Association Between Ambient Air Pollution and Elevated Risk of Tuberculosis Development

Long-term exposure to ambient fine particulate matter (PM2.5) and attributable pulmonary tuberculosis notifications in Ningxia Hui Autonomous Region, China: a health impact assessment

INTRODUCTION

Long-term exposure to fine particulate matter (≤2.5 µm (PM2.5)) has been associated with pulmonary tuberculosis (TB) notifications or incidence in recent publications. Studies quantifying the relative contribution of long-term PM2.5 on TB notifications have not been documented. We sought to perform a health impact assessment to estimate the PM2.5- attributable TB notifications during 2007-2017 in Ningxia Hui Autonomous Region (NHAR), China.

METHODS

PM2.5 attributable TB notifications were estimated at township level (n=358), stratified by age group and summed across NHAR. PM2.5-associated TB-notifications were estimated for total and anthropogenic PM2.5 mass and expressed as population attributable fractions (PAFs). The main analysis used effect and uncertainty estimates from our previous study in NHAR, defining a counterfactual of the lowest annual PM2.5 (30 µg/m3) level, above which we assumed excess TB notifications. Sensitivity analyses included counterfactuals based on the 5th (31 µg/m3) and 25th percentiles (38 µg/m3), and substituting effect estimates from a recent meta-analysis. We estimated the influence of PM2.5 concentrations, population growth and baseline TB-notification rates on PM2.5 attributable TB notifications.

RESULTS

Over 2007-2017, annual PM2.5 had an estimated average PAF of 31.2% (95% CI 22.4% to 38.7%) of TB notifications while the anthropogenic PAF was 12.2% (95% CI 9.2% to 14.5%). With 31 and 38 µg/m3 as counterfactuals, the PAFs were 29.2% (95% CI 20.9% to 36.3%) and 15.4% (95% CI 10.9% to 19.6%), respectively. PAF estimates under other assumptions ranged between 6.5% (95% CI 2.9% to 9.6%) and 13.7% (95% CI 6.2% to 19.9%) for total PM2.5, and 2.6% (95% CI 1.2% to 3.8%) to 5.8% (95% CI 2.7% to 8.2%) for anthropogenic PM2.5. Relative to 2007, overall changes in PM2.5 attributable TB notifications were due to reduced TB-notification rates (-23.8%), followed by decreasing PM2.5 (-6.2%), and population growth (+4.9%).

CONCLUSION

We have demonstrated how the potential impact of historical or hypothetical air pollution reduction scenarios on TB notifications can be estimated, using public domain, PM2.5 and population data. The method may be transferrable to other settings where comparable TB-notification data are available.

Black Phosphorus-Tungsten Oxide Sandwich-like Nanostructures for Highly Selective NO2 Detection

Modern chemical production processes often emit complex mixtures of gases, including hazardous pollutants such as NO2. Although widely used, gas sensors based on metal oxide semiconductors such as WO3 respond to a wide range of interfering gases other than NO2. Consequently, developing WO3 gas sensors with high NO2 selectivity is challenging. In this study, a simple one-step hydrothermal method was used to prepare WO3 nanorods modified with black phosphorus (BP) flakes as sensitive materials for NO2 sensing, and BP-WO3-based micro-electromechanical system gas sensors were fabricated. The characterization of the as-prepared BP-WO3 composite through X-ray diffraction scanning electron microscopy and X-ray photoelectron spectroscopy confirmed the successful formation of the sandwich-like nanostructures. The result of gas-sensing tests with 2-14 ppm NO2 indicated that the sensor response was 1.25-2.21 with response-recovery times of 36 and 36 s, respectively, at 190 °C. In contrast to pure WO3, which exhibited a response of 1.07-2.2 to 0.3-5 ppm H2S at 160 °C, BP-WO3 showed almost no response to H2S. Thus, compared with pure WO3, BP-WO3 exhibited significantly improved NO2 selectivity. Overall, the BP-WO3 composite with sandwich-like nanostructures is a promising material for developing highly selective NO2 sensors for practical applications.

