Zürcher Kathrin, Zwahlen Marcel, Ballif Marie, Rieder Hans L, Egger Matthias, Fenner Lukas
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
PLoS One. 2016 Oct 5;11(10):e0162575. doi: 10.1371/journal.pone.0162575. eCollection 2016.
Tuberculosis (TB) mortality declined in the northern hemisphere over the last 200 years, but peaked during the Russian (1889) and the Spanish (1918) influenza pandemics. We studied the impact of these two pandemics on TB mortality.
We retrieved historic data from mortality registers for the city of Bern and countrywide for Switzerland. We used Poisson regression models to quantify the excess pulmonary TB (PTB) mortality attributable to influenza.
Yearly PTB mortality rates increased during both influenza pandemics. Monthly influenza and PTB mortality rates peaked during winter and early spring. In Bern, for an increase of 100 influenza deaths (per 100,000 population) monthly PTB mortality rates increased by a factor of 1.5 (95%Cl 1.4-1.6, p<0.001) during the Russian, and 3.6 (95%Cl 0.7-18.0, p = 0.13) during the Spanish pandemic. Nationally, the factor was 2.0 (95%Cl 1.8-2.2, p<0.001) and 1.5 (95%Cl 1.1-1.9, p = 0.004), respectively. We did not observe any excess cancer or extrapulmonary TB mortality (as a negative control) during the influenza pandemics.
We demonstrate excess PTB mortality during historic influenza pandemics in Switzerland, which supports a role for influenza vaccination in PTB patients in high TB incidence countries.
在过去200年里，北半球的结核病死亡率有所下降，但在俄罗斯（1889年）和西班牙（1918年）流感大流行期间达到峰值。我们研究了这两次大流行对结核病死亡率的影响。
我们从伯尔尼市和瑞士全国的死亡率登记册中检索了历史数据。我们使用泊松回归模型来量化流感导致的额外肺结核（PTB）死亡率。
在两次流感大流行期间，每年的PTB死亡率均有所上升。每月的流感和PTB死亡率在冬季和早春达到峰值。在伯尔尼，每月流感死亡人数增加100例（每10万人），在俄罗斯流感大流行期间，PTB死亡率增加1.5倍（95%置信区间1.4 - 1.6，p<0.001），在西班牙流感大流行期间增加3.6倍（95%置信区间0.7 - 18.0，p = 0.13）。在全国范围内，这一系数分别为2.0（95%置信区间1.8 - 2.2，p<0.001）和1.5（95%置信区间1.1 - 1.9，p = 0.004）。在流感大流行期间，我们未观察到任何额外的癌症或肺外结核死亡率（作为阴性对照）。
我们证明了瑞士历史上流感大流行期间存在额外的PTB死亡率，这支持了在结核病高发病率国家对PTB患者进行流感疫苗接种的作用。
