Sleep and immune response in the context of the COVID-19 pandemic
Keywords:
sleep, immune system, sleep deprivation.Abstract
Introduction: A close relationship exists between the immune system and sleep.
Objective: Present elements showing the relationship between the immune system and the sleep process.
Methods: A bibliographic review was conducted in online databases related to sleep alterations and the immune status. The publications selected were original papers about prospective or retrospective studies and review papers. The period analyzed covered 46 years: from 1974 to 2020.
Data analysis and integration: The immune system and sleep are circadian processes governed by the suprachiasmatic nucleus of the hypothalamus which interact with one another modifying their mutual functions. Numerous studies agree that normal sleep enhances immune defenses, whereas sleep deprivation tends to lower them. During the COVID-19 pandemic, lifestyle changes have been described which include a reduction in the number of sleep hours, which may negatively impact an adequate immune response in the current context.
Conclusions: Regulation of the immune system and the sleep/wake cycle share a common circadian rhythm. A number of factors leading to sleep deprivation expose individuals to displaying unfavorable immune responses. Changes in our habits and customs caused by the current COVID-19 pandemic situation have led to the appearance of various sleep alterations in the population which may have a negative impact on our immune response.
Downloads
References
Sudhansu C. Medicina de los Trastornos del Sueño. Aspectos básicos, consideraciones técnicas y aplicaciones clínicas [Internet]. España: Elsevier; 2011. [citado 19 Mar 2020]. Disponible en: https://www.sciencedirect.com/book/9788480867337/medicina-de-los-trastornos-del-sueno#book-info
Irwin MR. Sleep and infectious disease risk. Sleep [Internet]. 2012[citado 19 Mar 2020]; 35(8):1025-1026. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397805/
Hobson JA. Dreaming: An introduction to the science of sleep. EE. UU.: Oxford University Press; 2002.
Irwin MR. Why sleep is important for health: A psychoneuroimmunology perspective. Annu Rev Psychol[Internet]. 2015[citado 19 Mar 2020]; 66:143-172. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25061767/
Rico-Rosillo MG, Vega-Robledo GB. Sueño y sistema inmune. Rev Alerg Mex[Internet]. 2018[citado 22 Mar 2020]; 65(2):160-170. Disponible en: https://www.revistaalergia.mx/ojs/index.php/ram/article/view/359/866
Toraldo DM, De Nuccio F, De Benedetto M, Scoditti E. Obstructive sleep apnoea syndrome: a new paradigm by chronic nocturnal intermittent hypoxia and sleepdisruption. Acta Otorhinolaryngol Ital [Internet] 2015[citado 22 Mar 2020]; 35(2): 69–74. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26019388/
Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath [Internet] 2016[citado 22 Mar 2020]; 20(2):457-65. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26169715/
Colla-Machado PE, Luzzi AA, Balian NR, Pigretti SG, Zurrú-Ganen MC, Cristiano E, Valiensi SM. Prevalence of silent cerebrovascular lesions in patients with obstructive sleep apnea syndrome. Rev Neurol[Internet] 2016[citado 26 Mar 2020];62(3):113-117.Disponible en: https://pubmed.ncbi.nlm.nih.gov/26815848/
Marquez-Romero JM, Morales-Ramírez M, Arauz A. Non-breathing-related sleep disorders following stroke. Neurologia [Internet] 2014[citado 26 Mar 2020]; 29(9): 511-516. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23810485/
Julia Santín M. Sueño y Epilepsia. Rev Med Clin Condes [Internet] 2013[citado 4 Abr 2020]; 24(3): 480-485. Disponible en: https://www.elsevier.es/es-revista-revista-medica-clinica-las-condes-202-articulo-sueno-epilepsia-S0716864013701846
