title: Does vitamin A supplementation interact with routine vaccinations? An analysis of the Ghana Vitamin A Supplementation Trial.
abstract: BACKGROUND
  The World Health Organization recommends vitamin A supplementation (VAS) at vaccination contacts after 6 mo of age to reduce mortality. However, it is unknown whether the effect of VAS is independent of vaccinations. One of the original VAS trials from Ghana had collected vaccination information.
  
  
  OBJECTIVE
  We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls.
  
  
  METHODS
  At enrollment, children aged 6-90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated.
  
  
  RESULTS
  VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80).
  
  
  CONCLUSIONS
  The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts.
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark. cb@ssi.dk
authors.forename: Christine S
authors.initials: CS
authors.lastname: Benn
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Jens
authors.initials: J
authors.lastname: Nielsen
authors.forename: Fred N
authors.initials: FN
authors.lastname: Binka
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001500:BCG Vaccine; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007239:Infections / Q000401:mortality*; D008297:Male; D008458:Measles Vaccine; D011322:Primary Prevention; D018570:Risk Assessment; D012737:Sex Factors; D014612:Vaccines / Q000494:pharmacology*; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014815:Vitamins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D001500:BCG Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine; D014612:Vaccines; D014815:Vitamins; D014801:Vitamin A