Maternal Priming: Bacillus Calmette-Guérin (BCG) Vaccine Scarring in Mothers Enhances the Survival of Their Child With a BCG Vaccine Scar

2019 ◽  
Vol 9 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Mike L T Berendsen ◽  
Christian Bjerregård Øland ◽  
Pauli Bles ◽  
Aksel Karl Georg Jensen ◽  
Poul-Erik Kofoed ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Vitamin A ◽  
Proportional Hazards Model ◽  
Controlled Trial ◽  
Child Survival ◽  
Cox Proportional Hazards Model ◽  
Bcg Vaccine ◽  
Lower Mortality ◽  
Bacillus Calmette Guerin ◽  
Vitamin A Supplementation

Abstract Background and Hypothesis Maternal priming might enhance the beneficial nonspecific effects (NSEs) of live measles vaccination (MV). Children with a bacillus Calmette-Guérin (BCG) vaccine scar have a lower mortality rate than those without a scar that is not explained by protection against tuberculosis. We examined the hypothesis that BCG scarring would have a stronger effect on a child if the mother also had a BCG scar. Methods In a randomized controlled trial (RCT) of early MV in children aged 4.5 months, the BCG-scar status of the children and their mother were registered at enrollment at 4.5 months of age. The children were followed up until they were 36 months of age. Using a Cox proportional hazards model, we compared mortality rate ratios according to maternal and child BCG-scar status after adjusting for where the BCG vaccine was given (the national hospital or elsewhere). We censored for other interventions that have immunomodulating effects on child survival, including neonatal vitamin A supplementation and early MV. Results A total of 2213 children had not received neonatal vitamin A supplementation and early MV; 83% of these children and 44% of the mothers had a BCG scar. Children whose mother had a BCG scar were not more likely to have a BCG scar than those whose mother did not have a BCG scar (risk ratio, 1.01 [95% confidence interval (CI), 0.98–1.05]). Among the children, having a BCG scar was associated with a 41% (95% CI, 5%–64%) lower mortality between the ages of 4.5 and 36 months. The reduction in mortality was 66% (95% CI, 33%–83%) if the mother also had a BCG scar but only 8% (95% CI, −83% to 53%) if the mother had no BCG scar (test of interaction, P = .04). Conclusions Maternal BCG priming might be important for the effect of BCG vaccination on child survival. Ensuring better BCG vaccine scarring among mothers and children could have a considerable effect on child mortality levels.

scholarly journals The effects of maternal and infant vitamin A supplementation on vitamin A status: a randomised trial in Kenya

2007 ◽  
Vol 98 (2) ◽  
pp. 422-430 ◽  
Author(s):  
R. A. Ayah ◽  
D. L. Mwaniki ◽  
P. Magnussen ◽  
A. E. Tedstone ◽  
T. Marshall ◽  
...  
Keyword(s):  
Vitamin A ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Maternal Serum ◽  
High Dose ◽  
Serum Retinol ◽  
Double Blind ◽  
Vitamin A Supplementation ◽  
Factors Affecting ◽  
Vitamin A Status

Postpartum vitamin A supplementation of mothers and infants is recommended, but the efficacy has been questioned. In this double-blind, placebo-controlled trial, Kenyan mother–infant pairs were randomised to maternal vitamin A (400 000 IU) or placebo < 24 h postpartum, and infant vitamin A (100 000 IU) or placebo at 14 weeks. Milk retinol was determined at weeks 4, 14 and 26, and maternal and infant serum retinol at weeks 14 and 26. Infant retinol stores were assessed at week 26, using a modified relative dose response (MRDR) test. Among 564 women, serum retinol at 36 weeks gestation was 0·81 (sd 0·21) μmol/l, and 33·3 % were < 0·7 μmol/l. Maternal serum retinol was not different between groups, but milk retinol was higher in the vitamin A group: (0·67 v. 0·60 μmol/l; 0·52 v. 0·44 μmol/l; 0·50 v. 0·44 μmol/l at 4, 14 and 26 weeks, respectively). When expressed per gram fat, milk retinol was higher in the vitamin A group only at 4 weeks. Infant serum retinol was not different between groups. However, although most infants had deficient vitamin A stores (MRDR>0·06 %) at 26 weeks, vitamin A to infants, but not mothers, resulted in a lower proportion of infants with deficient vitamin A stores (69 v. 78 %). High-dose postpartum vitamin A supplementation failed to increase serum retinol and infant stores, despite modest effects on milk retinol. Infant supplementation, however, increased stores. There is a need for a better understanding of factors affecting absorption and metabolism of vitamin A.

