and Saliva in Healthy People with Low Vitamin D Intake. Int J Gen Med 2021; 14:841-850. [PMID: 33737828 PMCID: PMC7961134 DOI: 10.2147/ijgm.s302912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/26/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose The routine examination of vitamin D levels is carried out by checking serum 25(OH)D levels, while serum 1.25(OH)D levels are less frequently utilized. The proposition that testing for salivary vitamin D can show a correlation with serum levels in healthy people is questionable, especially with low vitamin D intake. This study aimed to find the correlation between vitamin D levels, which were assessed as 25(OH)D and 1.25(OH)D in saliva, and serum 25(OH)D and 1.25(OH)D levels in people with low vitamin D intake. Patients and Methods This study is a cross-sectional study involving healthy men and women, aged 18–60 years, carried out from August to November, 2020, in North Sumatra Province, Indonesia. The parameters studied were the 25(OH)D and 1.25(OH)D levels in saliva and serum, and vitamin D intake. The statistical analysis used was the Spearman correlation test, performed to determine the correlation between each parameter. Results This study involved 56 study subjects, who were rural adults (male or female) with a 78.6% deficiency in 25(OH)D found by examining saliva, and a 76.8% deficiency found by examining the serum. All of the subjects were categorized as having low vitamin D intake (less than 15 micrograms per day). The analysis showed a moderate correlation between levels of saliva 25(OH)D and serum 25(OH)D (p = 0.424), and a weak correlation between levels of saliva 1.25(OH)D and serum 25(OH)D (p = 0.339). Conclusion In people with low vitamin D intake, there was a moderate correlation between serum 25(OH)D and saliva, but a weak correlation was found in the 1.25(OH)D assay. The use of saliva 25(OH)D levels to detect 25(OH)D in the circulation is a possible non-invasive alternative to serum testing. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/AxWZxKv9Tyo
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Affiliation(s)
- Dina Keumala Sari
- Nutrition Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Liza Meutia Sari
- Oral Medicine Department, Faculty of Dentistry, Universitas Syah Kuala, Banda Aceh, Indonesia
| | - Lidya Imelda Laksmi
- Anatomy Pathology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Farhat
- Ear, Nose, Throat, Head and Neck Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Huang K, Yang XJ, Hu CY, Ding K, Jiang W, Hua XG, Liu J, Cao JY, Sun CY, Zhang T, Kan XH, Zhang XJ. Short-term effect of ambient temperature change on the risk of tuberculosis admissions: Assessments of two exposure metrics. ENVIRONMENTAL RESEARCH 2020; 189:109900. [PMID: 32980000 DOI: 10.1016/j.envres.2020.109900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although the effects of seasonal variations and ambient temperature on the incidence of tuberculosis (TB) have been well documented, it is still unknown whether ambient temperature change is an independent risk factor for TB. The aim of this study was to assess the association between ambient temperature change and the risk of TB admissions. METHOD A distributed lag non-linear model (DLNM) combined with Poisson generalized linear regression model was performed to assess the association between ambient temperature change and the risk of TB admissions from 2014 to 2018 in Hefei, China. Two temperature change metrics including temperature change between neighboring days (TCN) and diurnal temperature range (DTR) were used to assess the effects of temperature change exposure. Subgroup analyses were performed by gender, age and season. Besides, the attributable risk was calculated to evaluated the public health significance. RESULTS The overall exposure-response curves suggested that there were statistically significant associations between two temperature change metrics and the risk of TB admissions. The maximum lag-specific relative risk (RR) of TB admissions was 1.088 (95%CI: 1.012-1.171, lag 4 day) for exposing to large temperature drop (TCN= -4 °C) in winter. Besides, the overall cumulative risk of TB admissions increased continuously and peaked at a lag of 7 days (RR=1.350, 95%CI: 1.120-1.628). Subgroup analysis suggested that exposure to large temperature drop had an adverse effect on TB admissions among males, females and adults. Similarly, large level of DTR exposure (DTR=15 °C) in spring also increased the risk of TB admissions on lag 0 day (RR=1.039, 95%CI: 1.016-1.063), and the cumulative RRs peaked at a lag of 1 days (RR=1.029, 95%CI: 1.012-1.047). We also found that females and elderly people were more vulnerable to the large level of DTR exposure. Additionally, the assessment of attributable risk suggested that taking target measures for the upcoming large temperature drop (b-AF = 4.17%, 95% eCI: 1.24%, 7.22%, b-AN = 1195) may achieve great public health benefits for TB prevention. CONCLUSION This study suggests that ambient temperature change is associated with the risk of TB admissions. Besides, TCN may be a better predictor for the TB prevention and public health.