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru

Tuberculosis (TB) transmission in healthcare facilities is common in high-incidence countries. Yet, the optimal approach for identifying inpatients who may have TB is unclear. We evaluated the diagnostic accuracy of qXR (Qure.ai, India) computer-aided detection (CAD) software versions 3.0 and 4.0 (v3 and v4) as a triage and screening tool within the FAST (Find cases Actively, Separate safely, and Treat effectively) transmission control strategy. We prospectively enrolled two cohorts of patients admitted to a tertiary hospital in Lima, Peru: one group had cough or TB risk factors (triage) and the other did not report cough or TB risk factors (screening). We evaluated the sensitivity and specificity of qXR for the diagnosis of pulmonary TB using culture and Xpert as primary and secondary reference standards, including stratified analyses based on risk factors. In the triage cohort (n = 387), qXR v4 sensitivity was 0.91 (59/65, 95% CI 0.81-0.97) and specificity was 0.32 (103/322, 95% CI 0.27-0.37) using culture as reference standard. There was no difference in the area under the receiver-operating-characteristic curve (AUC) between qXR v3 and qXR v4 with either a culture or Xpert reference standard. In the screening cohort (n = 191), only one patient had a positive Xpert result, but specificity in this cohort was high (>90%). A high prevalence of radiographic lung abnormalities, most notably opacities (81%), consolidation (62%), or nodules (58%), was detected by qXR on digital CXR images from the triage cohort. qXR had high sensitivity but low specificity as a triage in hospitalized patients with cough or TB risk factors. Screening patients without cough or risk factors in this setting had a low diagnostic yield. These findings further support the need for population and setting-specific thresholds for CAD programs.

Impact of diesel exhaust particles on infections with Mycobacterium bovis BCG in in vitro human macrophages and an in vivo Galleria mellonella model

There are strong suggestions for a link between pulmonary tuberculosis (TB) and air quality. Diesel exhaust is one of the main contributors to pollution and it is reported to be able to modify susceptibility to lung infections. In this study we exposed THP-1 human macrophages and Mycobacterium bovis BCG to diesel exhaust particles (DEPs). High cytotoxicity and activation of apoptosis was found in THP-1 cells at 3 and 6 days, but no effect was found on the growth of M. bovis BCG. Infection of THP-1 cells exposed to a non-cytotoxic DEP concentration showed a limited capacity to engulf latex beads. However, M. bovis BCG infection of macrophages did not result in an increase in the bacterial burden, but it did result in an increase in the bacteria recovered from the extracellular media, suggesting a poor contention of M. bovis BCG. We also observed that DEP exposure limited the production of cytokines. Using the Galleria mellonella model of infection, we observed that larvae exposed to low levels of DEPs were less able to survive after infection with M. bovis BCG and had a higher internal bacterial load after 4 days of infection. Unraveling the links between air pollution and impairment of human antimycobacterial immunity is vital, because pollution is rapidly increasing in areas where TB incidence is extremely high.

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru

Introduction

Tuberculosis (TB) transmission in healthcare facilities is common in high-incidence countries. Yet, the optimal approach for identifying inpatients who may have TB is unclear. We evaluated the diagnostic accuracy of qXR (Qure.ai, India) computer-aided detection (CAD) software versions 3.0 and 4.0 (v3 and v4) as a triage and screening tool within the FAST (Find cases Actively, Separate safely, and Treat effectively) transmission control strategy.

Methods

We prospectively enrolled two cohorts of patients admitted to a tertiary hospital in Lima, Peru: one group had cough or TB risk factors (triage) and the other did not report cough or TB risk factors (screening). We evaluated the sensitivity and specificity of qXR for the diagnosis of pulmonary TB using culture and Xpert as primary and secondary reference standards, including stratified analyses based on risk factors.

Results

In the triage cohort (n=387), qXR v4 sensitivity was 0.91 (59/65, 95% CI 0.81-0.97) and specificity was 0.32 (103/322, 95% CI 0.27-0.37) using culture as reference standard. There was no difference in the area under the receiver-operating-characteristic curve (AUC) between qXR v3 and qXR v4 with either a culture or Xpert reference standard. In the screening cohort (n=191), only one patient had a positive Xpert result, but specificity in this cohort was high (>90%). A high prevalence of radiographic lung abnormalities, most notably opacities (81%), consolidation (62%), or nodules (58%), was detected by qXR on digital CXR images from the triage cohort.

Conclusions

qXR had high sensitivity but low specificity as a triage in hospitalized patients with cough or TB risk factors. Screening patients without cough or risk factors in this setting had a low diagnostic yield. These findings further support the need for population and setting-specific thresholds for CAD programs.

