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The seasonality of tuberculosis, sunlight, vitamin D, and household crowding

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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 H.
dc.contributor.author Friedland, Jon S.
dc.contributor.author Evans, Carlton A.
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.ispartof urn:issn:1537-6613
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#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08


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