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The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding
Background. Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. Methods. Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tubercu...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130318/ https://www.ncbi.nlm.nih.gov/pubmed/24596279 http://dx.doi.org/10.1093/infdis/jiu121 |
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author | Wingfield, Tom Schumacher, Samuel G. Sandhu, Gurjinder Tovar, Marco A. Zevallos, Karine Baldwin, Matthew R. Montoya, Rosario Ramos, Eric S. Jongkaewwattana, Chulanee Lewis, James J. Gilman, Robert H. Friedland, Jon S. Evans, Carlton A. |
author_facet | Wingfield, Tom Schumacher, Samuel G. Sandhu, Gurjinder Tovar, Marco A. Zevallos, Karine Baldwin, Matthew R. Montoya, Rosario Ramos, Eric S. Jongkaewwattana, Chulanee Lewis, James J. Gilman, Robert H. Friedland, Jon S. Evans, Carlton A. |
author_sort | Wingfield, Tom |
collection | PubMed |
description | Background. Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. Methods. Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tuberculosis-exposed cohabitants were tested for tuberculosis infection with the tuberculin skin test (n = 1389) and QuantiFERON assay (n = 576) and vitamin D concentrations (n = 195) quantified from randomly selected cohabitants. Crowding was calculated for all tuberculosis-affected households and daily sunlight records obtained. Results. Fifty-seven percent of vitamin D measurements revealed deficiency (<50 nmol/L). Risk of deficiency was increased 2.0-fold by female sex (P < .001) and 1.4-fold by winter (P < .05). During the weeks following peak crowding and trough sunlight, there was a midwinter peak in vitamin D deficiency (P < .02). Peak vitamin D deficiency was followed 6 weeks later by a late-winter peak in tuberculin skin test positivity and 12 weeks after that by an early-summer peak in QuantiFERON positivity (both P < .04). Twelve weeks after peak QuantiFERON positivity, there was a midsummer peak in tuberculosis symptom onset (P < .05) followed after 3 weeks by a late-summer peak in tuberculosis diagnoses (P < .001). Conclusions. The intervals from midwinter peak crowding and trough sunlight to sequential peaks in vitamin D deficiency, tuberculosis infection, symptom onset, and diagnosis may explain the enigmatic late-summer peak in tuberculosis. |
format | Online Article Text |
id | pubmed-4130318 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-41303182014-08-18 The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding Wingfield, Tom Schumacher, Samuel G. Sandhu, Gurjinder Tovar, Marco A. Zevallos, Karine Baldwin, Matthew R. Montoya, Rosario Ramos, Eric S. Jongkaewwattana, Chulanee Lewis, James J. Gilman, Robert H. Friedland, Jon S. Evans, Carlton A. J Infect Dis Major Articles and Brief Reports Background. Unlike other respiratory infections, tuberculosis diagnoses increase in summer. We performed an ecological analysis of this paradoxical seasonality in a Peruvian shantytown over 4 years. Methods. Tuberculosis symptom-onset and diagnosis dates were recorded for 852 patients. Their tuberculosis-exposed cohabitants were tested for tuberculosis infection with the tuberculin skin test (n = 1389) and QuantiFERON assay (n = 576) and vitamin D concentrations (n = 195) quantified from randomly selected cohabitants. Crowding was calculated for all tuberculosis-affected households and daily sunlight records obtained. Results. Fifty-seven percent of vitamin D measurements revealed deficiency (<50 nmol/L). Risk of deficiency was increased 2.0-fold by female sex (P < .001) and 1.4-fold by winter (P < .05). During the weeks following peak crowding and trough sunlight, there was a midwinter peak in vitamin D deficiency (P < .02). Peak vitamin D deficiency was followed 6 weeks later by a late-winter peak in tuberculin skin test positivity and 12 weeks after that by an early-summer peak in QuantiFERON positivity (both P < .04). Twelve weeks after peak QuantiFERON positivity, there was a midsummer peak in tuberculosis symptom onset (P < .05) followed after 3 weeks by a late-summer peak in tuberculosis diagnoses (P < .001). Conclusions. The intervals from midwinter peak crowding and trough sunlight to sequential peaks in vitamin D deficiency, tuberculosis infection, symptom onset, and diagnosis may explain the enigmatic late-summer peak in tuberculosis. Oxford University Press 2014-09-01 2014-03-04 /pmc/articles/PMC4130318/ /pubmed/24596279 http://dx.doi.org/10.1093/infdis/jiu121 Text en © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Major Articles and Brief Reports Wingfield, Tom Schumacher, Samuel G. Sandhu, Gurjinder Tovar, Marco A. Zevallos, Karine Baldwin, Matthew R. Montoya, Rosario Ramos, Eric S. Jongkaewwattana, Chulanee Lewis, James J. Gilman, Robert H. Friedland, Jon S. Evans, Carlton A. The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title | The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title_full | The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title_fullStr | The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title_full_unstemmed | The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title_short | The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding |
title_sort | seasonality of tuberculosis, sunlight, vitamin d, and household crowding |
topic | Major Articles and Brief Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130318/ https://www.ncbi.nlm.nih.gov/pubmed/24596279 http://dx.doi.org/10.1093/infdis/jiu121 |
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