Coverage of the vitamin A supplementation programme for child survival in Nepal: success and challenges

2012 ◽  
Vol 32 (4) ◽  
pp. 233-238 ◽  
Author(s):  
A M Nguyen ◽  
D S Grover ◽  
K Sun ◽  
V K Raju ◽  
R D Semba ◽  
...  
Keyword(s):  
Vitamin A ◽  
Child Survival ◽  
Vitamin A Supplementation

scholarly journals Effect of neonatal vitamin A supplementation on mortality in infants in Tanzania (Neovita): a randomised, double-blind, placebo-controlled trial

The Lancet ◽  
2015 ◽  
Vol 385 (9975) ◽  
pp. 1324-1332 ◽  
Author(s):  
Honorati Masanja ◽  
Emily R Smith ◽  
Alfa Muhihi ◽  
Christina Briegleb ◽  
Salum Mshamu ◽  
...  
Keyword(s):  
Vitamin A ◽  
Controlled Trial ◽  
Double Blind ◽  
Vitamin A Supplementation ◽  
Double Blind Placebo

scholarly journals Refocusing vitamin A supplementation programmes to reach the most vulnerable

2020 ◽  
Vol 5 (7) ◽  
pp. e001997
Author(s):  
Erin McLean ◽  
Rolf Klemm ◽  
Hamsa Subramaniam ◽  
Alison Greig
Keyword(s):  
Vitamin A ◽  
Child Mortality ◽  
Vitamin A Deficiency ◽  
Child Survival ◽  
Public Health Problem ◽  
Mortality Rates ◽  
Vitamin A Supplementation ◽  
Use Of Resources ◽  
Year 2000 ◽  
Programme Coverage

WHO recommends vitamin A supplementation (VAS) programmes for children 6–59 months where vitamin A deficiency is a public health problem. However, resources for VAS are falling short of current needs and programme coverage is suffering. The authors present the case for considering the options for shifting efforts and resources from a generalised approach, to prioritising resources to reach populations with continued high child mortality rates and high vitamin A deficiency prevalence to maximise child survival benefits . This includes evaluating where child mortality and/or vitamin A deficiency has dropped, as well as using under 5 mortality rates as a proxy for vitamin A deficiency, in the absence of recent data. The analysis supports that fewer countries may now need to prioritise VAS than in the year 2000, but that there are still a large number of countries that do. The authors also outline next steps for analysing options for improved targeting and cost-effectiveness of programmes. Focusing VAS resources to reach the most vulnerable is an efficient use of resources and will continue to promote young child survival.

The Impact of Prenatal Vitamin A and Zinc Supplementation on Birth Size and Neonatal Survival - a Double-Blind, Randomized Controlled Trial in a Rural Area of Indonesia

2013 ◽  
Vol 83 (1) ◽  
pp. 14-25 ◽  
Author(s):  
Endy P. Prawirohartono ◽  
Lennarth Nyström ◽  
Detty S. Nurdiati ◽  
Mohammad Hakimi ◽  
Torbjörn Lind
Keyword(s):  
Randomized Controlled Trial ◽  
Birth Weight ◽  
Vitamin A ◽  
Zinc Supplementation ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Birth Length ◽  
Double Blind ◽  
Vitamin A Supplementation ◽  
Randomized Controlled

Background: Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in settings where infants and children are at risk of micronutrient deficiencies. Objective: To assess whether vitamin A and/or zinc supplementation given during pregnancy can improve birth weight, birth length, neonatal morbidity, or infant mortality. Methods: A double-blind, randomized controlled trial supplementing women (n = 2173) in Central Java, Indonesia throughout pregnancy with vitamin A, zinc, combined vitamin A+zinc, or placebo. Results: Out of 2173 supplemented pregnant women, 1956 neonates could be evaluated. Overall, zinc supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.8 vs. 48.5 cm, p = 0.04); vitamin A supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.7 vs. 48.2 cm, p = 0.04). These effects remained after adjusting for maternal height, pre-pregnancy weight, and parity. There was no effect of supplementation on birth weight, the proportion of low birth weight, neonatal morbidity, or mortality. Conclusions: Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length, but supplementation with zinc, vitamin A or a combination of zinc and vitamin A, have no effect on birth weight, neonatal morbidity, or mortality.

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