Vitamin D3 regulates PM-driven primary human neutrophil inflammatory responses

Recent evidence has demonstrated that both acute and chronic exposure to particulate air pollution are risk factors for respiratory tract infections and increased mortality from sepsis. There is therefore an urgent need to establish the impact of ambient particulate matter (PM) on innate immune cells and to establish potential strategies to mitigate against adverse effects. PM has previously been reported to have potential adverse effects on neutrophil function. In the present study, we investigated the impact of standard urban PM (SRM1648a, NIST) and PM2.5 collected from Chiang Mai, Thailand, on human peripheral blood neutrophil functions, including LPS-induced migration, IL-8 production, and bacterial killing. Both NIST and the PM2.5, being collected in Chiang Mai, Thailand, increased IL-8 production, but reduced CXCR2 expression and migration of human primary neutrophils stimulated with Escherichia coli LPS. Moreover, PM-pretreated neutrophils from vitamin D-insufficient participants showed reduced E. coli-killing activity. Furthermore, in vitro vitamin D3 supplementation attenuated IL-8 production and improved bacterial killing by cells from vitamin D-insufficient participants. Our findings suggest that provision of vitamin D to individuals with insufficiency may attenuate adverse acute neutrophilic responses to ambient PM.

Effect of gaseous pollutant and greenness exposure on mortality during treatment of newly treated tuberculosis patients: a provincial population-based cohort study

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.

Alveolar deposition of inhaled fine particulate matter increased risk of severity of pulmonary tuberculosis in the upper and middle lobes

Inhaled PM_2.5 associated with pulmonary tuberculosis https://bit.ly/3VXAKfq.

Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank

BACKGROUND

Socioeconomic status (SES) inequity was recognized as a driver of some certain infectious diseases. However, few studies evaluated the association between SES and the burden of overall infections, and even fewer identified preventable mediators. This study aimed to assess the association between SES and overall infectious diseases burden, and the potential roles of factors including lifestyle, environmental pollution, chronic disease history.

METHODS

We included 401,009 participants from the UK Biobank (UKB) and defined the infection status for each participant according to their diagnosis records. Latent class analysis (LCA) was used to define SES for each participant. We further defined healthy lifestyle score, environment pollution score (EPS) and four types of chronic comorbidities. We used multivariate logistic regression to test the associations between the four above covariates and infectious diseases. Then, we performed the mediation and interaction analysis to explain the relationships between SES and other variables on infectious diseases. Finally, we employed seven types of sensitivity analyses, including considering the Townsend deprivation index as an area level SES variable, repeating our main analysis for some individual or composite factors and in some subgroups, as well as in an external data from the US National Health and Nutrition Examination Survey, to verify the main results.

RESULTS

In UKB, 60,771 (15.2%) participants were diagnosed with infectious diseases during follow-up. Lower SES [odds ratio (OR) = 1.5570] were associated with higher risk of overall infections. Lifestyle score mediated 2.9% of effects from SES, which ranged from 2.9 to 4.0% in different infection subtypes, while cardiovascular disease (CVD) mediated a proportion of 6.2% with a range from 2.1 to 6.8%. In addition, SES showed significant negative interaction with lifestyle score (OR = 0.8650) and a history of cancer (OR = 0.9096), while a significant synergy interaction was observed between SES and EPS (OR = 1.0024). In subgroup analysis, we found that males and African (AFR) with lower SES showed much higher infection risk. Results from sensitivity and validation analyses showed relative consistent with the main analysis.

CONCLUSIONS

Low SES is shown to be an important risk factor for infectious disease, part of which may be mediated by poor lifestyle and chronic comorbidities. Efforts to enhance health education and improve the quality of living environment may help reduce burden of infectious disease, especially for people with low SES.

The association between air pollutants, meteorological factors and tuberculosis cases in Beijing, China: A seven-year time series study

BACKGROUND

Tuberculosis (TB) is a severe public health problem globally. Previous studies have revealed insufficient and inconsistent associations between air pollutants, meteorological factors and TB cases. Yet few studies have examined the associations between air pollutants, meteorological factors and TB cases in Beijing.

OBJECTIVE

The purpose of this study was to explore the impact of air pollutants and meteorological factors on TB in Beijing, and to provide novel insights into public health managers to formulate control strategies of TB.

METHODS

Data on the daily case of TB in Beijing during 2014-2020 were obtained from Chinese tuberculosis information management system. Concurrent data on the daily PM₁₀, PM_2.5, SO₂, NO₂, CO and O₃, were obtained from the online publication platform of the Chinese National Environmental Monitoring Center. Daily average temperature, average wind speed, relative humidity, sunshine duration and total precipitation were collected from the China Meteorological Science Data Sharing Service System. A distributed lag non-linear model was fitted to identify the non-linear exposure-response relationship and the lag effects between air pollutions, meteorological factors and TB cases in Beijing.