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Affiliation(s)
- Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiao-Jing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kun Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jie Liu
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ji-Yu Cao
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Chen-Yu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, 60657, Illinois, USA
| | - Tao Zhang
- Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022, China
| | - Xiao-Hong Kan
- Anhui Chest Hospital, 397 Jixi Road, Hefei, 230022, China; Anhui Medical University Clinical College of Chest, 397 Jixi Road, Hefei, 230022, China.
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
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Bonell A, Contamin L, Thai PQ, Thuy HTT, van Doorn HR, White R, Nadjm B, Choisy M. Does sunlight drive seasonality of TB in Vietnam? A retrospective environmental ecological study of tuberculosis seasonality in Vietnam from 2010 to 2015. BMC Infect Dis 2020; 20:184. [PMID: 32111195 PMCID: PMC7048025 DOI: 10.1186/s12879-020-4908-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major global health burden, with an estimated quarter of the world's population being infected. The World Health Organization (WHO) launched the "End TB Strategy" in 2014 emphasising knowing the epidemic. WHO ranks Vietnam 12th in the world of high burden countries. TB spatial and temporal patterns have been observed globally with evidence of Vitamin D playing a role in seasonality. We explored the presence of temporal and spatial clustering of TB in Vietnam and their determinants to aid public health measures. METHODS Data were collected by the National TB program of Vietnam from 2010 to 2015 and linked to the following datasets: socio-demographic characteristics; climatic variables; influenza-like-illness (ILI) incidence; geospatial data. The TB dataset was aggregated by province and quarter. Descriptive time series analyses using LOESS regression were completed per province to determine seasonality and trend. Harmonic regression was used to determine the amplitude of seasonality by province. A mixed-effect linear model was used with province and year as random effects and all other variables as fixed effects. RESULTS There were 610,676 cases of TB notified between 2010 and 2015 in Vietnam. Heat maps of TB incidence per quarter per province showed substantial temporal and geospatial variation. Time series analysis demonstrated seasonality throughout the country, with peaks in spring/summer and troughs in autumn/winter. Incidence was consistently higher in the south, the three provinces with the highest incidence per 100,000 population were Tay Ninh, An Giang and Ho Chi Minh City. However, relative seasonal amplitude was more pronounced in the north. Mixed-effect linear model confirmed that TB incidence was associated with time and latitude. Of the demographic, socio-economic and health related variables, population density, percentage of those under 15 years of age, and HIV infection prevalence per province were associated with TB incidence. Of the climate variables, absolute humidity, average temperature and sunlight were associated with TB incidence. CONCLUSION Preventative public health measures should be focused in the south of Viet Nam where incidence is highest. Vitamin D is unlikely to be a strong driver of seasonality but supplementation may play a role in a package of interventions.
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Affiliation(s)
- Ana Bonell
- London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.
