Zinc supplementation as adjunct therapy in children with measles accompanied by pneumonia: a double-blind, randomized controlled trial. 158 Efficacy of Immnunotherapy with an Oral Bacterial Lysate and Vitamin C in the Primary Prevention of Acute Respiratory Tract Infections in Children Global and regional child mortality and burden of disease attributable to zinc deficiency Respiratory infections reduce the growth response to vitamin A supplementation in a randomized controlled trial. A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania. Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study Maternal vitamin D supplementation during pregnancy and lactation to prevent acute respiratory infections in infancy in Dhaka, Bangladesh (MDARI trial): protocol for a prospective cohort study nested within a randomized controlled trial
BACKGROUND Zinc deficiency , common in developing countries , is associated with decreased immunocompetence . Zinc supplementation  benefits children with acute and persistent diarrhea and prevents pneumonia . Most deaths from vaccine-preventable diseases are from measles and whooping cough ; pneumonia is the most common complication of measles and often the proximate cause of related deaths . OBJECTIVE We evaluated the effect of zinc supplementation on episodes of illness in children with measles accompanied by pneumonia . DESIGN In a double-blind , r and omized controlled trial , children aged 9 mo-15 y who were admitted to the Infectious Diseases Hospital in Calcutta with clinical ly severe measles accompanied by pneumonia and who had been ill for < /= 7 d were r and omly assigned to receive zinc ( 20 mg , in elemental form as acetate , twice daily for 6 d ) or a placebo . All patients received st and ard treatment with antibiotics and an initial 100 000-IU dose of vitamin A ( as palmitate ) by mouth . RESULTS Time-to-event analysis using the Cox proportional hazards model ( 42 in the zinc group and 43 in the placebo group ) showed that the time needed for the resolution of fever and tachypnea , the return of appetite , and the achievement of a " much improved " or " cured " status was not different between the 2 groups . A high proportion of children had low serum retinol and zinc concentrations . Improvement in serum zinc and retinol concentrations after 6 d of treatment was not different between the 2 groups . CONCLUSION Children with severe measles accompanied by pneumonia treated with antibiotics and vitamin A did not show any additional benefit from also receiving a zinc supplement Background Airway infections are of great importance worldwide and nearly half of the pediatric consultations in industrialized countries are caused by respiratory tract infections ( RTIs ) . Acute respiratory tract infections ( ARTIs ) are among the main causes of morbidity and mortality in children and recurrent infections of the respiratory tract are the most frequent cause of pharmacotherapy in pediatric practice . The aim of this study was to evaluate the efficacy and tolerability of immunotherapy with oral bacterial lysates + vitamin C in the prevention of ARTIs in children . Methods 109 children with ages between 4 and 16 years with frequent respiratory tract infections ( 2–5 infections the previous winter ) were evaluated . Participants were r and omly allocated in 2 groups : 52 patients ( mean age 6.8 ± 2.9 years ; 20 males 32 females ) received no preventive therapy ( NPT group ) and 57 ( mean age 9.0 ± 3.3 years ; males 36 females 21 ) received immunotherapy with oral bacterial lysates + vitamin C ( VC group ) at the recommended dosage . Patients were followed up for 6 months , including the administration period . Primary end points were the type and number of ARTIs . Secondary end points ( after the infection occured ) included : time to clinical cure , severity of infection , absenteeism from school due to an ARTI , number of antibiotic courses or other drugs prescribed , and duration of concomitant drug treatment . Results There were significant differences between groups in the cumulative number of acute infectious episodes : 170 in NPT group ( 141 upper ARTIs , 29 lower ARTI , and 26 otitis episodes ) vs 55 in VC group ( 50 upper ARTIs , 5 lower ARTI and 4 otitis episodes ) . Patients in the NPT group received 127 antibiotic courses compared to 28 in the VC group ( P < 0.0001 ) . Patients in the NPT group had 475 days of absenteeism from school compared to 100 days in the VC group ( P < 0.0001 ) . No adverse events related to the trial medications were reported . Conclusions Immunotherapy with oral bacterial lysates and vitamin C appears to be very effective in the prevention of infectious episodes in pediatric patients with frequent respiratory tract infections . Future studies are needed to further explore the role of oral bacteroial lysates in ARTIs prevention Background / Objectives : Zinc is an essential micronutrient and deficiency can lead to an increased risk for infectious diseases and growth retardation among children under 5 years of age . We aim ed to estimate disease-specific and all-cause mortality attributable to zinc deficiency . Subject/ Methods : We estimated the prevalence of zinc deficiency in Latin America , Africa and Asia , where based on zinc availability in the diet and childhood stunting rates , zinc deficiency is widespread . The relative risks of death among zinc-deficient children for diarrhea , malaria and pneumonia were estimated from r and omized controlled trials . We used the comparative risk assessment methods to calculate deaths and burden of disease ( measured in disability-adjusted life years , DALYs ) from each of these three diseases attributable to zinc deficiency in these regions . Results : Zinc deficiency was responsible for 453 207 deaths ( 4.4 % of childhood deaths ) , and 1.2 % of the burden of disease ( 3.8 % among children between 6 months and 5 years ) in these three regions in 2004 . Of these deaths , 260 502 were in Africa , 182 546 in Asia and 10 159 in Latin America . Zinc deficiency accounted for 14.4 % of diarrhea deaths , 10.4 % of malaria deaths and 6.7 % of pneumonia deaths among children between 6 months and 5 years of age . Conclusions : Zinc deficiency contributes to substantial morbidity and mortality , especially from diarrhea .  