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; (2009) Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial. The American journal of clinical nutrition, 90 (3). pp. 629-639. ISSN 0002-9165 DOI:

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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-Guerin 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. Am J Clin Nutr 2009;90:629-39.

Item Type: Article
Keywords: guinea-bissau, child-mortality, bcg vaccine, measles immunization, tuberculin reaction, randomized-trial, pediatric ward, northern ghana, early infancy, west-africa, Anti-Infective Agents, administration & dosage, therapeutic use, BCG Vaccine, Child, Child, Preschool, Dietary Supplements, Diphtheria-Tetanus-Pertussis Vaccine, Dose-Response Relationship, Drug, Drug Interactions, Female, Ghana, epidemiology, Humans, Infant, Infection, mortality, Male, Measles Vaccine, Primary Prevention, Risk Assessment, Sex Factors, Vaccines, pharmacology, Vitamin A, administration & dosage, therapeutic use, Vitamins, administration & dosage, therapeutic use
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Tropical Epidemiology Group
Vaccine Centre
PubMed ID: 19640958
Web of Science ID: 269257300025


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