Association of influenza activity and environmental conditions with the risk of invasive pneumococcal disease

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creativework.keywords - en
Adult
Australia / epidemiology
Canada / epidemiology
Environment*
Female
Humans
Humidity
Influenza, Human / complications
Influenza, Human / epidemiology*
Male
Pneumococcal Infections / epidemiology
Pneumococcal Infections / etiology*
Risk Factors
Seasons
United States / epidemiology
dc.contributor.author
Berry, Isha
Tuite, Ashleigh R.
Salomon, Angela
Drews, Steven
Harris, Anthony D.
Hatchette, Todd
Johnson, Caroline
Kwong, Jeff
Lojo, Jose
McGeer, Allison
Mermel, Leonard
Ng, Victoria
Fisman, David N.
dc.date.accessioned
2024-06-28T20:30:15Z
dc.date.available
2024-06-28T20:30:15Z
dc.date.issued
2020-07-13
dc.description - en
The objective was to evaluate the short-term associations of influenza activity and environmental exposures with invasive pneumococcal disease (IPD) risk in temperate countries and to examine the generalizability of such associations across multiple jurisdictions. This case-crossover analysis of 19 566 individuals with IPD from 1998 to 2011 combined individual-level outcomes of IPD and population-level exposures. In adjusted models, increased influenza activity was associated with increases in IPD risk 2 weeks later. Increased humidity was associated with decreased IPD risk 1 week later. Other associations were heterogeneous; metaregression suggested that combinations of environmental factors might represent unique local risk signatures. For example, the heterogeneity in effects of UV radiation and humidity at a 2-week lag was partially explained by variation in temperature. In this study, influenza was associated with increased IPD risk in temperate countries. This association was not explained by coseasonality or case characteristics and appears generalizable. Absolute humidity was associated with decreased IPD risk in the same jurisdictions. The generalizable nature of these associations has important implications for influenza control and advances the understanding of the seasonality of this important disease.
dc.description.abstract - en
IMPORTANCE: Streptococcus pneumoniae is the most commonly identified cause of bacterial pneumonia, and invasive pneumococcal disease (IPD) has a high case fatality rate. The wintertime coseasonality of influenza and IPD in temperate countries has suggested that pathogen-pathogen interaction or environmental conditions may contribute to IPD risk. OBJECTIVES: To evaluate the short-term associations of influenza activity and environmental exposures with IPD risk in temperate countries and to examine the generalizability of such associations across multiple jurisdictions. DESIGN, SETTING, AND PARTICIPANTS: This case-crossover analysis of 19 566 individuals with IPD from 1998 to 2011 combined individual-level outcomes of IPD and population-level exposures. Participants lived in 12 jurisdictions in Canada (the province of Alberta and cities of Toronto, Vancouver, and Halifax), Australia (Perth, Sydney, Adelaide, Brisbane, and Melbourne), and the United States (Baltimore, Providence, and Philadelphia). Data were analyzed in 2019. EXPOSURES: Influenza activity, mean temperature, absolute humidity, and UV radiation at delays of 1 to 3 weeks before case occurrence in each jurisdiction. MAIN OUTCOMES AND MEASURES: Matched odds ratios (ORs) for IPD associated with changes in exposure variables, estimated using multivariable conditional logistic regression models. Heterogeneity in effects across jurisdictions were evaluated using random-effects meta-analytic models. RESULTS: This study included 19 566 patients: 9629 from Australia (mean [SD] age, 42.8 [30.8] years; 5280 [54.8%] men), 8522 from Canada (only case date reported), and 1415 from the United States (only case date reported). In adjusted models, increased influenza activity was associated with increases in IPD risk 2 weeks later (adjusted OR [aOR] per SD increase, 1.07; 95% CI, 1.01-1.13). Increased humidity was associated with decreased IPD risk 1 week later (aOR per 1 g/m3, 0.98; 95% CI, 0.96-1.00). Other associations were heterogeneous; metaregression suggested that combinations of environmental factors might represent unique local risk signatures. For example, the heterogeneity in effects of UV radiation and humidity at a 2-week lag was partially explained by variation in temperature (UV index: coefficient, 0.0261; 95% CI, 0.0078 to 0.0444; absolute humidity: coefficient, −0.0077; 95% CI, −0.0125 to −0.0030). CONCLUSIONS AND RELEVANCE: In this study, influenza was associated with increased IPD risk in temperate countries. This association was not explained by coseasonality or case characteristics and appears generalizable. Absolute humidity was associated with decreased IPD risk in the same jurisdictions. The generalizable nature of these associations has important implications for influenza control and advances the understanding of the seasonality of this important disease.
dc.identifier.doi
https://doi.org/10.1001/jamanetworkopen.2020.10167
dc.identifier.issn
2574-3805
dc.identifier.pubmedID
32658286
dc.identifier.uri
https://open-science.canada.ca/handle/123456789/2645
dc.language.iso
en
dc.publisher
JAMA Network Open
dc.rights - en
Creative Commons Attribution 4.0 International (CC BY 4.0)
dc.rights - fr
Creative Commons Attribution 4.0 International (CC BY 4.0)
dc.rights.openaccesslevel - en
Gold
dc.rights.openaccesslevel - fr
Or
dc.rights.uri - en
https://creativecommons.org/licenses/by/4.0/
dc.rights.uri - fr
https://creativecommons.org/licenses/by/4.0/deed.fr
dc.subject - en
Health
dc.subject - fr
Santé
dc.subject.en - en
Health
dc.subject.fr - fr
Santé
dc.title - en
Association of influenza activity and environmental conditions with the risk of invasive pneumococcal disease
dc.type - en
Article
dc.type - fr
Article
local.acceptedmanuscript.articlenum
e2010167
local.article.journalissue
7
local.article.journaltitle
JAMA Network Open
local.article.journalvolume
3
local.peerreview - en
Yes
local.peerreview - fr
Oui
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