- Oxford University Clinical Research Unit - Hanoi, National Hospital of Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam.
| | - Lucie Contamin
- Oxford University Clinical Research Unit - Hanoi, National Hospital of Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
- Institute of Research for Development, 34394, Montpellier, France
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, 1 Yec Xanh, Pham Dinh Ho, Hai Ba Trung, Hanoi, 100000, Vietnam
| | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit - Hanoi, National Hospital of Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
| | - Richard White
- TB Modelling Group, Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Behzad Nadjm
- London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
- Oxford University Clinical Research Unit - Hanoi, National Hospital of Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
| | - Marc Choisy
- Oxford University Clinical Research Unit - Hanoi, National Hospital of Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
- Institute of Research for Development, 34394, Montpellier, France
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Bodena D, Ataro Z, Tesfa T. Trend Analysis And Seasonality Of Tuberculosis Among Patients At The Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A Retrospective Study. Risk Manag Healthc Policy 2019; 12:297-305. [PMID: 31849546 PMCID: PMC6912008 DOI: 10.2147/rmhp.s228659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose Tuberculosis (TB) is one of the top 10 leading killer diseases in developing countries, particularly in Sub-Saharan Africa, including Ethiopia. Thus, this study aimed to assess the trend analysis and seasonality of TB at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Methods and patients A hospital-based retrospective study was conducted on 8,001 patients by reviewing all available patients’ data from January 1, 2015 to April 30, 2019, at the Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Socio-demographic characteristics and results of the GeneXpert assay were taken from the registration book. The data were entered into EpiData 3.1 and analyzed by using the statistical Package for Social Sciences (SPSS) version 20. Results From a total of 8,001 samples tested using Genexpert, the overall prevalence of Mycobacterium tuberculosis and rifampicin resistance was found to be 1,254 (15.7%) and 53 (4.1%), respectively. A decreasing trend of TB prevalence was observed, and decreased from 19.3% in 2015, 18.6% in 2016, to 18.4% in 2017, 13.5% in 2018 and down to 13.0% in 2019 (P-value<0.001). The maximum number of TB cases were reported during autumn (454, 17.1%) and summer (310, 17.2%) compared to other seasons of all the study period. Being between the ages of 15–29 years (adjusted odds ratio (AOR)=1.7, 95% confidence interval (CI)=1.41–1.98), of male gender (AOR=0.84, 95% CI=0.75–0.96), experiencing a relapse of TB (AOR=0.51, 95% CI=0.35–0.78), and being HIV positive (AOR=0.51, 95% CI=0.3–0.86) were found to be factors associated with high proportion of tuberculosis. Conclusion Prevalence of TB has decreased year to year between January 2015 and April 2019. However, a high percentage of patients are still testing positive for TB with different seasonal variations. Thus, understanding and managing TB in seasonal variation, controlling relapse of TB, and screening of all HIV positive patients are recommended steps to reduce the transmission of tuberculosis in Ethiopia.
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Affiliation(s)
- Dagne Bodena
- Hiwot Fana Specialized University Hospital, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Zerihun Ataro
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Jaganath D, Wobudeya E, Sekadde MP, Nsangi B, Haq H, Cattamanchi A. Seasonality of childhood tuberculosis cases in Kampala, Uganda, 2010-2015. PLoS One 2019; 14:e0214555. [PMID: 30964908 PMCID: PMC6456174 DOI: 10.1371/journal.pone.0214555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seasonality in tuberculosis (TB) has been described, especially in children. However, few studies have assessed seasonality of TB in the equatorial region, and none in children. OBJECTIVES To assess for seasonality of childhood TB cases in Kampala, Uganda, and determine the role of temperature, rainfall patterns, and influenza cases on TB diagnoses. METHODS We retrospectively analyzed demographic and clinical data of children (under 15 years) diagnosed with TB at a pediatric TB clinic in Kampala, Uganda from 2010 to 2015. We performed decomposition analysis of the monthly case time series to assess seasonality. We compared monthly mean plots and performed Poisson regression to assess any association between TB diagnoses and temperature, rainfall, and influenza. RESULTS Of the 713 childhood TB cases diagnosed at the clinic, 609 (85%) were clinically diagnosed and 492 (69%) were pulmonary cases. There were minimal monthly variations in TB cases, with a trough in December and peaks in July and October, but there was no significant seasonality. Temperature variations did not show a clear pattern with TB diagnoses. Rainfall alternated with TB diagnoses in the first half of the year, but then overlapped in the second half and was significantly associated with TB diagnoses. Influenza cases were significantly related to TB diagnoses with (β = 0.05, 95% CI 0.01 to 0.09, p = 0.01) or without (β = 0.06, 95% CI 0.01 to 0.1, p = 0.01) rainfall, and had particular overlap with pulmonary TB cases. CONCLUSIONS Seasonal variations in childhood TB diagnoses were non-significant. Temperature did not have a clear pattern with TB diagnoses, but rainfall and influenza cases correlated with the primarily clinically diagnosed childhood TB cases.