Justa Elizabeth GN, Alfonso-Alfonso M, Grass-Fernández D, Morales-Chacón LM, Pedroso-Ibáñez I, Ricardo-de la Fe Y, et al. Analysis of Sleep Macrostructure in Patients Diagnosed with Parkinson’s Disease. Behav Sci[Internet] 2019[citado 4 Abr 2020]; 9(1):6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30625988/
Salvador J, Iriarte J, Silva C, Gómez Ambrosi J, Díez Caballero A, Frühbeck G. The obstructive sleep apnoea syndrome in obesity: a conspirator in the shadow. Rev Med Univ Navarra [Internet] 2004. [citado 4 Abr 2020]; 48(2):55-62. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15382614/
Chen XF, Zhang Y, Xu X, Wang W, Yan H, Li Sh, et al. Mediating effects of anxiety, self-efficacy and sleep quality on the relationship between doctor-patient’s empathy and inflammatory marker in patients with ulcerative colitis. Med Sci Monit[Internet].2019[citado 10 Abr 2020]; 25: 7889–7897. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31634896/
Zhang W, Xu H, Zhao S, Yin S, Wang X, Guo J, et.al. Prevalence and influencing factors of co-morbid depression in patients with type 2 diabetes mellitus: A general hospital based study. Diabetol Metab Syndr[Internet]. 2015[citado 10 Abr 2020]; 7: 60. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26167205/
Terris M. Violencia en una sociedad violenta. Rev Fac Nac Sal Públ[Internet]. 2006[citado 10 Abr 2020]; 17(1):37-51.Disponible en: https://revistas.udea.edu.co/index.php/fnsp/article/view/13394/11982
Xiao H. Zhang Y,Kong D,Li Sh, Yang N. Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China.Med Sci Monit[Internet].2020[citado 13 Abr 2020]; 26: e923921. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7111105/
Xiao H. et al. Medical staff treating COVID-19 © Med Sci Monit, 2020; 26: e923549
Zhang Ch, Yang L, Liu Sh, Ma S, Wang Y, Cai Zh, et al. Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front Psychiatry [Internet].2020[citado 13 Abr 2020]; 11:306. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171048/
Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci[Internet].2010[citado 13 Abr 2020];11(2):114-126. Disponible en: https://www.nature.com/articles/nrn2762
Michael R Irwin, Mark R Opp. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology[Internet].2017[citado 13 Abr 2020];42(1):129–155. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27510422/
Obal F Jr, Krueger JM. Biochemical regulation of non-rapid-eye-movement sleep. Frontiers Biosci[Internet]. 2003[citado 16 Abr 2020]; 8(4):520-550. Disponible en: https://fbscience.com/Landmark/articles/10.2741/1033
Del Gallo F, Opp MR, Imeri L. The reciprocal link between sleep and immune responses. Arch Ital Biol[Internet]. 2014[citado 16 Abr 2020]; 152(2-3):93-102. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25828681/
Shneider A, Kudriavtsev A, Vakhrusheva A. Can melatonin reduce the severity of COVID-19 pandemic? Int Rev Immunol[Internet].2020[citado 16 Abr 2020]; 39(4):153-162. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32347747/
María Antonia RR, Aniso LL. Cronobiología del sistema inmune. Revista Cubana Hematol Inmunol Hemoter[Internet]. 2016[citado 16 Abr 2020];32(3):316-324.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955790/
Rockstrom MD, Chen L, Taishi P, Nguyen JT, Gibbons CM, Veasey SC, et al. Tumor necrosis factor alpha in sleep regulation. Sleep Rev Med [Internet].2018 [citado 19 Abr 2020];40:69-78. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1087079217301478?via%3Dihub
Kapsimalis F, Richardson G, Opp MR, Kryger M. Cytokines and normal sleep. Curr Opin Pulm Med[Internet]. 2005[citado 19 Abr 2020]; 11(6):481-484. Disponible en: https://pubmed.ncbi.nlm.nih.gov/16217172/
Imeri L, Opp MR. How (and why) the immune system makes us sleep. Nat Rev Neurosci[Internet]. 2009[citado 19 Abr 2020]; 10(3):199-210.
Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839418/
Obal F Jr, Krueger JM. Biochemical regulation of non-rapid-eye movement sleep. Front Biosci[Internet]. 2003[citado 19 Abr 2020]; 8:520-550.Disponible en: https://fbscience.com/Landmark/articles/10.2741/1033
Raison ChL, Rye DB, Woolwine BJ, Vogt GJ, Bautista BM, Spivey JR, et al. Chronic interferon-alpha administration disrupts sleep continuity and depth in patients with hepatitis C: association with fatigue, motor slowing, and increased evening cortisol. Biol Psychiatry[Internet]. 2010[citado 19 Abr 2020]; 68(10):942-949. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20537611/
Manfridi A, Brambilla D, Bianchi S, Mariotti M, Opp MR, Imeri L. Interleukin-1b enhances non-rapid eye movement sleep when microinjected into the dorsal raphe nucleus and inhibits serotonergic neurons in vitro. Eur J Neurosci[Internet]. 2003[citado 19 Abr 2020]; 18(5):1041-1049. Disponible en: https://pubmed.ncbi.nlm.nih.gov/12956704/
Morrow JD, Opp MR. Sleep-wake behavior and responses of interleukin-6 deficient mice to sleep deprivation. Brain Behav Immun [Internet].2005[citado 19 Abr 2020]; 19(1):28-39. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15581736/
O'Neill JS, Reddy AB. Circadian clocks in human red blood cells. Nature[Internet].2011[citado 19 Abr 2020]; 469:498-503. Disponible en: https://www.nature.com/articles/nature09702
Mendez-Ferrer S, Lucas D, Battista M, Frenette PS. Haematopoietic stem cell release is regulated by circadian oscillations. Nature[Internet].2008[citado 23 Abr 2020];452:442-447. Disponible en: https://www.nature.com/articles/nature06685
Lucas D, Battista M, Shi PA, Isola L, Frenette PS. Mobilized hematopoietic stem cell yield depends on species-specific circadian timing. Cell Stem Cell [Internet]. 2008[citado 23 Abr 2020]; 3(4):364-366.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089094/
Cho H, Zhao X, Hatori M, Yu RT, Barish GD, Lam MT, et al. Regulationof circadian behaviour and metabolism by REV-ERB-alpha and REVERB-beta. Nature [Internet].2012 [citado 23 Abr 2020]; 485(7396):123-127. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367514/
Moldofsky H, Lue FA, Eisen J, Keystone E,GorczYnski RM. The relationship of interleukin-1 and immune functions to sleep in humans. Psychosom Med[Internet]. 1986[citado 23 Abr 2020]; 48(5):309-318.Disponible en: https://pubmed.ncbi.nlm.nih.gov/3487810/
Darko DF, Miller JC, Gallen C, White J, Koziol J, Brow SJ, et al. Sleep electroencephalogram delta frequency amplitude, night plasma levels of tumor necrosis factor α and human immunodeficiency virus infection. Proc Natl Acad Sci USA[Internet]. 1995[citado 23 Abr 2020]; 92(26):12080-12084.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40300/
Pabst MJ, Beranova S, Krueger JM. Effects of muramyl peptides on macrophages, monokines and sleep. Neuroimmunomodulation[Internet].1999[citado 23 Abr 2020]; 6:261-283. Diponible en: https://www.karger.com/Article/Abstract/26384
Prather AA. Better together: Sleep, circadian genes, and immunity. Brain Behavior and Immunity[Internet].2020[citado 23 Abr 2020];87:202-202. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S088915912030475X?via%3Dihub
Palmblad J, Petrini B, Wasserman J, Åkerstedt, T. Lymphocyte and granulocyte reactions during sleep deprivation. Psychosom Med [Internet]. 1979[citado 23 Abr 2020]; 41(4):273-278. Disponible en: https://pubmed.ncbi.nlm.nih.gov/482523/
Benca RM, Kushida CA, Everson CA, Kalski R, Berfmann BM, Rechtschaffenc A. Sleep deprivation in the rat: VII. Immune function. Sleep[Internet]. 1989[citado 27 Abr 2020]; 12(1):47-52.Dsiponible en: https://academic.oup.com/sleep/article/12/1/47/2742646
Dinges DF, Douglas SD, Zaugg L,Campbell DE, McMann JM, Whitehosuse WG, et al. Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivation. J Clin Invest[Internet].1994[citado 27 Abr 2020]; 93(5):1930- 1939.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC294300/
Born J, Lange T, Hansen K, Mölle M, FehmHL. Effects of sleep and circadian rhythm on human circulating immune cells. J Immunol[Internet]. 1997[citado 27 Abr 2020]; 158(9):4454-4464. Disponible en: https://pubmed.ncbi.nlm.nih.gov/9127011/
Moldofsky H, Lue FA, Davidson J, et al. Comparison of sleepwake circadian immune functions in women vs men. Sleep Res 1989;18:431.
