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Epidemic influenza and vitamin D

Published online by Cambridge University Press:  07 September 2006

J. J. CANNELL
Affiliation:
Atascadero State Hospital, 10333 El Camino Real, Atascadero, CA, USA
R. VIETH
Affiliation:
Mount Sinai Hospital, Pathology and Laboratory Medicine, Department of Medicine, Toronto, Ontario, Canada
J. C. UMHAU
Affiliation:
Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
M. F. HOLICK
Affiliation:
Departments of Medicine and Physiology, Boston University School of Medicine, Boston, MA, USA
W. B. GRANT
Affiliation:
SUNARC, San Francisco, CA, USA
S. MADRONICH
Affiliation:
Atmospheric Chemistry Division, National Center for Atmospheric Research, Boulder, CO, USA
C. F. GARLAND
Affiliation:
Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
E. GIOVANNUCCI
Affiliation:
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Abstract

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In 1981, R. Edgar Hope-Simpson proposed that a ‘seasonal stimulus’ intimately associated with solar radiation explained the remarkable seasonality of epidemic influenza. Solar radiation triggers robust seasonal vitamin D production in the skin; vitamin D deficiency is common in the winter, and activated vitamin D, 1,25(OH)2D, a steroid hormone, has profound effects on human immunity. 1,25(OH)2D acts as an immune system modulator, preventing excessive expression of inflammatory cytokines and increasing the ‘oxidative burst’ potential of macrophages. Perhaps most importantly, it dramatically stimulates the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection. Volunteers inoculated with live attenuated influenza virus are more likely to develop fever and serological evidence of an immune response in the winter. Vitamin D deficiency predisposes children to respiratory infections. Ultraviolet radiation (either from artificial sources or from sunlight) reduces the incidence of viral respiratory infections, as does cod liver oil (which contains vitamin D). An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's ‘seasonal stimulus’.

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2006 Cambridge University Press
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