Landscape analysis of interactions between nutrition and vaccine responses in children

TY - JOUR

T1 - Landscape analysis of interactions between nutrition and vaccine responses in children

AU - Savy, Mathilde

AU - Edmond, Karen

AU - Fine, Paul E M

AU - Hall, Andrew

AU - Hennig, Branwen J

AU - Moore, Sophie E

AU - Mulholland, Kim

AU - Schaible, Ulrich

AU - Prentice, Andrew M

PY - 2009/11

Y1 - 2009/11

N2 - The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested. This report provides a critical review of the published interactions between nutritional status and/or supplementation and vaccine responses in children. Due to an absence of evidence for most nutrients, this analysis focused on protein-energy, vitamins A and D, and iron and zinc. All vaccines were considered. Both observational studies and clinical trials that led to peer-reviewed publications in English or French were included. These criteria led to a pool of 58 studies for protein-energy malnutrition, 43 for VA, 4 for vitamin D, 10 for iron, and 22 for zinc. Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses. Evidence for definitive adjunctive effects of micronutrient supplementation at the time of vaccination is also weak. Overall, the paucity, poor quality, and heterogeneity of data make it difficult to draw firm conclusions. The use of simple endpoints that may not correlate strongly with disease protection adds uncertainty. A detailed examination of the immunological mechanisms involved in potential interactions, employing modern methodologies, is therefore required. This would also help us understand the proposed, but still unproven, negative interactions between VAS and vaccine safety, a resolution of which is urgently required.

AB - The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested. This report provides a critical review of the published interactions between nutritional status and/or supplementation and vaccine responses in children. Due to an absence of evidence for most nutrients, this analysis focused on protein-energy, vitamins A and D, and iron and zinc. All vaccines were considered. Both observational studies and clinical trials that led to peer-reviewed publications in English or French were included. These criteria led to a pool of 58 studies for protein-energy malnutrition, 43 for VA, 4 for vitamin D, 10 for iron, and 22 for zinc. Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses. Evidence for definitive adjunctive effects of micronutrient supplementation at the time of vaccination is also weak. Overall, the paucity, poor quality, and heterogeneity of data make it difficult to draw firm conclusions. The use of simple endpoints that may not correlate strongly with disease protection adds uncertainty. A detailed examination of the immunological mechanisms involved in potential interactions, employing modern methodologies, is therefore required. This would also help us understand the proposed, but still unproven, negative interactions between VAS and vaccine safety, a resolution of which is urgently required.

KW - Anemia, Iron-Deficiency/diagnosis

KW - Child

KW - Dietary Supplements/statistics & numerical data

KW - Diphtheria-Tetanus-Pertussis Vaccine/immunology

KW - Humans

KW - Immunotherapy/methods

KW - Malnutrition/immunology

KW - Nutritional Status

KW - Patient Selection

KW - Protein-Energy Malnutrition/immunology

KW - Safety

KW - Vaccines/immunology

KW - Vitamin A/administration & dosage

KW - Vitamin D/administration & dosage

KW - Vitamin D Deficiency/diagnosis

KW - Zinc/deficiency

U2 - 10.3945/jn.109.105312

DO - 10.3945/jn.109.105312

M3 - Review article

C2 - 19793845

SN - 0022-3166

VL - 139

SP - 2154S-218S

JO - The Journal of nutrition

JF - The Journal of nutrition

IS - 11

ER -