Effect of maternal vitamin D supplementation on nasal pneumococcal acquisition, carriage dynamics and carriage density in infants in Dhaka, Bangladesh

Mahgol Taghivand,Daniel E Roth,Eleanor M Pullangyeum,Davidson H Hamer,Eric O Ohuma,Shaun K Morris,Abdullah A Mahmud,Stanley H Zlotkin,Jonathan B Gubbay,Mohammed Z Rahman,Lisa G Pell,Tahmeed Ahmed

doi:10.1186/s12879-022-07032-y

Abstract

BackgroundInvasive pneumococcal disease is a major cause of infant morbidity and death worldwide. Vitamin D promotes anti-pneumococcal immune responses in vitro, but whether improvements in infant vitamin D status modify risks of nasal pneumococcal acquisition in early life is not known.MethodsThis is a secondary analysis of data collected in a trial cohort in Dhaka, Bangladesh. Acute respiratory infection (ARI) surveillance was conducted from 0 to 6 months of age among 1060 infants of women randomized to one of four pre/post-partum vitamin D dose combinations or placebo. Nasal swab samples were collected based on standardized ARI criteria, and pneumococcal DNA quantified by qPCR. Hazards ratios of pneumococcal acquisition and carriage dynamics were estimated using interval-censored survival and multi-state modelling.ResultsPneumococcal carriage was detected at least once in 90% of infants by 6 months of age; overall, 69% of swabs were positive (2616/3792). There were no differences between any vitamin D group and placebo in the hazards of pneumococcal acquisition, carriage dynamics, or carriage density (p > 0.05 for all comparisons).ConclusionDespite in vitro data suggesting that vitamin D promoted immune responses against pneumococcus, improvements in postnatal vitamin D status did not reduce the rate, alter age of onset, or change dynamics of nasal pneumococcal colonization in early infancy.Trial registration Registered in ClinicalTrials.gov with the registration number of NCT02388516 and first posted on March 17, 2015.

Highlights

Invasive pneumococcal disease is a major cause of infant morbidity and death worldwide
Bangladesh is a low- and middle-income countries (LMICs) with a high burden of invasive pneumococcal disease (IPD) [34] and a high prevalence of maternal and neonatal Vitamin D (VD) deficiency [35]. In this sub-study of a randomized controlled trial and nested cohort study in Bangladesh [33, 35], we aimed to estimate the dose-dependent effect of maternal VD supplementation during pregnancy and lactation on the risk of nasal pneumococcal acquisition, carriage dynamics and nasal pneumococcal carriage density in infants from birth to 6 months of age
Study design and participants This was a secondary analysis of data collected during the Maternal Vitamin D Supplementation to Prevent Acute Respiratory Infections (MDARI) study nested in the Maternal Vitamin D for Infant Growth (MDIG) trial (ClinicalTrials.gov:NCT02388516; First Registered: 17/03/2015)

Summary

Introduction

Invasive pneumococcal disease is a major cause of infant morbidity and death worldwide. Streptococcus pneumoniae (pneumococcus) is one of the leading bacterial causes of meningitis, sepsis, pneumonia and otitis media in young children worldwide, with the burden falling on low- and middle-income countries (LMICs) [1]. Taghivand et al BMC Infectious Diseases (2022) 22:52 pneumococcus as a culture-confirmed cause of neonatal sepsis almost as commonly as Streptococcus agalactiae (group B streptococcus) in infants 0–59 days of age [2]. Carriage is asymptomatic but can be an antecedent to otitis media and invasive pneumococcal disease (IPD), usually attributable to a recently acquired serotype [9]. Factors influencing progression from carriage to disease include the virulence of the colonizing serotype (certain serotypes are more likely to cause IPD), respiratory virus co-infections, and host immune status [6,7,8]

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