Key result
Neonatal vitamin A supplementation did not augment oral polio vaccine responses in infants compared to placebo, with median Sabin-1 IgA titres of 932 vs 1774 (p=0.04).
Why the study?
Micronutrient deficiencies may contribute to reduced oral vaccine immunogenicity in developing countries, leading to the hypothesis that neonatal vitamin A supplementation would improve oral vaccine responses.
Does single, high-dose neonatal vitamin A supplementation improve poliovirus-specific IgA responses to oral polio vaccine in Zimbabwean infants?
RCT (n=181)
placebo-controlled
randomised
Does single, high-dose neonatal vitamin A supplementation improve poliovirus-specific IgA responses to oral polio vaccine in Zimbabwean infants?
Absolute Event Rate: 932% vs 1774%
p-value: p=0.04
Neonatal vitamin A supplementation did not augment oral polio vaccine responses in Zimbabwean infants.
Neonatal vitamin A was not associated with augmented OPV responses and should not change practice; leaves open effects on other vaccines in deficient populations.
BACKGROUND: Micronutrient deficiencies may contribute to reduced oral vaccine immunogenicity in developing countries. We hypothesised that neonatal vitamin A supplementation (NVAS) would improve oral vaccine responses. METHODS: We performed a cross-sectional study of infants recruited at birth to the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial, a randomised controlled trial of single, high-dose NVAS vs placebo conducted in Zimbabwe between 1997-2001. We measured poliovirus-specific IgA to type 1-3 polio strains by semiquantitative capture ELISA in cryopreserved plasma samples collected at 6 months of age. RESULTS: A total of 181 infants fulfilled inclusion criteria, of whom 80 were randomised to NVAS and 101 to placebo. There were no significant differences in baseline characteristics between groups. At 6 months of age, median (IQR) vaccine titres for infants randomised to NVAS vs placebo were 932 (421-3001) vs 1774 (711-5431) for Sabin-1 (p=0.04); 1361 (705-3402) vs 2309 (1081-4283) for Sabin-2 (p=0.15); and 1584 (796-4216) vs 2260 (996-5723) for Sabin-3 (p=0.14), respectively. After adjusting for breast feeding status, birth weight, season and infant sex in a linear regression model, there was only weak evidence of difference in log mean titres between vitamin A and placebo groups for Sabin-1 (p=0.08) and no evidence of difference in log mean titres for Sabin-2 and Sabin-3. CONCLUSIONS: NVAS did not augment oral polio vaccine responses in Zimbabwean infants. Further research is required to understand the impact of NVAS on responses to other oral vaccines.The trial is registered with clinicaltrials.gov identifier: NCT00198718.
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Church et al. (2018) conducted an RCT in Oral vaccine immunogenicity (n=181). Neonatal vitamin A supplementation vs. placebo was evaluated on poliovirus-specific IgA to type 1 polio strain (Sabin-1) at 6 months of age (p=0.04). Neonatal vitamin A supplementation did not augment oral polio vaccine responses in infants compared to placebo, with median Sabin-1 IgA titres of 932 vs 1774 (p=0.04).
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