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Affiliation(s)
- Devan Jaganath
- Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, United States of America
| | - Eric Wobudeya
- Directorate of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Betty Nsangi
- USAID RHITES-EC, University Research Co. LLC, Kampala, Uganda
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Adithya Cattamanchi
- Division of Pulmonology and Critical Care Medicine, University of California, San Francisco, San Francisco, United States of America
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, San Francisco, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, United States of America
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Hong Y, Kim Y, Lee JJ, Lee MG, Lee CY, Kim Y, Heo J, Han SS, Lee SJ, Kim WJ, Hong JY. Levels of vitamin D-associated cytokines distinguish between active and latent tuberculosis following a tuberculosis outbreak. BMC Infect Dis 2019; 19:151. [PMID: 30760247 PMCID: PMC6375131 DOI: 10.1186/s12879-019-3798-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D levels are associated with the extent of mycobactericidal activity. Interleukin (IL)-15 and IL-32 play roles in the vitamin D-mediated tuberculosis (TB) defense mechanism. Vitamin D induces IL-1β, which plays an important role in terms of resistance to TB. We evaluated whether the levels of vitamin D-related cytokines distinguished between those with active TB and latent TB infection (LTBI). METHODS In total, 50 TB-infected patients (25 with active TB and 25 with LTBI following a TB outbreak in a high school) were enrolled. Plasma 25-hydroxyvitamin D (25[OH]D), IL-15, IL-32, and IL-1β levels were measured via enzyme-linked immunosorbent assays. Mycobacterium tuberculosis-specific antigen-induced and unstimulated cytokine levels were measured in the supernatants of the QuantiFERON TB Gold-In-Tube (QFT-GIT) assay. RESULTS Plasma 25(OH)D and plasma IL-15 levels were lower in patients with active TB than in LTBI subjects (25(OH)D: 16.64 ng/mL vs. 21.6 ng/mL, P = 0.031; IL-15: 148.9 pg/mL vs. 189.8 pg/mL, P = 0.013). Plasma 25(OH)D levels correlated with the plasma levels of IL-15 and IL-1β in TB-infected patients. In addition, the plasma 25(OH)D levels correlated positively with the level of unstimulated IL-15 (IL-15nil) and negatively with that of TB antigen-stimulated IL-32 (IL-32TB) in QFT-GIT supernatants. Although the IL-15nil and IL-15TB levels were higher in LTBI subjects than patients with active TB, the IL-32nil and IL-32TB levels were higher in the latter patients. A combination of the IL-15nil and IL-32TB levels accurately predicted 91.3% of active TB patients and latent subjects, with an area under the curve of 0.964. CONCLUSIONS Our preliminary data showed that the levels of the vitamin D-related cytokines IL-15 and IL-32 differed between active TB patients and LTBI subjects. This result might be used as a basic data for developing biomarkers distinguishing between active TB and LTBI.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine,Kangwon National University, Chuncheon, Republic of Korea
| | - Youngmi Kim
- Institute of New frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jae Jun Lee
- Institute of New frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Myung Goo Lee
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Gangwon-do Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77, Sakju-ro, Chuncheon-si, Gangwon-do 200-704 Republic of Korea
