The delayed effect of wildfire season particulate matter on subsequent influenza season in a mountain west region of the USA

Particularly in rural settings, there has been little research regarding the health impacts of fine particulate matter (PM_2.5) during the wildfire season smoke exposure period on respiratory diseases, such as influenza, and their associated outbreaks months later. We examined the delayed effects of PM_2.5 concentrations for the short-lag (1-4 weeks prior) and the long-lag (during the prior wildfire season months) on the following winter influenza season in Montana, a mountainous state in the western United States. We created gridded maps of surface PM_2.5 for the state of Montana from 2009 to 2018 using spatial regression models fit with station observations and Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol optical thickness data. We used a seasonal quasi-Poisson model with generalized estimating equations to estimate weekly, county-specific, influenza counts for Montana, associated with delayed PM_2.5 concentration periods (short-lag and long-lag effects), adjusted for temperature and seasonal trend. We did not detect an acute, short-lag PM_2.5 effect nor short-lag temperature effect on influenza in Montana. Higher daily average PM_2.5 concentrations during the wildfire season was positively associated with increased influenza in the following winter influenza season (expected 16% or 22% increase in influenza rate per 1 μg/m³ increase in average daily summer PM_2.5 based on two analyses, p = 0.04 or 0.008). This is one of the first observations of a relationship between PM_2.5 during wildfire season and influenza months later.