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dc.contributor.author | Wingfield, Tom | |
dc.contributor.author | Schumacher, Samuel G. | |
dc.contributor.author | Sandhu, Gurjinder | |
dc.contributor.author | Tovar, Marco A. | |
dc.contributor.author | Zevallos, Karine | |
dc.contributor.author | Baldwin, Matthew R. | |
dc.contributor.author | Montoya, Rosario | |
dc.contributor.author | Ramos, Eric S. | |
dc.contributor.author | Jongkaewwattana, Chulanee | |
dc.contributor.author | Lewis, James J. | |
dc.contributor.author | Gilman, Robert Hugh | |
dc.contributor.author | Friedland, Jon S. | |
dc.contributor.author | Evans, Carlton Anthony William | |
dc.date.accessioned | 2020-06-10T18:12:15Z | |
dc.date.available | 2020-06-10T18:12:15Z | |
dc.date.issued | 2014 | |
dc.identifier.uri | https://hdl.handle.net/20.500.12866/8069 | |
dc.description.abstract | 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. | en_US |
dc.language.iso | eng | |
dc.publisher | Oxford University Press | |
dc.relation.ispartofseries | Journal of Infectious Diseases | |
dc.rights | info:eu-repo/semantics/restrictedAccess | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es | |
dc.subject | Crowding | en_US |
dc.subject | Family Characteristics | en_US |
dc.subject | Sunlight | en_US |
dc.subject | Adult | en_US |
dc.subject | Cohort Studies | en_US |
dc.subject | crowding | en_US |
dc.subject | Female | en_US |
dc.subject | household | en_US |
dc.subject | Humans | en_US |
dc.subject | Incidence | en_US |
dc.subject | Interferon-gamma Release Tests | en_US |
dc.subject | Male | en_US |
dc.subject | Peru/epidemiology | en_US |
dc.subject | seasonality | en_US |
dc.subject | Seasons | en_US |
dc.subject | sunlight | en_US |
dc.subject | Tuberculin Test | en_US |
dc.subject | tuberculosis | en_US |
dc.subject | Tuberculosis/epidemiology | en_US |
dc.subject | vitamin D | en_US |
dc.subject | Vitamin D/blood | en_US |
dc.title | The seasonality of tuberculosis, sunlight, vitamin D, and household crowding | en_US |
dc.type | info:eu-repo/semantics/article | |
dc.identifier.doi | https://doi.org/10.1093/infdis/jiu121 | |
dc.subject.ocde | https://purl.org/pe-repo/ocde/ford#3.03.08 | |
dc.relation.issn | 1537-6613 |
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