Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants

Nasopharyngeal colonization is a risk factor for pneumococcal disease, a le ading cause of complications and death in infants. We assessed the impact o f vitamin A supplementation in reducing pneumococcal colonization in infant s from an area with endemic vitamin A deficiency. We recruited 464 2-mo-old infants from a rural area in South India. Infants were randomly assigned t o receive two 7000-mug retinol equivalent doses of vitamin A (n = 239) or p lacebo (n = 225) orally at birth, and nasopharyngeal specimens were collect ed at ages 2, 4 and 6 mo. We studied the effect of vitamin A on culture-con firmed pneumococcal colonization and on the distribution of pneumococcal se rotypes. Analyses were conducted by intention-to-treat. The risk of coloniz ation among infants aged 4 mo who were not colonized by age 2 mo was signif icantly reduced in the vitamin A group compared with the placebo group [odd s ratio 0.51 (0.28, 0.92), P = 0.02). The odds of colonization were 27% low er in the treatment group than in the placebo group [odds ratio 0.73 (0.48, 1.1), P = 0.13]. No differences were detected in the prevalence of invasiv e serotypes. The risk of colonization with penicillin-resistant isolates wa s 74% lower in the vitamin A group than in the placebo group at 2 mo of age . However, the prevalence of penicillin-resistant isolates was only 4%. Neo natal vitamin A supplementation may play a role in lowering morbidity rates associated with pneumococcal disease by delaying the age at which coloniza tion occurs.