HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: 90/3/629    most recent ajcn.2009.27477v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Related articles in AJCN Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Benn, C. S Articles by Ross, D. A PubMed PubMed Citation Articles by Benn, C. S Articles by Ross, D. A Agricola Articles by Benn, C. S Articles by Ross, D. A

Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial^1,2,3

¹ From the Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark (CSB and JN); the Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau (PA); the University of Ghana, Accra, Ghana (FNB); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (DAR).

² Supported by the Danish International Development Agency (CSB).

³ Address correspondence to CS Benn, Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. E-mail: cb{at}ssi.dk.

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.

Related articles in AJCN:

Vitamin supplements and vaccines: maximize benefits, evaluate potential risks

Charles B Stephensen and Kimberly A Livingston
AJCN 2009 90: 457-458. [Full Text]  

This article has been cited by other articles:

				M. Savy, K. Edmond, P. E. M. Fine, A. Hall, B. J. Hennig, S. E. Moore, K. Mulholland, U. Schaible, and A. M. Prentice Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children J. Nutr., November 1, 2009; 139(11): 2154S - 2218S. [Abstract] [Full Text] [PDF]

				C. B Stephensen and K. A Livingston Vitamin supplements and vaccines: maximize benefits, evaluate potential risks Am. J. Clinical Nutrition, September 1, 2009; 90(3): 457 - 458. [Full Text] [PDF]