Serum vitamin D levels and risk of prevalent tuberculosis, incident tuberculosis and tuberculin skin test conversion among prisoners

Abstract

Poor vitamin D status has been associated with tuberculosis (TB); whether poor status is cause or consequence of disease is uncertain. We conducted a case-control study and two nested case-control studies to determine whether vitamin D levels were associated with active TB, tuberculin skin test (TST) conversion, and risk of progression to the active TB in prisoners in Brazil. In multivariable conditional logistic regression, subnormal vitamin D levels (OR, 3.77; 95% CI, 1.04-13.64) were more likely in prisoners with active TB. In contrast, vitamin D was not found to be a risk factor for either TST conversion ( Tuberculosis (TB) is a major global public health problem, causing approximately 1.4 million deaths annually 1 . The World Health Organization estimates that one-third of the world's population has latent TB 1 , of which approximately 10% will develop active disease 2 . Understanding which individuals will progress to TB and which will maintain lifelong immune control or achieve clearance, remains an important scientific question with substantial public health implications. This high-risk group also provides the opportunity to examine host factors that currently lack complete understanding in the disease pathway for active TB.One of the prominent host factors that has been implicated in TB risk is vitamin D levels 3 . Nutritional deficiency, low exposure to sunlight due to spending only short periods of time outdoors, and seasonal changes resulting in reduced ultraviolet radiation type B (UVB) may be associated with subnormal vitamin D levels 4 . Vitamin D levels of <30 ng/ml, which are characterized clinically as either insufficient (29-20 ng/ml) or deficient (<20 ng/ml). Vitamin D is composed of a group of secosteroid molecules that are predominantly synthesized

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil

“…A key question is whether the prison environment is the primary driver of TB risk or whether high TB rates in prisons are primarily a consequence of a population with preexisting high-risk attributes (e.g., HIV, substance abuse). The marked increase in TB risk that occurs upon incarceration, along with the decline in incidence following release, implicates the prison environment in driving disease in the population, whether it is due to transmission or acquired host factors (e.g., malnutrition, vitamin D deficiency) in the prison [31]. The observed peak of active TB incidence at 5 years and subsequent decline is consistent with an extremely high annual risk of infection occurring among a highly susceptible population, such that the majority of inmates would be exposed within 3–4 years.…”

Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis

“…In the updated search during peer review, we identified one additional eligible study published between January 1, 2018, and June 8, 2019, that had not been included in the IPD meta-analysis [39]. Details are provided as supporting information (S3 Fig, S3 Table).…”

“…In the one publication we identified that appeared after the target dates for the IPD meta-analysis, Maceda and colleagues [39] reported on a nested case-control study of 72 male prisoners in Brazil. Mean 25–(OH)D levels did not differ significantly among cases (92.5 ± 37.0 nmol/L) and controls (93.8 ± 27.5 nmol/L), and there was no association between serum 25–(OH)D < 75 nmol/L and risk of incident TB disease during 1 year of follow-up (aOR 0.59; 95% CI 0.13–2.62) (S3 Table).…”

Migrants rescued on the Mediterranean Sea route: nutritional, psychological status and infectious disease control

“…In fact, an increasing body of evidence has shown that vitamin D plays a key role in modulating the immune response to infections; vitamin D deficiency increases the risk for susceptibility to several common infectious diseases (like pneumonia, tuberculosis, influenza, and others) and to depression [37][38][39][40]. Moreover, if results of serological screening for HIV showed that there were no subjects suffering from secondary immunodepression, on the other hand screening for viral liver diseases showed that a proportion of the patients were suffering from hepatitis B requiring counseling and treatment.…”