RESULTS

In the single-factor model, the excess risk (ER) of TB was significantly positively associated with every 10 μg/m³ increase in NO₂ in lag 1 week (ER: 1.3%; 95% confidence interval [CI]: 0.4%, 2.3%) and every 0.1 m/s increase in average wind speed in lag 5 weeks (ER: 0.3%; 95% CI: 0.1%, 0.5%), and was negatively associated with every 10 μg/m³ increase in O₃ in lag 1 week (ER: -1.2%; 95% CI: -1.8%, -0.5%), every 5 °C increase in average temperature (ER: -1.7%; 95% CI: -2.9%, -0.4%) and every 10% increase in average relative humidity (ER: -0.4%; 95% CI: -0.8%, -0.1%) in lag 10 weeks, respectively. In the multi-factor model, the lag effects between TB cases and air pollutants, meteorological factors were similar. The subgroup analysis suggests that the effects of NO₂, O₃, average wind speed and relative humidity on TB were greater in male or labor age subgroup, while the effect of CO was greater in the elderly. In addition, no significant associations were found between PM_2.5, SO_2, sunshine duration and TB cases.

CONCLUSION

Our findings provide a better understanding of air pollutants and meteorological factors driving tuberculosis occurrence in Beijing, which enhances the capacity of public health manager to target early warning and disease control policy-making.

Pediatric tuberculosis in India: Justice and human rights

Tuberculosis (TB) is the deadliest infectious disease across the world, with the greatest burden occurring in India. Pregnant women and children are especially vulnerable to adverse effects from infection, and they tend to have diminished ability to protect themselves. Malnutrition, HIV, and other causes of immune suppression such as exposure to air pollution make one more prone to serious illness or death from TB infection. Risk factors are influenced by maternal education, access to health care, poverty, nutrition, healthcare stigma, and sanitation, among others. Current literature is heavily clinical, lacking focus on upstream factors, with a skew toward secondary and tertiary prevention strategies (i.e., case finding and treatment), and less emphasis on primary prevention (e.g., wealth equity and environmental regulation). Given concerns with extremely drug resistant TB and because infectious diseases can permeate National borders, public health nurses, and other healthcare professionals must educate themselves and advocate on behalf of vulnerable populations such as children in India. Improved sanitation, air quality monitoring, women's education, and increased access to health care are cost-effective and evidence-based strategies to address pediatric TB in India, a challenge which is grounded in human rights and justice.

Impact of the synergistic effect of pneumonia and air pollutants on newly diagnosed pulmonary tuberculosis in southern Taiwan

BACKGROUND

An increased incidence of pulmonary tuberculosis (PTB) among patients with pulmonary diseases exposed to air pollution has been reported.

OBJECTIVE

To comprehensively investigate the association between pneumonia (PN) and air pollution with PTB through a large-scale follow-up study.

METHODS

We conducted a retrospective study using data from the Kaohsiung Medical University Hospital Research Database and the Taiwan Air Quality Monitoring Database. We included adult patients with PN, PTB and other comorbidities according to ICD-9 codes. Control subjects without PN were matched by age, sex and ten comorbidities to each PN patient at a ratio of 4:1.

RESULTS

A total of 82,590 subjects were included. The PTB incidence rate was significantly higher in the PN group (2,391/100,000) than in the control group (1,388/100,000). The crude hazard ratio (HR) of PN-associated PTB incidence decreased with time, and the overall 7 years the HR (95% confidence interval; CI) was 1.74 (1.55-1.96). The overall adjusted HR and 95% CI of PN-related PTB in the multivariate Cox regression analysis was 3.38 (2.98-3.84). In addition, there was a cumulative lag effect of all air pollutants within 30 days of exposure. The peak adjusted HRs for PTB were noted on the 3rd, 8th, 12th and 12th days of PM_2.5, O₃, SO₂ and NO exposure, respectively. The overall peak HRs (95% CI) of PM_2.5, O₃, SO₂ and NO were 1.145 (1.139-1.152), 1.153 (1.145-1.161), 1.909 (1.839-1.982) and 1.312 (1.259-1.367), respectively, and there was a synergistic effect with pneumonia on the risk of PTB.

CONCLUSIONS

A strong association was found between past episodes of PN and the future risk of PTB. In addition, air pollutants including PM_2.5, SO₂, O₃ and NO, together with previous episodes of PN, had both long-term and short-term impact on the incidence of PTB.

