Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth

Rd, Semba; Munasir, Zakiudin; Akib, Arwin Ap; Melikian, George; Permaesih, Dewi; Muherdiyantiningsih,; Marituti, S; Muhilal,

doi:10.1080/080352501317061477

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Two studies of vitamin A supplementation at birth have both indicated a more beneficial effect in boys 13 14. With regard to morbidity, an Indonesian study of the effect on morbidity and growth of either 25 000 or 50 000 IU vitamin A or placebo given with the three doses of DTP vaccines found better effect on morbidity of the lower dose 8. In our study there was no differential mortality effect of dose in the group aged 6-18 months.…”

Section: Discussionsupporting

confidence: 39%

“…We carried out the present study because two previous studies had suggested that the lower dose had a better effect on mortality7 and morbidity 8. Our study was not large enough to document a reduction in mortality, and the mortality fell during the trial making it more difficult to document a significant effect.…”

Section: Discussionmentioning

confidence: 94%

“…For instance, there is no clear evidence that a large dose is better than a small dose, the tendency being the opposite in the two previous studies of different doses 7 8…”

Section: Introductionmentioning

confidence: 87%

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Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality

Benn

Martins

Rodrigues

et al. 2005

BMJ

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Objectives To determine whether the dose of vitamin A currently recommended by the World Health Organization or half this dose gives better protection against childhood morbidity and mortality. Design Randomised study. Setting A combined oral polio vaccine and vitamin A supplementation campaign in Guinea-Bissau, Africa. Participants 4983 children aged 6 months to 5 years. Interventions One of two doses of vitamin A (recommended and half); oral polio vaccine. Main outcome measures Mortality and morbidity at six and nine months. Results Mortality was lower in the children who took half the recommended dose of vitamin A compared with the full dose at both six months (mortality rate ratio 0.69, 95% confidence interval 0.36 to 1.35) and nine months (0.62, 0.36 to 1.06) of follow-up. There was a significant interaction between sex and dose, the lower dose being associated with significantly reduced mortality in girls (0.19, 0.06 to 0.66) but not in boys (1.98, 0.74 to 5.29). The lower dose of vitamin A was consistently associated with lower hospital case fatality in girls (0.19, 0.02 to 1.45). Paradoxically, in children aged 6-18 months, the low dose was associated with slightly higher morbidity. Conclusions Half the dose of vitamin A currently recommended by WHO may provide equally good or better protection against mortality but not against morbidity.

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Section: Discussionsupporting

confidence: 39%

Section: Discussionmentioning

confidence: 94%

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Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality

Benn

Martins

Rodrigues

et al. 2005

BMJ

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“…This analysis revealed that bulging fontanelle was not associated with long-term physical and developmental abnormalities (129). In contrast, an Indonesian study that administered VA or placebo with the 3 doses of DTP/OPV vaccine and with MV found only 1 case of bulging fontanelle from the placebo group (130). This study also reported significantly higher prevalence of vomiting in the placebo group than in the VA group.…”

Section: Va and Bcg Vaccinementioning

confidence: 78%

Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children

Savy

Edmond²,

Fine³

et al. 2009

The Journal of Nutrition

129

146

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The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested. This report provides a critical review of the published interactions between nutritional status and/or supplementation and vaccine responses in children. Due to an absence of evidence for most nutrients, this analysis focused on protein-energy, vitamins A and D, and iron and zinc. All vaccines were considered. Both observational studies and clinical trials that led to peer-reviewed publications in English or French were included. These criteria led to a pool of 58 studies for protein-energy malnutrition, 43 for VA, 4 for vitamin D, 10 for iron, and 22 for zinc. Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses. Evidence for definitive adjunctive effects of micronutrient supplementation at the time of vaccination is also weak. Overall, the paucity, poor quality, and heterogeneity of data make it difficult to draw firm conclusions. The use of simple endpoints that may not correlate strongly with disease protection adds uncertainty. A detailed examination of the immunological mechanisms involved in potential interactions, employing modern methodologies, is therefore required. This would also help us understand the proposed, but still unproven, negative interactions between VAS and vaccine safety, a resolution of which is urgently required.

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“…There is no clear evidence, however, that a large dose is better than a smaller one. Serial population-based field trials (19)(20)(21)(22)(23) have studied the effect of different administered doses of vitamin A on children's mortality and/or morbidity. Previous researches have HAZ, height-for-age Z-score; WAZ, weight-for-age Z-score; WHZ, weight-for-height Z-score; SNK, Student-Newman-Keuls test.…”

Section: Effects Of Intervention On the Prevalence Of Vad And Anaemiamentioning

confidence: 99%

Effect of biscuits fortified with different doses of vitamin A on indices of vitamin A status, haemoglobin and physical growth levels of pre-school children in Chongqing

Zhang

Chen

Qü

et al. 2010

Public Health Nutr.

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Objective: To investigate the efficacy of biscuits fortified with different doses of vitamin A on improving vitamin A deficiency (VAD), anaemia and physical growth of pre-school children. Design: A randomised double-masked population-based field interventional trial with a positive control group. Setting: Banan district of Chongqing, China. Subjects: A total of 580 pre-school children aged 3-6 years were randomly recruited into four groups. Children in groups I and II were given biscuits fortified with vitamin A at 30 % of the recommended daily intake (RDA) and 100 % of the RDA once a day for 9 and 3 months, respectively. Children in group III received biscuits containing 20 000 IU of vitamin A once a week for 3 months. Initially, the children in group IV received a 200 000 IU vitamin A capsule just once. At the beginning and end of the study, blood samples were collected to measure Hb, serum retinol, retinol-binding protein and prealbumin, and weight and height were measured. Results: All the fortification types significantly decreased the prevalence of VAD and anaemia in each group (P , 0?05). The effect of 9-month intervention on group I was the most efficient (P , 0?0045). After intervention, the Z-scores of height-for-age, weight-for-age and weight-for-height in all groups increased markedly compared with baseline (P , 0?05), but no significant difference was observed among the groups. Conclusions: Data indicated that consuming vitamin A-fortified biscuits with daily 100 % RDA for 3 months has the same effect on the improvement of VAD, anaemia and physical growth as did the weekly 20 000 IU and single 200 000 IU administration in pre-school children.

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Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth

Abstract: Although improving vitamin A nutriture is of general importance in reducing diarrheal and measles morbidity and mortality in developing countries, this clinical trial showed no apparent benefit of vitamin A capsules for infant health when given through childhood immunization programs.

Cited by 8 publications

References 28 publications

Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality

Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality

Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children

Effect of biscuits fortified with different doses of vitamin A on indices of vitamin A status, haemoglobin and physical growth levels of pre-school children in Chongqing

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