期刊
JOURNAL OF INFECTIOUS DISEASES
卷 210, 期 5, 页码 774-783出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiu121
关键词
crowding; household; seasonality; sunlight; tuberculosis; vitamin D
资金
- Wellcome Trust
- charity Innovation For Health and Development (IFHAD)
- Imperial College Biomedical Research Centre
- British Infection Association
- Global Health Trials consortium (Medical Research Council)
- Global Health Trials consortium (Department for International Development)
- Global Health Trials consortium (Wellcome Trust)
- World Health Organization
- Sir Halley Stewart Trust
- Foundation for Innovative New Diagnostics
- Bill & Melinda Gates Foundation
- Medical Research Council [MR/K012126/1, MR/K007467/1] Funding Source: researchfish
- MRC [MR/K007467/1] Funding Source: UKRI
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.
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