Effect of vitamin A supplementation on measles vaccination in nine-month-old infants

Abstract

Objective: Childhood immunization programs have been suggested as an infrastructure to deliver vitamin A supplements to children in developing countries. The effects of giving vitamin A, a potent immune enhancer, with measles immunization to nine-month-old infants is unknown.

Methods: A randomized, double-masked, placebo-controlled clinical trial of vitamin A, 100,000 IU at the time of standard titer Schwarz measles immunization was conducted with nine-month-old infants in Bogor District, West Java, Indonesia. Antibody titers to measles were measured at baseline and one and six months following immunization.

Results: 394 infants received measles immunization, and 37 infants (9.4%) had baseline antibody titers > 1:120, which is consistent with previous natural measles infection. Of the remaining infants, 98.8% seroconverted to measles, and 99.3% had titers consistent with protection against measles six months postimmunization. Seroconversion rates were similar in vitamin A and placebo treatment groups.

Conclusion: High dose vitamin A supplementation can be given without reducing seroconversion to standard titer Schwatz measles immunization in nine-month-old infants.

PIP: The feasibility of combining vitamin A supplementation and measles immunization was investigated in a double-masked, placebo-controlled clinical trial involving 394 9-months-old infants in Bogor district, West Java, Indonesia. Vitamin A, a potent immune enhancer, has been shown to reduce child mortality by 20-50% in developing countries and is among the most cost-effective child survival interventions. 130 infants received a placebo; 132 were given 25,000 IU of vitamin A at 6, 10, and 14 weeks and 100,000 IU at 9 months; and the final 132 were given 50,000 IU of vitamin A at 6, 10, and 14 weeks and 100,000 IU at 9 months. 37 (9.4%) of the study infants had pre-immunization measles titers greater than 1:120 at 9 months of age, indicative of a previous history of natural measles infection. 98.8% of the remaining infants had seroconverted to measles 1 month after immunization, regardless of whether they received vitamin A or placebo; after 6 months, 99.3% had titers consistent with protection against measles. Geometric mean titers were 1:1772 and 1:2298 at 1 month post-immunization and 1:1164 and 1:1900 at 6 months post-immunization in infants receiving vitamin A and placebo, respectively. Since vitamin A supplementation does not interfere with seroconversion to standard titer Schwarz measles immunization, its inclusion in Expanded Program on Immunization campaigns is recommended.