Investigating Spatial Patterns of Pulmonary Tuberculosis and Main Related Factors in Bandar Lampung, Indonesia Using Geographically Weighted Poisson Regression

Tuberculosis (TB) is a highly infectious disease, representing one of the major causes of death worldwide. Sustainable Development Goal 3.3 implies a serious decrease in the incidence of TB cases. Hence, this study applied a spatial analysis approach to investigate patterns of pulmonary TB cases and its drivers in Bandar Lampung (Indonesia). Our study examined seven variables: the growth rate of pulmonary TB, population, distance to the city center, industrial area, green open space, built area, and slum area using geographically weighted Poisson regression (GWPR). The GWPR model demonstrated excellent results with an R2 and adjusted R2 of 0.96 and 0.94, respectively. In this case, the growth rate of pulmonary TB and population were statistically significant variables. Spatial pattern analysis of sub-districts revealed that those of Panjang and Kedaton were driven by high pulmonary TB growth rate and population, whereas that of Sukabumi was driven by the accumulation of high levels of industrial area, built area, and slums. For these reasons, we suggest that local policymakers implement a variety of infectious disease prevention and control strategies based on the spatial variation of pulmonary TB rate and its influencing factors in each sub-district.

Association of Single Nucleotide Polymorphism rs17580 with Smoking and Pulmonary Tuberculosis

This study aimed to investigate the correlation between SERPINA1 single nucleotide polymorphism (SNP) rs17580, smoking, and pulmonary tuberculosis (TB). A total of 420 TB patients (observation group) and 640 patients without pulmonary disease (control group) were randomly included. The frequencies of different genotypes were counted in both groups, and the correlation between SNP genotypes and the occurrence of TB was analyzed. Statistical models were performed to analyze the correlation between rs17580 and TB and the correlation between rs17580. The frequencies of genotypes TT, TA, and AA at the rs17580 locus in patients with TB were not statistically different from those in the control group ( $P>0.05$ ), and the distributions of the two groups were in accordance with the Hardy–Weinberg equilibrium law. rs17580 was analyzed in dominant, recessive, and codominant models, exhibiting no statistical difference ( $P>0.05$ ). There was no significant difference among the three genotypes in the 1–5 typing (χ2 = 1.034, $P=0.998$ ), and the difference between T and C was not statistically significant (χ2 = 0.012, $P=0.999$ ). There was a significant difference between the three genotypes between the smoking group and the nonsmoking group in TB patients ( $P<0.05$ ). There was no significant difference among three genotypes in the alcoholic group and the nonalcoholic group in TB patients ( $P>0.05$ ). There was no statistical difference in the time to cure among the 3 genotypes in TB patients ( $P>0.05$ ). A type mutation of rs17580 in the SERPINA1 gene was strongly associated with a higher risk of development of TB in smoking patients.

Short-term effect of ambient air pollutant change on the risk of tuberculosis outpatient visits: a time-series study in Fuyang, China

There is growing evidence that air pollution plays a role in TB, and most studies have been conducted in the core countries with inconsistent results. Few studies have comprehensively included the six common air pollutants, so they cannot consider whether various pollutants interact with each other. Our objectives were to investigate the association between short-term exposure to six common air pollutants and the risk of tuberculosis outpatient visits in Fuyang, China, 2015-2020. We combined the two models to explore the effects of exposure to six air pollutants on the risk of tuberculosis outpatient visits, including the Poisson generalized linear regression model and distributed lag non-linear model (DLNM). We performed stratified analyses for the season, type of cases, gender, and age. We used the lag-specific relative risks and cumulative relative risk obtained by increasing pollutant concentration by per 10 units to evaluate the connection between six air pollutants and TB; PM_2.5 (RR = 1.0018, 95% CI: 1.0004-1.0032, delay of 12 days) and SO₂ (RR = 1.0169, 95% CI: 1.0007-1.0333, lag 0-16 days) were 0.9549 (95% CI: 0.9389-0.9712, lag 0 day) and 0.8212 (95% CI: 0.7351-0.9173, 0-20-day lag). Stratified analyses showed that seasonal differences had a greater impact on TB, males were more likely to develop TB than females, older people were more likely to develop TB than younger people, and air pollution had a great impact on new cases. Exposure to O₃, CO, PM₁₀, PM_2.5, and NO₂ increases the risk of TB outpatient visits, except SO₂ which reduces the risk. The incidence of TB has seasonal fluctuations. It is necessary for the government to establish a sound environmental monitoring and early warning system to strengthen the monitoring and emission management of pollutants in the atmosphere. Management, prevention, and treatment measures should be developed for high-risk groups (males and older people), reducing the risk of TB by reducing their specific behaviors and changing their lifestyle. We need to pay more attention to the impact of seasonal effects on TB to protect TB patients and avoid a shortage of medical resources, and it is necessary for the government to develop some seasonal preventive measures in the future.

