title: Zinc supplementation and TNF-α levels in vaccinated cardiac patients.
abstract: OBJECTIVE
  To investigate whether zinc supplementation could affect serum tumor necrosis factor-alpha (TNF-α) levels in congenital and acquired cardiac patients attending for an influenza vaccine.
  
  
  METHODS
  9-18 years old, voluntary children with cardiac disease were weighed, measured height and blood samples for hemoglobin level, zinc level, IgA and IgG titers of influenza A and B serotypes and TNF-α levels were obtained. The children were randomly assigned to 1 of 2 groups: ZV group received both zinc supplementation and influenza vaccine; V group received influenza vaccine. Serum TNF-α levels were measured at 28 days after the immunization.
  
  
  RESULTS
  Mean (±SD) serum zinc level was 100 (±20) μg/dL. Cases with congenital heart disease had lower serum zinc levels than acquired ones (93±17 μg/dL, 116±18 μg/dL; respectively, p<0.001). Median titers of serum TNF-α decreased after vaccination (78.9 pg/mL, 74.8 pg/mL; p<0.05) but this significant change occurred only in ZV group (77.1 pg/mL, 73.4 pg/mL; p=0.001). Vaccine associated adverse events were similar in ZV and V groups except malaise (0% in ZV and 23.8% in V group; p<0.05). Adverse events were similar in patients with congenital and acquired heart diseases. During the previous influenza season, 77.3% had more than two episodes of upper respiratory tract infection (URTI), however, after vaccination only 13.6% had more than two episode of URTI.
  
  
  CONCLUSIONS
  Zinc supplementation has a beneficial effect on malaise, one of the influenza vaccine associated adverse events, and decrease serum TNF-α levels.
authors.affiliation: Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey. siyalcin@hacettepe.edu.tr
authors.forename: S Songül
authors.initials: SS
authors.lastname: Yalçın
authors.forename: Defne
authors.initials: D
authors.lastname: Engür-Karasimav
authors.forename: Dursun
authors.initials: D
authors.lastname: Alehan
authors.forename: Kadriye
authors.initials: K
authors.lastname: Yurdakök
authors.forename: Süheyla
authors.initials: S
authors.lastname: Ozkutlu
authors.forename: Turgay
authors.initials: T
authors.lastname: Coşkun
mesh_terms: D000293:Adolescent; D002648:Child; D019587:Dietary Supplements; D006331:Heart Diseases / Q000097:blood* / Q000151:congenital / Q000276:immunology; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects* / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D007252:Influenza Vaccines; D014409:Tumor Necrosis Factor-alpha; D015032:Zinc