The effect of high-dose vitamin A supplementation at birth on measles incidence during the first 12 months of life in boys and girls: an unplanned study within a randomised trial

Abstract

Vitamin A treatment reduces mortality during acute measles infection, and vitamin A supplementation (VAS) to children above 6 months of age may reduce the incidence of measles infection. The effect of VAS at birth on measles incidence is unknown. In a randomised placebo-controlled trial in Guinea-Bissau, normal-birth-weight newborns were randomised to 50000IU (15mg) VAS or placebo. During the trial, a measles epidemic occurred. We linked data from the trial with data from the measles infection surveillance and studied the effect of VAS on the measles incidence before 12 months of age in both sexes. A total of 165 measles cases were identified among the 4183 children followed from 28d of age. Up to 6 months of age, the incidence rate ratio of measles for VAS compared with placebo was 0·54 (95% CI 0·25, 1·15) among boys and 1·57 (95% CI 0·80, 3·08) among girls (test of interaction, P=0·04). The corresponding figures at 12 months were 0·67 (95% CI 0·43, 1·05) and 1·17 (95% CI 0·76, 1·79) (test of interaction, P=0·08). VAS compared with placebo tended to be associated with less measles hospitalisation or death during the first 6 months of life in boys (P=0·06), but not in girls. VAS at birth may affect the susceptibility to measles infection during the first 6 months of life in a sex-differential manner.