LPS Response Is Impaired by Urban Fine Particulate Matter

Fine particulate matter (PM_2.5) is a complex mixture of components with diverse chemical and physical characteristics associated with increased respiratory and cardiovascular diseases mortality. Our study aimed to investigate the effects of exposure to concentrated PM_2.5 on LPS-induced lung injury onset. BALB/c male mice were exposed to either filtered air or ambient fine PM_2.5 in an ambient particle concentrator for 5 weeks. Then, an acute lung injury was induced with nebulized LPS. The animals were euthanized 24 h after the nebulization to either LPS or saline. Inflammatory cells and cytokines (IL-1β, IL-4, IL-5, IL-6, IL-10, IL-17, TNF) were assessed in the blood, bronchoalveolar lavage fluid (BALF), and lung tissue. In addition, lung morphology was assessed by stereological methods. Our results showed that the PM+LPS group showed histological evidence of injury, leukocytosis with increased neutrophils and macrophages, and a mixed inflammatory response profile, with increased KC, IL-6, IL-1β, IL-4, and IL-17. Our analysis shows that there is an interaction between the LPS nebulization and PM_2.5 exposure, differently modulating the inflammatory response, with a distinct response pattern as compared to LPS or PM_2.5 exposure alone. Further studies are required to explain the mechanism of immune modulation caused by PM_2.5 exposure.

Association of long-term exposure to ambient air pollution with the number of tuberculosis cases notified: a time-series study in Hong Kong

To analyze the association of long-term exposure to air pollution and its attributable risks with the number of tuberculosis (TB) cases notified, a quasi-Poisson regression model combined with a distributed lag nonlinear model (DLNM) was constructed using monthly data on air pollution and TB cases notified in Hong Kong from 1999 to 2018. Nonlinear relationships between PM₁₀, PM_2.5, and CO and TB cases notified were identified. The concentrations of PM₁₀, PM_2.5, and CO corresponding to the minimum numbers of TB cases notified (the minimum TB notification concentrations, MTNCs) were 58.3 μg/m³, 41.7 μg/m³, and 0.1 mg/m³, respectively. Compared with the MTNCs, the overall cumulative numbers of TB cases notified increased by 76.93% (95% CI: 13.08%, 176.83%), 88.81% (95% CI: 26.09%, 182.71%), and 233.43% (95% CI: 13.56%, 879.03%) for the 95th percentiles of PM₁₀ and PM_2.5 and for the 97.5th percentiles of CO, respectively. The TB notification rate attributed to concentration ranges above the 97.5th percentile of PM₁₀, PM_2.5, and CO was 3.38% (95% empirical confidence intervals [eCI]: 0.93%, 5.61%), 4.73% (95% eCI: 1.87%, 7.15%), and 3.34% (95% eCI: 0.29%, 5.83%), respectively. Long-term exposure to high concentrations of air pollution in Hong Kong may be associated with increases in the number of TB cases notified for this area.

Associations between lung-deposited dose of particulate matter and culture-positive pulmonary tuberculosis pleurisy

Epidemiological studies identified the relationship between air pollution and pulmonary tuberculosis. Effects of lung-deposited dose of particulate matter (PM) on culture-positive pulmonary tuberculosis remain unclear. This study investigates the association between lung-deposited dose of PM and pulmonary tuberculosis pleurisy. A case-control study of subjects undergoing pleural effusion drainage of pulmonary tuberculosis (case) and chronic heart failure (control) was conducted. Metals and biomarkers were quantified in the pleural effusion. The air pollution exposure was measured and PM deposition in the head, tracheobronchial, alveolar region, and total lung region was estimated by Multiple-path Particle Dosimetry (MPPD) Model. We performed multiple logistic regression to examine the associations of these factors with the risk of tuberculosis. We observed that 1-μg/m³ increase in PM₁₀ was associated with 1.226-fold increased crude odds ratio (OR) of tuberculosis (95% confidence interval (CI): 1.023-1.469, p<0.05), 1-μg/m³ increase in PM_2.5-10 was associated with 1.482-fold increased crude OR of tuberculosis (95% CI: 1.048-2.097, p < 0.05), 1-ppb increase in NO₂ was associated with 1.218-fold increased crude OR of tuberculosis (95% CI: 1.025-1.447, p < 0.05), and 1-ppb increase in O₃ was associated with 0.735-fold decreased crude OR of tuberculosis (95% CI: 0.542 0.995). We observed 1-μg/m³ increase in PM deposition in head and nasal region was associated with 1.699-fold increased crude OR of tuberculosis (95% CI: 1.065-2.711, p < 0.05), 1-μg/m³ increase in PM deposition in tracheobronchial region was associated with 1.592-fold increased crude OR of tuberculosis (95% CI: 1.095-2.313, p < 0.05), 1-μg/m³ increase in PM deposition in alveolar region was associated with 3.981-fold increased crude OR of tuberculosis (95% CI: 1.280-12.386, p < 0.05), and 1-μg/m³ increase in PM deposition in total lung was associated with 1.511-fold increased crude OR of tuberculosis (95% CI: 1.050-2.173, p < 0.05). The results indicate that particle deposition in alveolar region could cause higher risk of pulmonary tuberculosis pleurisy than deposition in other lung regions.

