Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial

被引:53
作者
Benn, Christine S. [1 ]
Aaby, Peter [2 ]
Nielsen, Jens [1 ]
Binka, Fred N. [3 ]
Ross, David A. [4 ]
机构
[1] Statens Serum Inst, Bandim Hlth Project, DK-2300 Copenhagen S, Denmark
[2] Indepth Network, Bandim Hlth Project, Bissau, Guinea Bissau
[3] Univ Ghana, Accra, Ghana
[4] London Sch Hyg & Trop Med, London WC1, England
关键词
GUINEA-BISSAU; CHILD-MORTALITY; BCG VACCINE; MEASLES IMMUNIZATION; TUBERCULIN REACTION; RANDOMIZED-TRIAL; PEDIATRIC WARD; NORTHERN GHANA; EARLY INFANCY; WEST-AFRICA;
D O I
10.3945/ajcn.2009.27477
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
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.
引用
收藏
页码:629 / 639
页数:11
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