Westermann J, Lange T, Textor J,Born J . System Consolidation during Sleep--A Common Principle Underlying Psychological and Immunological Memory Formation. Trends Neurosci[Internet].2015[citado 30 Abr 2020]; 38(10):585-597.Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0166223615001745?via%3Dihub
Spiegel K, Sheridan JF, Van-Cauter E. Effect of sleep deprivation on response to immunization. JAMA [Internet]. 2002[citado 30 Abr 2020]; 288(12):1471-1472. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/1032061
Straub RH, Cutolo M, Buttgereit F, Pongratz G. Energy regulation and neuroendocrine-immune control in chronic inflammatory diseases. J Inter Med[Internet]. 2010[citado 30 Abr 2020]; 267(6):543-560. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2010.02218.x
Mills P, Kim JH, Bardwell W, Hong S, Dimsdale JE. Predictors of fatigue in obstructive sleep apnea. Sleep Breath[Internet]. 2008[citado 30 Abr 2020]; 12(4):397-399.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633300/
Cavadini G, Petrzilka S, Kohler P, Jud C, Tobler I, Birchler Th. TNF-alpha suppresses the expression of clock genes by interfering with E-box-mediated transcription. Proc Natl Acad Sci USA[Internet].2007[citado 30 Abr 2020];104(31):12843-12848. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1937554/
Prather, AA, Janicki-Deverts, D, Hall MH, Cohen S. Behaviorally assessed sleep and susceptibility to the common cold. Sleep[Internet]. 2015 [citado 30 Abr 2020]; 38 (9), 1353–1359. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531403/
Patel, S.R., Malhotra, A., Gao, X., Hu, F.B., Neuman, M.I., Fawzi, W.W. A prospective study of sleep duration and pneumonia risk in women. Sleep[Internet]. 2015[citado 2 May 2020]; 35(1):97–101.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242694/
Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med[Internet]. 2006[citado 2 May 2020]; 166(16): 1756-1762. Disponible en: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410868
Prather AA, Leung, CW. Association of insufficient sleep with respiratory infection among adults in the United States. JAMA Intern Med [Internet]. 2016[citado 2 May 2020]; 176(6):850–852. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899278/
Bollinger T, Bollinger A, Skrum L, Dimitrov S, Lange T, Solbach W. Sleep-dependent activity of T cells and regulatory T cells. Clin Exp Immunol[Internet]. 2009[citado 4 May 2020]; 155(2):231-238. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675254/
Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch[Internet].2012[citado 4 May 2020];463(1):121-137. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/
Toth LA, Opp MR, Mao L. Somnogenic effects of sleep deprivation and Escherichia coli inoculation in rabbits. J Sleep Res[Internet]. 1995[citado 4 May 2020]; 4(1): 30-40. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2869.1995.tb00148.x
Brown R, Pang G, Husband AJ, King MG. Suppression of immunity to influenza virus infection in the respiratory tract following sleep disturbance. Reg Immunol. 1989; 2(5):321-325.
Renegar KB, Floyd RA, Krueger JM. Effects of short-term sleep deprivation on murine immunity to influenza virus in young adult and senescent mice. Sleep[Internet]. 1998[citado 7 May 2020]; 21(3):241-248.Disponible en: https://academic.oup.com/sleep/article/21/3/241/2731636
Lange T, Perras B, Fehm HL, Born J. Sleep enhances the human antibody response to hepatitis A vaccination. Psychosom Med[Internet]. 2003[citado 7 May 2020]; 65:831-835.Disponible en: https://pubmed.ncbi.nlm.nih.gov/14508028/
Everson CA, Toth LA. Systemic bacterial invasion induced by sleep deprivation. Am J Physiol Regul Integr Comp Physiol[Internet]. 2000[citado 7 May 2020]; 278(4):905-916. Disponible en: https://journals.physiology.org/doi/full/10.1152/ajpregu.2000.278.4.R905?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
Landis C, Pollack S, Helton WS. Microbial translocation and NK cell cytotoxicity in female rats sleep deprived on small platforms. Sleep Res 1997; 26:619.
