HIV infection, seasonality and younger age predicting incident Bell’s palsy among black South Africans

Abstract

Background Although South Africa (SA) is facing a high prevalence of HIV infection, there is no literature from this region on a link between Bell’s palsy and HIV. The aim of this study was to identify the occurrence of Bell’s palsy in relation to demographics, seasons and HIV status among black South Africans. Methods This retrospective cohort was conducted among adult black patients, without Bell’s palsy in 2003, presenting to the neurology outpatients department at Dr. George Mukhari Academic hospital, Pretoria, South Africa, between 2004 (study baseline) and 2012 (end test). Gender, age, HIV status, and seasons were potential predictors of Bell’s palsy using Cox regression model and Kaplan Meier curves. Results From the baseline of 1487 patients, 20.9% (n = 311) experienced Bell’s palsy onset by the end of the study. In univariate analysis, male gender (RR = 2.1 95% CI 1.7–2.5; P < 0.0001), age less than 30 years (RR = 2.9 95% CI 2.4–3.6; P < 0.0001), HIV seropositivity (RR =2.9 95% CI 2.3–4.9; P < 0.0001). The highest incidence in winter (30.3% n = 136/450) vs. incidences during other seasons with Intermediate values during Summer (25.3% n = 136/450) and Autumn (20.7% n = 64/308) and the lowest incidence in Spring (23.7% n = 16/353) P < 0.0001) were predictors of Bell’s palsy. In multivariate analysis at adjusting for gender, the most significant and independent predictors of incident Bell’s palsy were HIV seropositivity (HR = 6.3 95% CI 4.8–8.3; P < 0.0001), winter (HR = 1.6 95% CI 1.2–2.1; P < 0.0001) vs. other seasons, and younger age < 30 years (HR = 7.1 95% CI 5.6–9.1; P < 0.0001) vs. older age groups. Conclusion Seasonality, younger age and HIV positivity are important and independent risk factors of Bell’s palsy. Education and awareness programs on the possible effects of HIV and seasons on the development of Bell’s palsy are necessary. This would lead to a better understanding and even a possible development of avoidance measures for this condition amongst young black South Africans.

Monthly and seasonal variations in vestibular neuritis

“…There have been several studies on the seasonality of Bell palsy and SSNHL. Studies have revealed that Bell palsy was significantly higher during the cold season, [ 17 , 21 , 22 ] although other studies have shown unclear association between Bell palsy and seasons. [ 16 , 23 ] One study revealed that the incidence of SSNHL peaked in autumn, [ 18 ] but most other studies showed nonsignificant distributions for seasons.…”

Association of Influenza Vaccination With Risk of Bell Palsy Among Older Adults in Taiwan

“…In Taiwan, the fluVc is only administered for a short period each year, especially from October to December, middle autumn to early winter . It may take bias when using SCCS if the incidence of BP varies with different seasons, which is a concern because previous studies have examined the association between seasonal variation and the onset of BP . Fortunately, the present findings indicated that seasonality did not affect BP incidence in this SCCS.…”

“…6,7,9 It may take bias when using SCCS if the incidence of BP varies with different seasons, which is a concern because previous studies have examined the association between seasonal variation and the onset of BP. 22,[44][45][46][47] Fortunately, the present findings indicated that seasonality did not affect BP incidence in this SCCS. The diagnosis of BP is made after various conditions that mimic BP have been excluded.…”

Monthly Variation in Bell’s Palsy Based on Population Data of Korea

“…In a study with 591 patients in Germany, the numbers of patients with Bell's palsy were significantly different according to month, with the highest noted in December and the lowest in July [11]. In a study of 311 black patients with Bell's palsy in South Africa, winter was a significant predictor of Bell's palsy [14].…”