Effect modification of greenness on PM2.5 associated all-cause mortality in a multidrug-resistant tuberculosis cohort

RATIONALE

Evidence for the association between fine particulate matter (PM_2.5) and mortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollution-related mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely unknown.

METHODS

2305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of 1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index (NDVI) in the 500 m buffer of patient's residence, annual average PM_2.5 and estimated oxidant capacity O_x were assigned to patients regarding their geocoded home addresses. Cox proportional hazards regression models were used to estimate HRs per 10 μg/m³ exposure to PM_2.5 and all-cause mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates.

RESULTS

HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM_2.5 associated with mortality for the full cohort and individuals with the greatest tertile of NDVI. Exposures to PM_2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432 to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM_2.5-related mortality, while greater greenness flattened the risk with HRs reduced in 0.188-0.194 on average.

CONCLUSIONS

Individuals with MDR-TB could benefit from greenness by having attenuated associations between PM_2.5 and mortality. Improving greener space and air quality may contribute to lower the risk of mortality from TB/MDR-TB and other diseases.

Tuberculosis treatment delay and nosocomial exposure remain important risks for patients undergoing regular hemodialysis

BACKGROUND AND OBJECTIVE

Studies have reported an increased tuberculosis (TB) incidence among patients with end-stage renal disease (ESRD). This nationwide nested Case-control study investigated the risk of active TB due to nosocomial exposure and its correlation with the delay in TB treatment in hemodialysis patients.

METHODS

Adult (aged ≥20 years) patients with incident ESRD over 2000-2010 were identified from Taiwan National Health Insurance Research Database; 2331 patients with incident active TB (Case) were matched with 11,655 patients without TB (control) by age, sex, year of ESRD onset, Charlson comorbidity index, chronic obstructive pulmonary disease, and diabetes mellitus, at a 1:5 case-to-control ratio.

RESULTS

Compared with the control group, the Case group had greater nosocomial exposure to index patients with pulmonary TB (2.36 vs. 0.11 month of exposure, p < 0.001). Nosocomial exposure increased active TB risk (adjusted odds ratio [OR; 95% confidence interval, CI]: 1.60 [1.55-1.66] per month of exposure), particularly when the exposure time was either within 6 months before the index case was diagnosed or 6-15 months before the ESRD patient became an incident active TB case. For patients with active TB, cough-related medication prescriptions (proxy for cough symptoms) exponentially increased over 6 months before TB treatment.

CONCLUSION

Nosocomial exposure attributed to delay in the diagnosis of index pulmonary TB is important in TB transmission among patients undergoing regular hemodialysis. Additional studies investigating how TB can be diagnosed and treated early are warranted.

SUMMARY AT A GLANCE

Our study revealed that nosocomial exposure, attributed to delay in pulmonary TB diagnosis, is important in TB transmission among patients undergoing regular hemodialysis. Strategies to diagnose and treat TB early are crucial to infection control, and they warrant further investigations.

Forecasting the Tuberculosis Incidence Using a Novel Ensemble Empirical Mode Decomposition-Based Data-Driven Hybrid Model in Tibet, China

Objective

The purpose of this study is to develop a novel data-driven hybrid model by fusing ensemble empirical mode decomposition (EEMD), seasonal autoregressive integrated moving average (SARIMA), with nonlinear autoregressive artificial neural network (NARNN), called EEMD-ARIMA-NARNN model, to assess and forecast the epidemic patterns of TB in Tibet.

Methods

The TB incidence from January 2006 to December 2017 was obtained, and then the time series was partitioned into training subsamples (from January 2006 to December 2016) and testing subsamples (from January to December 2017). Among them, the training set was used to develop the EEMD-SARIMA-NARNN combined model, whereas the testing set was used to validate the forecasting performance of the model. Whilst the forecasting accuracy level of this novel method was compared with the basic SARIMA model, basic NARNN model, error-trend-seasonal (ETS) model, and traditional SARIMA-NARNN mixture model.