| | - Chang Youl Lee
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Gangwon-do Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77, Sakju-ro, Chuncheon-si, Gangwon-do 200-704 Republic of Korea
| | - Youlim Kim
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Gangwon-do Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77, Sakju-ro, Chuncheon-si, Gangwon-do 200-704 Republic of Korea
| | - Jeongwon Heo
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine,Kangwon National University, Chuncheon, Republic of Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine,Kangwon National University, Chuncheon, Republic of Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine,Kangwon National University, Chuncheon, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine,Kangwon National University, Chuncheon, Republic of Korea
| | - Ji Young Hong
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Gangwon-do Republic of Korea
- Institute of New frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, 77, Sakju-ro, Chuncheon-si, Gangwon-do 200-704 Republic of Korea
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Kim EH, Bae JM. Seasonality of tuberculosis in the Republic of Korea, 2006-2016. Epidemiol Health 2018; 40:e2018051. [PMID: 30486553 PMCID: PMC6288684 DOI: 10.4178/epih.e2018051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/20/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES While the seasonality of notified tuberculosis has been identified in several populations, there is not a descriptive epidemiological study on the seasonality of tuberculosis in Korea. This study aimed to evaluate the seasonality of tuberculosis in Korea from 2006 to 2016. METHODS Data regarding notified cases of tuberculosis by year and month was obtained from the Infectious Diseases Surveillance Yearbook, 2017 published by the Korea Centers for Disease Control and Prevention. Seasonal decomposition was conducted using the method of structural model of time series analysis with simple moving averages. RESULTS While the trough season was winter from 2006 to 2016, the peak season was summer between 2006 and 2012, but shifted to spring between 2013 and 2016. CONCLUSIONS Notified tuberculosis in Korea also showed seasonality. It is necessary to evaluate factors related to the seasonality of tuberculosis for controlling tuberculosis.
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Affiliation(s)
- Eun Hee Kim
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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22
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Kim EH, Bae JM. Vitamin D supplementation as a control program against latent tuberculosis infection in Korean high school students. Epidemiol Health 2018; 40:e2018035. [PMID: 30056639 PMCID: PMC6232659 DOI: 10.4178/epih.e2018035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022] Open
Abstract
The prevalence of latnet Mycobacterium tuberculosis infection (LTBI) in the first-grade high school students in South Korea was 2.1%, which was the lowest level at congregated settings in 2017. For LTBI cases refusing anti-tuberculosis (TB) medication or having poor compliance, additional support should be considered. Eight systematic reviews concluded that vitamin D (VD) deficiency is a risk factor for TB. While three of four South Korean adolescents were VD deficiency, VD supplementation could be a practical remedy to protect LTBI students of refusing anti-TB medication or having poor compliance.
