title: Vitamin A supplements, routine immunization, and the subsequent risk of Plasmodium infection among children under 5 years in sub-Saharan Africa.
abstract: Recent studies, partly based on murine models, suggest childhood immunization and vitamin A supplements may confer protection against malaria infection, although strong evidence to support these theories in humans has so far been lacking. We analyzed national survey data from children aged 6-59 months in four sub-Saharan African countries over an 18-month time period, to determine the risk of Plasmodium spp. parasitemia (n=8390) and Plasmodium falciparum HRP-2 (PfHRP-2)-related antigenemia (n=6121) following vitamin A supplementation and standard vaccination. Bacille Calmette Guerin-vaccinated children were more likely to be PfHRP-2 positive (relative risk [RR]=4.06, 95% confidence interval [CI]=2.00-8.28). No association was identified with parasitemia. Measles and polio vaccination were not associated with malaria. Children receiving vitamin A were less likely to present with parasitemia (RR=0.46, 95% CI=0.39-0.54) and antigenemia (RR=0.23, 95% CI=0.17-0.29). Future studies focusing on climate seasonality, placental malaria and HIV are needed to characterize better the association between vitamin A and malaria infection in different settings.
authors: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States.
authors: Maria-Graciela
authors: MG
authors: Hollm-Delgado
authors: Evolutionary Ecology of Infectious Disease Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors: Frédéric B
authors: FB
authors: Piel
authors: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors: Daniel J
authors: DJ
authors: Weiss
authors: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors: Rosalind E
authors: RE
authors: Howes
authors: Departments of Mental Health and Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States.
authors: Elizabeth A
authors: EA
authors: Stuart
authors: Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
authors: Simon I
authors: SI
authors: Hay
authors: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States.
authors: Robert E
authors: RE
authors: Black
mesh_terms: D017954:Africa South of the Sahara; D000367:Age Factors; D000953:Antigens, Protozoan; D001500:BCG Vaccine / Q000008:administration & dosage; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000276:immunology / Q000469:parasitology / Q000517:prevention & control; D008297:Male; D008458:Measles Vaccine / Q000008:administration & dosage; D018512:Parasitemia / Q000175:diagnosis* / Q000276:immunology / Q000469:parasitology / Q000517:prevention & control; D010963:Plasmodium falciparum / Q000276:immunology*; D023321:Poliovirus Vaccines / Q000008:administration & dosage; D015800:Protozoan Proteins; D012306:Risk; D012621:Seasons; D014801:Vitamin A / Q000008:administration & dosage*
chemical_list: D000953:Antigens, Protozoan; D001500:BCG Vaccine; C514457:HRP-2 antigen, Plasmodium falciparum; D008458:Measles Vaccine; D023321:Poliovirus Vaccines; D015800:Protozoan Proteins; D014801:Vitamin A
keywords: Africa; Plasmodium; child health; epidemiology; global health; human; malaria; vaccination; vitamin A
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