Results

By comparing the accuracy level of the forecasting measurements including root-mean-square error, mean absolute deviation, mean error rate, mean absolute percentage error, and root-mean-square percentage error, it was shown that the EEMD-SARIMA-NARNN combined method produced lower error rates than the others. The descriptive statistics suggested that TB was a seasonal disease, peaking in late winter and early spring and a trough in autumn and early winter, and the TB epidemic indicated a drastic increase by a factor of 1.7 from 2006 to 2017 in Tibet, with average annual percentage change of 5.8 (95% confidence intervals: 3.5–8.1).

Conclusion

This novel data-driven hybrid method can better consider both linear and nonlinear components in the TB incidence than the others used in this study, which is of great help to estimate and forecast the future epidemic trends of TB in Tibet. Besides, under present trends, strict precautionary measures are required to reduce the spread of TB in Tibet.

Photocatalytic Oxidation of PLA/TiO2-Composite Films for Indoor Air Purification

Non-decomposable plastic has been replaced with polylactic acid, which is a biodegradable aliphatic polyester stationary phase, in composite films embedded with a TiO₂ photocatalyst for mitigation of indoor air pollution. PLA has superior properties relative to those of other biopolymers, such as a relatively high melting point, crystallinity, and rigidity. This study aimed to incorporate TiO₂-anatase into PLA for use as a photocatalyst using the blown film method. Photocatalytic oxidation, an advanced oxidative process, has been recognized as an economical technique providing convenience and efficiency with indoor air treatment. Therefore, the use of new environmentally friendly biodegradable polymers provides an alternative way to address the severe environmental concerns caused by non-decomposable plastics. UV-vis spectrophotometry and scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDX) were used to observe the dispersibility and mixing capacity of the TiO₂-anatase PLA matrix. TiO₂ dosages were 5, 10, and 15% (wt/wt), and they were incorporated with a twin-screw extruder. SEM-EDX images demonstrated the homogeneity of TiO₂ distribution in the PLA matrix. The energy band gaps of TiO₂ in the PLA/TiO₂-composite films were between 3.14 and 3.22 eV. The relationship between the photocatalytic oxidation rate and the TiO₂ dosage in the PLA/TiO₂-composite films was determined. A prototype reactor model is geared toward the development of air purifiers for indoor air conditioning. Rate constants for benzene degradation were obtained using first-order kinetics to find rate constants matching experimental findings. In the PLA/TiO₂-composite film, the TiO₂-anatase photocatalyst was able to degrade 5 ppm benzene. This work contributes to the use of ecoefficient photocatalytic oxidation.

A Scoping Review on Air Quality Monitoring, Policy and Health in West African Cities

Ambient air pollution is a global health threat that causes severe mortality and morbidity from respiratory, cardiovascular, and other diseases. Its impact is especially concerning in cities; as the urban population increases, especially in low- and middle-income countries, large populations risk suffering from these health effects. The Economic Community of West African States (ECOWAS) comprises 15 West African countries, in which many cities are currently experiencing fast growth and industrialization. However, government-led initiatives in air quality monitoring are scarce in ECOWAS countries, which makes it difficult to effectively control and regulate air quality and subsequent health issues. A scoping study was performed following the Arksey and O'Malley methodological framework in order to assess the precise status of air quality monitoring, related policy, and legislation in this region. Scientific databases and gray literature searches were conducted, and the results were contrasted through expert consultations. It was found that only two ECOWAS countries monitor air quality, and most countries have insufficient legislation in place. Public health surveillance data in relation to air quality data is largely unavailable. In order to address this, improved air quality surveillance, stricter and better-enforced regulations, regional cooperation, and further research are strongly suggested for ECOWAS.

An Opportunity to END TB: Using the Sustainable Development Goals for Action on Socio-Economic Determinants of TB in High Burden Countries in WHO South-East Asia and the Western Pacific Regions

The progress towards ending tuberculosis (TB) by 2035 is less than expected in 11 high TB burden countries in the World Health Organization South-East Asia and Western Pacific regions. Along with enhancing measures aimed at achieving universal access to quality-assured diagnosis, treatment and prevention services, massive efforts are needed to mitigate the prevalence of health-related risk factors, preferably through broader actions on the determinants of the "exposure-infection-disease-adverse outcome" spectrum. The aim of this manuscript is to describe the major socio-economic determinants of TB and to discuss how there are opportunities to address these determinants in an englobing manner under the United Nations Sustainable Development Goals (SDGs) framework. The national TB programs must identify stakeholders working on the other SDGs, develop mechanisms to collaborate with them and facilitate action on social-economic determinants in high TB burden geographical areas. Research (to determine the optimal mechanisms and impact of such collaborations) must be an integral part of this effort. We call upon stakeholders involved in achieving the SDGs and End TB targets to recognize that all goals are highly interlinked, and they need to combine and complement each other's efforts to end TB and the determinants behind this disease.