Effect of vitamin A administered at Expanded Program on Immunization contacts on antibody response to oral polio vaccine

Objective: Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV). Design: Randomized, double blind, placebo-controlled trial. Interventions: Mothers in the intervention group received 60 mg retinol equivalent (RE) vitamin A 3-4 weeks after delivery and their infants 7.5 mg RE with each OPV dose at 6, 10 and 14 weeks of age. The control group mothers and their infants received a placebo at each of these contacts. Main outcomes: Geometric mean (GM) titer of neutralizing antibodies and proportion of children with protective titer to the three polioviruses at 26 weeks of age. Results: Vitamin A supplementation increased the proportion of infants with protective antibody titer against poliovirus type 1 (relative risk (RR) 1.15, 95% confidence interval (CI) 1.03-1.28) and the GM antibody titer (ratio of GM 1.55, 95% Cl 1.03 - 2.31) following immunization. The proportion of infants with protective antibody titer against poliovirus type 2 (RR 0.99, 95% Cl 0.94-1.05) or type 3 (RR 1.05, 95% CI 0.96 - 1.15) was not significantly different in vitamin A and placebo groups. The GM antibody titer for poliovirus type 2 (ratio of GM 0.99, 95% Cl 0.64 - 1.54) or pollovirus type 3 (ratio of GM 1.10, 95% CI 0.69 - 1.75) also did not differ across groups. Conclusions: Vitamin A given to the mothers in the postpartum period and their infants with OPV did not interfere with the antibody response to any of the three polioviruses and enhanced the response to poliovirus type 1. Sponsorship: Division of Child Health and Development, WHO, Geneva, Norwegian Universities Committee for Development and Research and Indian Council of Medical Research, Panacea Biotec Ltd, India (provided the oral polio vaccine).