ACUTE RESPIRATORY-INFECTIONS PREVENT IMPROVEMENT OF VITAMIN-A STATUS IN YOUNG INFANTS SUPPLEMENTED WITH VITAMIN-A

At immunization contact, 165 infants 2.5 mo old were randomly assigned to receive either 15 mg vitamin A (retinyl palmitate) or placebo. Thr ee doses were given at monthly intervals with each diptheria, pertussi s, tetanus and oral polio (DPT/OPV) immunization dose. The diarrhea an d acute respiratory infection (ARI) morbidity was similar in the vitam in A and placebo groups. However, the duration (days per child-year, m ean +/- so) of ARI was less in the vitamin A group compared with place bo group (27.6 +/- 17.1 vs. 40.8 +/- 22.7; P = 0.005). Easting retinol concentrations were measured at entry and in 61 infants, the relative dose response (RDR) test was done 1 mo after the third dose of vitami n A. Eighty-five percent of the infants had serum retinol concentratio n < 0.70 mol/L at entry. After 3 mo the serum retinol levels improved significantly in both groups, and in the vitamin A-supplemented group the serum retinol concentration was significantly better than that in the placebo group (P = 0.02). However, 61% of the infants remained def icient despite vitamin A supplementation. Among vitamin A-supplemented infants only, diarrhea and ARI morbidity during the 3-mo period were compared in children with normal versus children with abnormal RDR at the end of the supplementation period. The ARI episodes were more freq uent in the supplemented infants who remained vitamin A deficient at t he end of the 3 mo (P = 0.027). Also, the cumulative duration (days, m ean +/- so) of fever and cough was 5.0 +/- 2.8 in the normal versus 11 .2 +/- 6.0 in the deficient group (P = 0.04). The results of this stud y suggest that a large proportion of infants remain vitamin A deficien t even after large dose vitamin A supplementation because of frequent respiratory infections, particularly those accompanied by fever.