Everson CA. Sustained sleep deprivation impairs host defense. Amm J Physiol[Internet].1993[citado 7 May 2020];265(5):1148-1154.Disponible en: https://journals.physiology.org/doi/abs/10.1152/ajpregu.1993.265.5.R1148
Casey FB, Eisenberg J, Peterson D, Pieper D. Altered antigen uptake and distribution due to exposure to extreme environmental temperatures or sleep deprivation. J Reticuloendothelial Soc.1974; 15(2):87-95.
Nikolich-Zugich J, Knox K, Tafich Rios C, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience[Internet]. 2020[citado 7 May 2020];42(2):505-514.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145538/
Huang CH, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet [Internet]. 2020 [citado 7 May 2020]; 395:497-506.Disponible en: doi: 10.1016/S0140-6736(20)30183-5.
Oberfeld B, et al. SnapShot: COVID-19. Cell [Internet]. 2020[citado 7 May 2020]; 18(4):954. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190493/
Prompetchara, E, Ketloy, Ch, Palaga, T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pac. J. Allergy Immunol[Internet]2020[citado 9 May 2020];38(1):1–9.Disponbile en: https://pubmed.ncbi.nlm.nih.gov/32105090/
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet[Internet] 2020[citado 9 May 2020];8(5):475-481.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102538/
Wang D, Hu B, Hu Ch, Zhu F, Liu Ch, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA[Internet] 2020[citado 9 May 2020];323(11):1061-1069. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2761044
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet [Internet] 2020[citado 9 May 2020];395(10223):507-513. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext
Méndez R, Menéndez R, Amara-Elori I, Feced L, Piró A, Ramírez P, et al. Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality. J Infect [Internet] 2019[citado 9 May 2020]; 78 (6):423–431. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30965065/
Bermejo-Martin JF, Martín-Fernández M, López-Mestanza C, Duque P, Almansa R. Shared features of endothelial dysfunction between sepsis and its preceding risk factors (Aging and chronic disease). J Clin Med[Internet] 2018[citado 9 May 2020]; 7(11):400.Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262336/
Morales-Blanhir JE, Valencia-Flores M, Lozano-Cruz OA. El síndrome de apnea obstructiva del sueño como factor de riesgo para enfermedades cardiovasculares y su asociación con hipertensión pulmonar. Neumol Cir Torax[Internet] 2017[citado 9 May 2020];76(1):51-60. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0028-37462017000100051
Merino-Andreu M, Álvarez-Ruiz de Larrinaga A, Madrid-Pérez JA, Martínez-Martínez MA, PuertasCuesta FJ, Asencio-Guerra AJ, et al. Sueño saludable: evidencias y guías de actuación. Documento oficial de la Sociedad Española de Sueño. Rev Neurol [Internet] 2016[citado 9 May 2020]; 63 (Supl 2):1-27.Disponible en: https://ses.org.es/blog-post/revista-neurologia-sueno-saludable-evidencias-guias-actuacion-documento-oficial-la-sociedad-espanola-sueno/
Downloads
Published
How to Cite
Issue
Section
License
La Revista Cubana de Higiene y Epidemiologia protege los derechos de autor, y opera con una Licencia Creative Commons 4.0.(Licencia Creative Commons Atribución-No Comercial 4.0 Internacional (CC BY-NC 4.0).Al publicar en ella los autores permiten copiar y redistribuir el material en cualquier medio o formato; remezclar, transformar y crear a partir del material. Debe reconocer adecuadamente la autoría, proporcionar un enlace a la licencia http://creativecommons.org/licenses/by-nc/4.0/ e indicar si se han realizado cambios. No puede utilizar el material para una finalidad comercial. No hay restricciones adicionales.
Los autores autorizan la publicación de sus escritos conservando los derechos de autoría, y cediendo y transfiriendo a la revista todos los derechos protegidos por las leyes de propiedad intelectual que rigen en Cuba, que implican la edición para difundir la obra.
Los autores podrán establecer acuerdos adicionales para la distribución no exclusiva de la versión de la obra publicada en la revista (por ejemplo, situarla en un repositorio institucional o publicarla en un libro), con el reconocimiento de haber sido publicada primero en esta revista.
