Newborn vitamin A supplementation does not affect nasopharyngeal carriage of Streptococcus pneumoniae in Bangladeshi infants at age 3 months.

Nasopharyngeal (NP) carriage of S. pneumoniae (Spn) is a risk factor for pneumococcal disease and its transmission. We assessed the impact of vitamin A (VA) supplementation shortly after birth in reducing Spn colonization in early infancy in rural Bangladesh. We recruited 500 infants participating in a cluster-randomized trial that reported a 15% reduction in mortality following receipt of an oral dose of VA (52.25 μmol) compared to placebo. NP specimens were collected at the age of 3 mo to study the effect of VA on the prevalence of culture-confirmed Spn. Analyses were conducted by intention to treat. Spn carriage prevalence did not differ between VA and placebo recipients [OR = 0.83 (95% CI: 0.55-1.27); P = 0.390]. Spn carriage at the age of 3 mo was not lowered by VA given at birth. Results are similar to those from an Indian study in which impact on Spn carriage was assessed at the age of 4 mo [OR = 0.73 (95% CI: 0.48-1.10); P = 0.128]. The point estimate of the pooled effect size for the 2 studies is OR = 0.78 [(95% CI: 0.58-1.04); P = 0.095], which may imply a modest impact on carriage. If so, then the evidence thus far would suggest that Spn carriage reduction is unlikely to be a primary ancillary benefit of newborn VA supplementation.

[1]  A. Sommer,et al.  Effects of vitamin A or beta carotene supplementation on pregnancy-related mortality and infant mortality in rural Bangladesh: a cluster randomized trial. , 2011, JAMA.

[2]  T. Cherian,et al.  Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates , 2009, The Lancet.

[3]  G. Brundtland,et al.  Nutrition and infection: malnutrition and mortality in public health. , 2009 .

[4]  R. Semba.  The role of vitamin A and related retinoids in immune function. , 2009, Nutrition reviews.

[5]  R. Dagan.  Impact of pneumococcal conjugate vaccine on infections caused by antibiotic-resistant Streptococcus pneumoniae. , 2009, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[6]  M. Lipsitch,et al.  Impaired Innate and Adaptive Immunity to Streptococcus pneumoniae and Its Effect on Colonization in an Infant Mouse Model , 2009, Infection and Immunity.

[7]  N. Krug,et al.  Pneumococcal vaccines: mechanism of action, impact on epidemiology and adaption of the species. , 2008, International journal of antimicrobial agents.

[8]  A. Sommer,et al.  Newborn Vitamin A Supplementation Reduced Infant Mortality in Rural Bangladesh , 2008, Pediatrics.

[9]  Robert E Black,et al.  What works? Interventions for maternal and child undernutrition and survival , 2008, The Lancet.

[10]  W. Hanage.  Serotype-specific problems associated with pneumococcal conjugate vaccination. , 2008, Future microbiology.

[11]  J. Katz,et al.  Newborn vitamin A dosing reduces the case fatality but not incidence of common childhood morbidities in South India. , 2007, The Journal of nutrition.

[12]  K. Auranen,et al.  Nasopharyngeal colonization: a target for pneumococcal vaccination , 2006, Expert review of vaccines.

[13]  T. Cherian,et al.  Effectiveness of Heptavalent Pneumococcal Conjugate Vaccine in Children Younger Than 5 Years of Age for Prevention of Pneumonia: Updated Analysis Using World Health Organization Standardized Interpretation of Chest Radiographs , 2006, The Pediatric infectious disease journal.

[14]  T. Cherian,et al.  Pneumococcal vaccination in developing countries , 2006, The Lancet.

[15]  S. Awasthi,et al.  High nasopharyngeal carriage of drug resistant Streptococcus pneumoniae and Haemophilus influenzae in North Indian schoolchildren , 2005, Tropical medicine & international health : TM & IH.

[16]  C. Roberts,et al.  Vitamin A for acute respiratory infection in developing countries: a meta‐analysis , 2004, Acta paediatrica.

[17]  L. Caulfield,et al.  Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. , 2004, The American journal of clinical nutrition.

[18]  R. de Groot,et al.  Streptococcus pneumoniae colonisation: the key to pneumococcal disease. , 2004, The Lancet. Infectious diseases.

[19]  M. Jacobs.  Worldwide trends in antimicrobial resistance among common respiratory tract pathogens in children , 2003, The Pediatric infectious disease journal.

[20]  J. Katz,et al.  Impact of supplementing newborn infants with vitamin A on early infant mortality: community based randomised trial in southern India , 2003, BMJ : British Medical Journal.

[21]  J. Katz,et al.  Nasopharyngeal carriage of resistant pneumococci in young South Indian infants , 2002, Epidemiology and Infection.

[22]  J. García-Rodríguez,et al.  Dynamics of nasopharyngeal colonization by potential respiratory pathogens. , 2002, The Journal of antimicrobial chemotherapy.

[23]  T. Cherian,et al.  Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP). , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  George M. Carlone,et al.  Evaluation of a Medium (STGG) for Transport and Optimal Recovery of Streptococcus pneumoniae from Nasopharyngeal Secretions Collected during Field Studies , 2001, Journal of Clinical Microbiology.

[25]  J. Katz,et al.  Pneumococcal nasopharyngeal colonization in young South Indian infants. , 2001, The Pediatric infectious disease journal.

[26]  J. Katz,et al.  Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants. , 2001, The Journal of nutrition.

[27]  D. Thurnham,et al.  The effect of vitamin A on epithelial integrity , 1999, Proceedings of the Nutrition Society.

[28]  R. Huebner,et al.  Nasopharyngeal carriage and antimicrobial resistance in isolates of Streptococcus pneumoniae and Haemophilus influenzae type b in children under 5 years of age in Botswana. , 1998, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[29]  A. Sommer,et al.  Impact of neonatal vitamin A supplementation on infant morbidity and mortality. , 1996, The Journal of pediatrics.

[30]  T. Schoeb,et al.  Effects of viral and mycoplasmal infections, ammonia exposure, vitamin A deficiency, host age, and organism strain on adherence of Mycoplasma pulmonis in cultured rat tracheas. , 1993, Laboratory animal science.

[31]  H. Biesalski,et al.  Biochemical, Morphological, and Functional Aspects of Systemic and Local Vitamin A Deficiency in the Respiratory Tract , 1992, Annals of the New York Academy of Sciences.

[32]  Martin W. Bloem,et al.  Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhea in preschool and school children in northeastern Thailand. , 1990, American journal of epidemiology.

[33]  R. Milton,et al.  Mild vitamin A deficiency and childhood morbidity--an Indian experience. , 1987, The American journal of clinical nutrition.

[34]  H. Biesalski,et al.  Vitamin A and ciliated cells I. Respiratory epithelia , 1986, Zeitschrift fur Ernahrungswissenschaft.

[35]  A. J. Lamb,et al.  Impaired local immune response in vitamin A-deficient rats. , 1980, Clinical and experimental immunology.

[36]  Clinical,et al.  Performance standards for antimicrobial disk susceptibility tests : approved standard , 2006 .

[37]  A. Sommer,et al.  Potential interventions for the prevention of childhood pneumonia in developing countries: a meta-analysis of data from field trials to assess the impact of vitamin A supplementation on pneumonia morbidity and mortality. The Vitamin A and Pneumonia Working Group. , 1995, Bulletin of the World Health Organization.