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Affiliation(s)
- Eun Hee Kim
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Kim EW, Teles RMB, Haile S, Liu PT, Modlin RL. Vitamin D status contributes to the antimicrobial activity of macrophages against Mycobacterium leprae. PLoS Negl Trop Dis 2018; 12:e0006608. [PMID: 29965969 PMCID: PMC6044553 DOI: 10.1371/journal.pntd.0006608] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/13/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background The immune system depends on effector pathways to eliminate invading pathogens from the host in vivo. Macrophages (MΦ) of the innate immune system are armed with vitamin D-dependent antimicrobial responses to kill intracellular microbes. However, how the physiological levels of vitamin D during MΦ differentiation affect phenotype and function is unknown. Methodology/principal The human innate immune system consists of divergent MΦ subsets that serve distinct functions in vivo. Both IL-15 and IL-10 induce MΦ differentiation, but IL-15 induces primary human monocytes to differentiate into antimicrobial MΦ (IL-15 MΦ) that robustly express the vitamin D pathway. However, how vitamin D status alters IL-15 MΦ phenotype and function is unknown. In this study, we found that adding 25-hydroxyvitamin D3 (25D3) during the IL-15 induced differentiation of monocytes into MΦ increased the expression of the antimicrobial peptide cathelicidin, including both CAMP mRNA and the encoded protein cathelicidin in a dose-dependent manner. The presence of physiological levels of 25D during differentiation of IL-15 MΦ led to a significant vitamin D-dependent antimicrobial response against intracellular Mycobacterium leprae but did not change the phenotype or phagocytic function of these MΦ. These data suggest that activation of the vitamin D pathway during IL-15 MΦ differentiation augments the antimicrobial response against M. leprae infection. Conclusions/significance Our data demonstrates that the presence of vitamin D during MΦ differentiation bestows the capacity to mount an antimicrobial response against M. leprae. A key function of MΦ is to recognize, phagocytose and mount an antimicrobial response against microbial pathogens to defend the host. In humans, monocytes are recruited to the site of infection and differentiate into MΦ upon the onset of microbial infection. The MΦ phenotype and function are determined by the cytokine profile of the microenvironment in which the monocyte enters. Additionally, vitamin D is known to trigger direct antimicrobial responses against invading pathogens in MΦ, but also disrupts the differentiation of immune subsets within the myeloid lineage. Therefore, we investigated whether vitamin D status during MΦ differentiation influenced either phenotype or function. Here, we found that the IL-15 MΦphenotype is sustained regardless of vitamin D status. In contrast, antimicrobial MΦ differentiated in the presence of vitamin D exhibited a robust expression of an antimicrobial peptide, relative to MΦ differentiated in the absence of vitamin D. The antimicrobial MΦ armed with cathelicidin prior to M. leprae challenge demonstrated a strong antimicrobial response against the invading pathogen. Our study reveals that the presence of sufficient levels of vitamin D prior to microbial infection contributes to effectively reduce the viability of the pathogen in MΦ.
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Affiliation(s)
- Elliot W. Kim
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Rosane M. B. Teles
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States of America
| | - Salem Haile
- Department of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Philip T. Liu
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States of America
- UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, Los Angeles, Los Angeles, California, United States of America
| | - Robert L. Modlin
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, California, United States of America
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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Abstract
Tuberculosis (TB) has troubled mankind for millennia, but current treatment strategies are long and complicated and the disease remains a major global health problem. The risk of Mycobacterium tuberculosis (Mtb) infection or progression of active TB disease is elevated in individuals with vitamin D deficiency. High-dose vitamin D was used to treat TB in the preantibiotic era, and in vitro experimental data show that vitamin D supports innate immune responses that restrict growth of Mtb. Several randomized controlled trials have tested whether adjunctive vitamin D supplementation enhances the clinical and microbiological response to standard antimicrobial chemotherapy for pulmonary TB. The effects have been modest at best, and attention is turning to the question of whether vitamin D supplementation might have a role in preventing acquisition or reactivation of latent Mtb infection. In this article, we describe the effects of vitamin D on host immune responses to Mtb in vitro and in vivo and review the results of clinical trials in the field. We also reflect on the findings of clinical trials of vitamin D supplementation for the prevention of acute respiratory tract infections, and discuss how these findings might influence the design of future trials to evaluate the role of vitamin D in the prevention and treatment of TB.
