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IJE Advance Access originally published online on September 16, 2008
International Journal of Epidemiology 2009 38(1):304-311; doi:10.1093/ije/dyn195
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

The effect of vitamin A supplementation administered with missing vaccines during national immunization days in Guinea-Bissau

Christine Stabell Benn1,2,*, Cesario Martins1,2, Amabelia Rodrigues1,2, Henrik Ravn1,2, Ane Bærent Fisker1,2, Dorthe Christoffersen1,2 and Peter Aaby1,2

1Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
2Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.

* Corresponding author. Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark. E-mail: cb{at}ssi.dk


  Abstract

Background WHO recommends high-dose Vitamin A supplementation (VAS) at vaccination contacts after 6 months of age. It has not been studied whether the effect of VAS on mortality depends on the type of vaccine. We have hypothesized that VAS administered with measles vaccine (MV) is more beneficial than VAS with diphtheria–tetanus–pertussis (DTP) vaccine. We assessed the effect of VAS administered with different vaccines during national immunization days (NIDs).

Methods In 2003, VAS was distributed during NIDs in Guinea-Bissau. Children 6 months or older were given VAS, and if they were missing vaccines, these were often given as well. We compared survival between children who had received VAS alone, VAS with DTP or DTP + MV, or VAS with MV. We also compared the survival between participants and non-participants. We followed 6- to 17-month old children until 18 months of age and analysed survival in Cox models.

Results Twenty of 982 VAS-recipients died during follow-up. The mortality rate ratio (MRR) for VAS with DTP + MV or VAS with DTP was 3.43 (1.36–8.61) compared with VAS only. There were no deaths among those who received VAS with MV alone (P = 0.0005 for homogeneity of VAS effects). Children who received VAS with DTP had higher mortality than non-participants who did not receive VAS [MRR = 3.04 (1.31–7.07)].

Conclusion The study design does not allow for definite conclusions. However, the results are compatible with our a priori hypothesis that VAS is more beneficial when given with MV and potentially harmful when given with DTP. Randomized trials testing the impact on mortality of the current WHO policy seem warranted.

Keywords Vitamin A, diphtheria–tetanus–pertussis vaccine, measles vaccine, child mortality, low income populations

Accepted 21 August 2008


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This article has been cited by other articles:


Home page
 Am. J. Clin. Nutr.Home page
C. S Benn, P. Aaby, J. Nielsen, F. N Binka, and D. A Ross
Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial
Am. J. Clinical Nutrition, September 1, 2009; 90(3): 629 - 639.
[Abstract] [Full Text] [PDF]


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