Interaction between neonatal vitamin A supplementation and timing of measles vaccination: A retrospective analysis of three randomized trials from Guinea-Bissau

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Abstract

Background: In Guinea-Bissau we conducted three trials of neonatal vitamin A supplementation (NVAS) from 2002 to 2008. None of the trials found a beneficial effect on mortality. From 2003 to 2007, an early measles vaccine (MV) trial was ongoing, randomizing children 1:2 to early MV at 4.5 months or no early MV, in addition to the usual MV at 9 months. We have previously found interactions between vitamin A and vaccines. Objective: We investigated whether there were interactions between NVAS and early MV. Design: We compared the mortality of NVAS and placebo recipients: first, from 4.5 to 8 months for children randomized to early MV or no early MV; and second, from 9 to 17 months in children who had received two MV or one MV. Mortality rates (MR) were compared in Cox models producing mortality rate ratios (MRR). Results: A total of 5141 children were randomized to NVAS (N= 3015) or placebo (N= 2126) and were later randomized to early MV (N= 1700) or no early MV (N= 3441). Between 4.5 and 8 months, NVAS compared with placebo was associated with higher mortality in early MV recipients (MR = 30 versus MR = 0, p= 0.01), but not in children who did not receive early MV (p for interaction between NVAS and early MV = 0.03). From 9 to 17 months NVAS was not associated with mortality. Overall, from 4.5 to 17 months NVAS was associated with increased mortality in early MV recipients (Mortality rate ratio = 5.39 (95% confidence interval: 1.62, 17.99)). Conclusions: These observations indicate that NVAS may interact with vaccines given several months later. This may have implications for the planning of future child intervention programs.

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APA

Benn, C. S., Martins, C. L., Fisker, A. B., Diness, B. R., Garly, M. L., Balde, I., … Aaby, P. (2014). Interaction between neonatal vitamin A supplementation and timing of measles vaccination: A retrospective analysis of three randomized trials from Guinea-Bissau. Vaccine, 32(42), 5468–5474. https://doi.org/10.1016/j.vaccine.2014.07.090

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