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Affiliation(s)
- S Brighenti
- Department of Medicine, Center for Infectious Medicine (CIM), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - P Bergman
- Department of Laboratory Medicine (LABMED), Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A R Martineau
- Blizard Institute, Centre for Immunobiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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25
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Maceda EB, Gonçalves CCM, Andrews JR, Ko AI, Yeckel CW, Croda J. Serum vitamin D levels and risk of prevalent tuberculosis, incident tuberculosis and tuberculin skin test conversion among prisoners. Sci Rep 2018; 8:997. [PMID: 29343733 PMCID: PMC5772514 DOI: 10.1038/s41598-018-19589-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/03/2018] [Indexed: 01/09/2023] Open
Abstract
Poor vitamin D status has been associated with tuberculosis (TB); whether poor status is cause or consequence of disease is uncertain. We conducted a case-control study and two nested case-control studies to determine whether vitamin D levels were associated with active TB, tuberculin skin test (TST) conversion, and risk of progression to the active TB in prisoners in Brazil. In multivariable conditional logistic regression, subnormal vitamin D levels (OR, 3.77; 95% CI, 1.04–13.64) were more likely in prisoners with active TB. In contrast, vitamin D was not found to be a risk factor for either TST conversion (OR, 2.49; 95% CI, 0.64–9.66) or progression to active disease (OR, 0.59; 95% CI, 0.13–2.62). Black race (OR, 11.52; 95% CI, 2.01–63.36), less than 4 years of schooling (OR, 2.70; 95% CI, 0.90–8.16), cigarette smoking (OR, 0.23; 95% CI, 0.06–0.79) were identified as risk factors for TST conversion. Risk of progression to active TB was found to be associated with cigarette smoking (OR, 7.42; 95% CI, 1.23–44.70). Our findings in the prison population show that poor vitamin D status is more common in individuals with active TB, but is not a risk factor for acquisition of latent TB or progression to active TB.
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Affiliation(s)
- Elisangela B Maceda
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA.,Oswaldo Cruz Foundation, Salvador, Brazil
| | - Catherine W Yeckel
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Julio Croda
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil. .,School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil. .,Oswaldo Cruz Foundation, Campo Grande, Brazil.
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26
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Ballif M, Zürcher K, Reid SE, Boulle A, Fox MP, Prozesky HW, Chimbetete C, Zwahlen M, Egger M, Fenner L. Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes. BMJ Open 2018; 8:e017405. [PMID: 29330173 PMCID: PMC5780693 DOI: 10.1136/bmjopen-2017-017405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa. SETTING Five ART programmes participating in the International Epidemiology Database to Evaluate AIDS in South Africa, Zambia and Zimbabwe. PARTICIPANTS We analysed data of 331 634 HIV-positive adults (>15 years), who initiated ART between January 2004 and December 2014. PRIMARY OUTCOME MEASURE We calculated aggregated averages in monthly counts of PTB diagnoses and ART initiations. To account for time trends, we compared deviations of monthly event counts to yearly averages, and calculated correlation coefficients. We used multivariable regressions to assess associations between deviations of monthly ART initiation and PTB diagnosis counts from yearly averages, adjusted for monthly air temperatures and geographical latitude. As controls, we used Kaposi sarcoma and extrapulmonary tuberculosis (EPTB) diagnoses. RESULTS All programmes showed monthly variations in PTB diagnoses that paralleled fluctuations in ART initiations, with recurrent patterns across 2004-2014. The strongest drops in PTB diagnoses occurred in December, followed by April-May in Zimbabwe and South Africa. This corresponded to holiday seasons, when clinical activities are reduced. We observed little monthly variation in ART initiations and PTB diagnoses in Zambia. Correlation coefficients supported parallel trends in ART initiations and PTB diagnoses (correlation coefficient: 0.28, 95% CI 0.21 to 0.35, P<0.001). Monthly temperatures and latitude did not substantially change regression coefficients between ART initiations and PTB diagnoses. Trends in Kaposi sarcoma and EPTB diagnoses similarly followed changes in ART initiations throughout the year. CONCLUSIONS Monthly variations in PTB diagnosis at ART programmes in Southern Africa likely occurred regardless of seasonal variations in temperatures or latitude and reflected fluctuations in clinical activities and changes in health-seeking behaviour throughout the year, rather than climatic factors.
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Affiliation(s)
- Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Stewart E Reid
- Division of Infection Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Tuberculosis Department Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Matthew P Fox
- Departments of Epidemiology and Global Health, Boston University, Boston, USA
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, University of Stellenbosch & Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
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