Does the effect of vitamin A supplements depend on vaccination status? An observational study from Guinea-Bissau.
Does the effect of vitamin A supplements depend on vaccination status? An observational study from Guinea-Bissau.
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DOI：
10.1136/bmjopen-2011-000448
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Benn CS
中科院分区：
文献类型：
--
作者：
Fisker AB;Aaby P;Bale C;Balde I;Biering-Sørensen S;Agergaard J;Martins C;Bibby BM;Benn CS
据估计，维生素A补充剂（VAS）可使全因死亡率降低24%。既往研究表明，VAS的影响可能因疫苗接种状态而异。作者评价了运动中提供的VAS对儿童总体生存率的影响，并按补充时的性别和疫苗接种状态进行了评价。观察性队列研究。这项研究是在几内亚比绍Bandim卫生项目的城市研究区进行的。作者记录了2007年12月和2008年7月为6至35个月大的儿童开展的两次全国性维生素A运动的参与或不参与情况。 通过检查疫苗接种卡确定疫苗接种状态。对所有儿童进行前瞻性随访。在提供死亡率比（MRR）的考克斯模型中比较了补充和未补充儿童的死亡率。作者从2007年5567名儿童中的93%和2008年5799名儿童中的90%获得了信息。2007年VAS覆盖率为58%，2008年为68%。补充组的死亡率为1.5%（44例死亡/2873人-年），未补充组为1.6%（20例死亡/1260人-年）（校正MRR=0.78（0.46; 1.34））。男孩和女孩的效果相似。2007年和2008年接种疫苗卡的比例分别为86%和84%。麻疹疫苗作为末次疫苗接种的儿童（2814名儿童，校正MRR=0.34（0.14; 0.85））的VAS效果与白喉-破伤风-百日咳疫苗作为末次疫苗接种的儿童（3680名儿童，校正MRR=1.29（0.52; 3.22），相互作用p=0.04）的VAS效果不同。VAS的效果因最近的疫苗接种而异，麻疹疫苗接种后有益，但白喉-破伤风-百日咳疫苗接种后无效。据估计，维生素A补充剂（VAS）可使全因死亡率降低24%。VAS的效果可能因疫苗接种状态而异，麻疹疫苗（MV）接种或接种后有益，但白喉-破伤风-百日咳（DTP）疫苗接种后无效。VAS的效果是不均匀的。VAS的效果随疫苗接种状态而变化：当MV是最近的疫苗时，补充儿童的死亡率低于未补充儿童，但当DTP是最近的疫苗时，死亡率则不同。VAS的效果往往因补充季节而异。在个人层面上收集信息，并对儿童进行前瞻性随访。由于研究的观察性质，应谨慎解释补充和未补充儿童的比较。然而，选择偏差不太可能在不同的方向上对DTP和MV作为最新疫苗的儿童起作用。
Vitamin A supplementation (VAS) is estimated to reduce all-cause mortality by 24%. Previous studies indicate that the effect of VAS may vary with vaccination status. The authors evaluated the effect of VAS provided in campaigns on child survival overall and by sex and vaccination status at the time of supplementation. Observational cohort study. The study was conducted in the urban study area of the Bandim Health Project in Guinea-Bissau. The authors documented participation or non-participation in two national vitamin A campaigns in December 2007 and July 2008 for children between 6 and 35 months of age. Vaccination status was ascertained by inspection of vaccination cards. All children were followed prospectively. Mortality rates for supplemented and non-supplemented children were compared in Cox models providing mortality rate ratios (MRRs). The authors obtained information from 93% of 5567 children in 2007 and 90% of 5799 children in 2008. The VAS coverage was 58% in 2007 and 68% in 2008. Mortality in the supplemented group was 1.5% (44 deaths/2873 person-years) and 1.6% (20 deaths/1260 person-years) in the non-supplemented group (adjusted MRR=0.78 (0.46; 1.34)). The effect was similar in boys and girls. Vaccination cards were seen for 86% in 2007 and 84% in 2008. The effect of VAS in children who had measles vaccine as their last vaccine (2814 children, adjusted MRR=0.34 (0.14; 0.85)) differed from the effect in children who had diphtheria–tetanus–pertussis vaccine as their last vaccine (3680 children, adjusted MRR=1.29 (0.52; 3.22), p=0.04 for interaction). The effect of VAS differed by most recent vaccination, being beneficial after measles vaccine but not after diphtheria–tetanus–pertussis vaccine. Vitamin A supplementation (VAS) is estimated to reduce all-cause mortality by 24%. The effect of VAS may vary with vaccination status, being beneficial with or after measles vaccine (MV) but not after diphtheria–tetanus–pertussis (DTP) vaccine. The effect of VAS is heterogeneous. The effect of VAS varied with vaccination status: supplemented children had lower mortality than non-supplemented children when MV was the most recent vaccine but not when DTP was the most recent vaccine. The effect of VAS tended to differ by season of supplementation. Information was collected on the individual level, and the children were followed prospectively. Due to the observational nature of the study, the comparison of supplemented and non-supplemented children should be interpreted with caution. However, a selection bias is unlikely to have worked in different directions for children who had DTP and MV as the most recent vaccine.
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