Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak

Abstract

Background Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. Objective To evaluate the association between vitamin A supplementation and mortality in EVD. Methods This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014–2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. Results There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. Conclusion Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.

Nutritional Care for Patients with Ebola Virus Disease

“…Most of the articles (n = 14) on nutritional support during Ebola treatment were case studies, cohort studies, or management recommendations focused on the clinical features, care provided, and outcomes observed ( 2 – 15 ). Four articles focused solely on patient care provided in the United States and Europe ( 5 , 6 , 8 , 14 ).…”

“…Four articles focused solely on patient care provided in the United States and Europe ( 5 , 6 , 8 , 14 ). Six described patients in West Africa during the 2014 outbreak: 3 in Sierra Leone ( 3 , 4 , 11 ), 1 in the Democratic Republic of the Congo ( 9 ), 1 in Liberia ( 2 ), and 1 in both Liberia and Sierra Leone ( 15 ). One particular study was a prospective cohort study on the effects of supplemental vitamin A on disease mortality rate ( 15 ).…”

Potential roles of micronutrient deficiency and immune system dysfunction in the coronavirus disease 2019 (COVID-19) pandemic

“…[138] Early administration of vitamin A reduced the mortality rate of patients with Ebola virus disease during the Western African outbreak. [139] …”

The rationale for a multi-step therapeutic approach based on antivirals, drugs and nutrients with immunomodulatory activity in patients with coronavirus-SARS2-induced disease of different severities

“…Some vitamins, like vitamins E, D and A, have been used in clinical trials for the treatment of patients with persistent viral infections, including HBV, HCV and HIV. These micronutrients have been demonstrated to enhance both the innate and the adaptive immunity against these pathogens (61,(68)(69)(70)(71)(72)(73) and to decrease susceptibility of CD4þ T lymphocytes to HIV-1 infection (74) . Furthermore, vitamins A, D and E have been suggested to improve innate and adaptive immune response against respiratory viruses, including influenza virus, rhinovirus and respiratory syncytial virus both in vivo and in vitro studies (75) .…”