Benn CS, Aaby P, Nielsen J, et al. Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial. Am J Clin Nutr 2009 Sep;90(3):629-639.
PMID: 19640958
doi:10.3945/ajcn.2009.27477
http://www.ajcn.org/cgi/content/abstract/90/3/629
http://www.ajcn.org/cgi/content/full/90/3/629
http://www.ajcn.org/cgi/reprint/90/3/629.pdf
related:
Stephensen CB, Livingston KA. Vitamin supplements and vaccines: maximize benefits, evaluate potential risks. Am J Clin Nutr 2009 Sep;90(3):457-458. (Editorial)
PMID: 19640957
http://www.ajcn.org/cgi/content/full/90/3/457
http://www.ajcn.org/cgi/reprint/90/3/457.pdf
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Am J Clin Nutr. 2009 Sep;90(3):629-39. Epub 2009 Jul 29.
Comment in:
• Am J Clin Nutr. 2009 Sep;90(3):457-8.
Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial.
Benn CS, Aaby P, Nielsen J, Binka FN, Ross DA.
Statens Serum Institut, Copenhagen, Denmark.
BACKGROUND: The World Health Organization recommends vitamin A supplementation (VAS) at vaccination contacts after 6 mo of age to reduce mortality. However, it is unknown whether the effect of VAS is independent of vaccinations. One of the original VAS trials from Ghana had collected vaccination information. OBJECTIVE: We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls. DESIGN: At enrollment, children aged 6-90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated. RESULTS: VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80). CONCLUSIONS: The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts.
Publication Types:
• Research Support, Non-U.S. Gov't
PMID: 19640958