Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants

Abstract

Background: Iron deficiency may impair adaptive immunity and is common among African infants at time of vaccination. Whether iron deficiency impairs vaccine response and whether iron supplementation improves humoral vaccine response is uncertain. Methods: We performed two studies in southern coastal Kenya. In a birth cohort study, we followed infants to age 18 mo and assessed whether anemia or iron deficiency at time of vaccination predicted vaccine response to three-valent oral polio, diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine, ten-valent pneumococcal-conjugate vaccine and measles vaccine. Primary outcomes were anti-vaccine-IgG and seroconversion at age 24 wk and 18 mo. In a randomized trial cohort follow-up, children received a micronutrient powder (MNP) with 5 mg iron daily or a MNP without iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were anti-measles IgG, seroconversion and avidity at age 11.5 mo and 4.5 y. Findings: In the birth cohort study, 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometric indices and maternal Stoffel et al. Iron and Vaccine Response antibodies, hemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis-IgG at 24 wk (p = 0.0071, p = 0.0339) and 18 mo (p = 0.0182, p = 0.0360); (B) anti-pertussis filamentous hemagglutinin-IgG at 24 wk (p = 0.0423); and (C) anti-pneumococcus 19 IgG at 18 mo (p = 0.0129). Anemia and serum transferrin receptor at time of vaccination were the strongest predictors of seroconversion against diphtheria (p = 0.0484, p = 0.0439) and pneumococcus 19 at 18 mo (p = 0.0199, p = 0.0327). In the randomized trial, 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5 y. Compared to infants that did not receive iron, those who received iron at time of vaccination had higher anti-measles-IgG (p = 0.0415), seroconversion (p = 0.0531) and IgG avidity (p = 0.0425) at 11.5 mo. Interpretation: In Kenyan infants, anemia and iron deficiency at time of vaccination predict decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine may be increased by iron supplementation at time of vaccination. These findings argue that correction of iron deficiency during early infancy may improve vaccine response.

Early Life Vaccination of Companion Animal Pets

“…This immune system is composed of physical and chemical barriers, phagocytic leukocytes, dendritic cells, natural killer cells, and plasma proteins. It provides barriers to infection, while the circulating soluble factors of the complement system provide additional support [1,[5][6][7][8]14,16,22].…”

“…T-lymphocytes also orchestrate the development of the adaptive immune response [1,[5][6][7]. In many species, except dogs, cats, and mice, the thymus starts decreasing in size at birth, although the immunosenescence associated with a decline in thymic output is an evolutionary conserved event [19][20][21][22][23][24][25][26]. Furthermore, the thymus gland can involute transiently with stress, infections, pregnancy, and malnutrition [20].…”

“…For literally hundreds of years, vaccinations have played a key role in offsetting the undeveloped adaptive immunity of the young human and animal [1,2,9,16]. Both the innate and adaptive (acquired) immune systems and immune memory evolve along with the functional roles of the pituitary-thyroid-hypothalamic axis, the thymus gland and its gradual involution, and the maturation of the microbiome in the gut [1,2,6,7,13,[18][19][20][21][22][23].…”

COVID-19 vaccinations in patients with inflammatory bowel disease

“… 1 Other vaccines such as those against hepatitis A and B virus, tetanus, and herpes zoster have also been shown to be potentially less effective in patients with IBD than in control groups. 9 …”

“…Of note, concurrent anaemia, which is a common finding in patients with active IBD, might impair response to vaccinations. 9 There is therefore an urgent need for better understanding of both the effectiveness of potential vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with underlying health conditions, as well as the potential impact of effective disease control on rates of vaccine response.…”