title: Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants.
abstract: Nasopharyngeal colonization is a risk factor for pneumococcal disease, a leading cause of complications and death in infants. We assessed the impact of vitamin A supplementation in reducing pneumococcal colonization in infants from an area with endemic vitamin A deficiency. We recruited 464 2-mo-old infants from a rural area in South India. Infants were randomly assigned to receive two 7000-microg retinol equivalent doses of vitamin A (n = 239) or placebo (n = 225) orally at birth, and nasopharyngeal specimens were collected at ages 2, 4 and 6 mo. We studied the effect of vitamin A on culture-confirmed pneumococcal colonization and on the distribution of pneumococcal serotypes. Analyses were conducted by intention-to-treat. The risk of colonization among infants aged 4 mo who were not colonized by age 2 mo was significantly reduced in the vitamin A group compared with the placebo group [odds ratio 0.51 (0.28, 0.92), P = 0.02). The odds of colonization were 27% lower in the treatment group than in the placebo group [odds ratio 0.73 (0.48, 1.1), P = 0.13]. No differences were detected in the prevalence of invasive serotypes. The risk of colonization with penicillin-resistant isolates was 74% lower in the vitamin A group than in the placebo group at 2 mo of age. However, the prevalence of penicillin-resistant isolates was only 4%. Neonatal vitamin A supplementation may play a role in lowering morbidity rates associated with pneumococcal disease by delaying the age at which colonization occurs.
authors.affiliation: Department of International Health, John Hopkins School of Hygiene & Public Health, Baltimore 21205, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Coles
authors.forename: L
authors.initials: L
authors.lastname: Rahmathullah
authors.forename: R
authors.initials: R
authors.lastname: Kanungo
authors.forename: R D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: M
authors.initials: M
authors.lastname: Santhosham
authors.forename: J M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D009017:Morbidity; D016017:Odds Ratio; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000517:prevention & control*; D012424:Rural Population; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014802:Vitamin A Deficiency / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D014801:Vitamin A