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Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial.
Am J Clin Nutr 2009; 90(3):629-39AJ

Abstract

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.

Authors+Show Affiliations

Statens Serum Institut, Copenhagen, Denmark. cb@ssi.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19640958

Citation

Benn, Christine S., et al. "Does Vitamin a Supplementation Interact With Routine Vaccinations? an Analysis of the Ghana Vitamin a Supplementation Trial." The American Journal of Clinical Nutrition, vol. 90, no. 3, 2009, pp. 629-39.
Benn CS, Aaby P, Nielsen J, et al. Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial. Am J Clin Nutr. 2009;90(3):629-39.
Benn, C. S., Aaby, P., Nielsen, J., Binka, F. N., & Ross, D. A. (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. 629-39. doi:10.3945/ajcn.2009.27477.
Benn CS, et al. Does Vitamin a Supplementation Interact With Routine Vaccinations? an Analysis of the Ghana Vitamin a Supplementation Trial. Am J Clin Nutr. 2009;90(3):629-39. PubMed PMID: 19640958.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial. AU - Benn,Christine S, AU - Aaby,Peter, AU - Nielsen,Jens, AU - Binka,Fred N, AU - Ross,David A, Y1 - 2009/07/29/ PY - 2009/7/31/entrez PY - 2009/7/31/pubmed PY - 2009/9/30/medline SP - 629 EP - 39 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 90 IS - 3 N2 - 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. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/19640958/Does_vitamin_A_supplementation_interact_with_routine_vaccinations_An_analysis_of_the_Ghana_Vitamin_A_Supplementation_Trial_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.2009.27477 DB - PRIME DP - Unbound Medicine ER -