Zinc supplementation provided as an adjunct treatment for diarrhea may be the best way to target children most at risk of deficiency BACKGROUND Studies on the effect of vitamin A supplementation on growth have yielded various results . It is possible that such growth is dependent on the burden of infectious diseases in the population . METHODS We analysed data from a r and omized , double-masked , placebo-controled trial to examine the role of respiratory infections and diarrhoea in modifying the growth response to vitamin A supplementation . A single high dose of vitamin A or placebo was given every 4 months to 1405 children aged 6 - 48 months , and 4430 child treatment cycles were used in this analysis . RESULTS Vitamin A supplementation modestly improved linear but not ponderal growth of children who experienced little respiratory infection and especially of those who had vitamin A intake below the normative requirement ( < 400 RE/day ) . Children who received vitamin A and were free of respiratory infection grew 0.22 cm/4 months ( 95 % CI : 0.08 , 0.37 ) more in height than the placebo group , but those with > or = 21.5 % of days of respiratory infection did not show a significant growth response to vitamin A supplementation . Children who experienced no respiratory infection and had vitamin A intake < 400 RE/day benefited most , gaining 0.31 cm/4 months ( 95 % CI : 0.10 , 0.52 ) more in height compared to the placebo group . Diarrhoea was associated with poorer growth , but did not significantly modify the effect of  vitamin A supplementation  on growth . CONCLUSIONS Vitamin A supplementation improves the linear growth of children who have a low intake of vitamin A but this impact is muted with increasing levels of respiratory infections OBJECTIVES To determine whether vitamin A supplements result in reduced mortality among HIV-infected and uninfected children . DESIGN R and omized , double blind , placebo-controlled trial . METHODS Starting in April , 1993 , we r and omized 687 children age 6 months to 5 years who were admitted to the hospital with pneumonia . Children who were severely malnourished or had clinical signs of vitamin A deficiency were excluded . At baseline children received placebo or 400 000 IU ( or half that for infants ) of vitamin A , in addition to st and ard treatment for pneumonia . They received further doses of the same regimen 4 and 8 months after hospital discharge . Sera from children were tested for HIV antibodies by enzyme-linked immunosorbent assay and Western blot tests . For positive children < 15 months of age , HIV infection was confirmed by amplified heat-denatured HIV-p24 antigen assays with confirmatory neutralization assays . HIV status was ascertained for 648 of 687 enrolled children . The mean duration of follow-up was 24.4 months ( SD = 12.1 ) . RESULTS Of 648 children 58 ( 9 % ) were HIV-infected . Compared with uninfected children , all-cause mortality was higher among HIV-infected children , as was mortality caused by pneumonia or diarrhea ( P < 0.001 for each ) . Overall vitamin A supplements result ed in a 49 % reduction in mortality [ relative risk ( RR ) , 0.51 ; 95 % confidence interval ( CI ) , 0.29 to 0.90 , P = 0.02 ] . Vitamin A supplements reduced all-cause mortality by 63 % among HIV-infected children ( RR 0.37 ; CI 0.14 to 0.95 , P = 0.04 ) and by 42 % among uninfected children ( RR 0.58 , CI 0.28 to 1.19 , P = 0.14 ) . Vitamin A supplements were also associated with a 68 % reduction in AIDS-related deaths ( P = 0.05 ) and a 92 % reduction in diarrhea-related deaths ( P = 0.01 ) . CONCLUSION Vitamin A deficiency , which is common among children in many developing countries , is particularly severe among HIV-infected children . Our findings indicate that vitamin A supplements , a low cost intervention , reduce mortality of HIV-infected children Background Low serum levels of 25-hydroxyvitamin D3 are associated with an increased risk of respiratory tract infections ( RTIs ) . Clinical trials with vitamin D3 against various infections have been carried out but data are so far not conclusive . Thus , there is a need for additional r and omised controlled trials of effects of vitamin D3 on infections . Objective To investigate if supplementation with vitamin D3 could reduce infectious symptoms and antibiotic consumption among patients with antibody deficiency or frequent RTIs . Design A double-blind r and omised controlled trial . Setting Karolinska University Hospital , Huddinge . Participants 140 patients with antibody deficiency ( selective IgA subclass deficiency , IgG subclass deficiency , common variable immune disorder ) and patients with increased susceptibility to RTIs ( > 4 bacterial RTIs/year ) but without immunological diagnosis . Intervention Vitamin D3 ( 4000 IU ) or placebo was given daily for 1 year . Primary and secondary outcome measures The primary endpoint was an infectious score based on five parameters : symptoms from respiratory tract , ears and sinuses , malaise and antibiotic consumption . Secondary endpoints were serum levels of 25-hydroxyvitamin D3 , microbiological findings and levels of antimicrobial peptides ( LL-37 , HNP1–3 ) in nasal fluid . Results The overall infectious score was significantly reduced for patients allocated to the vitamin D group ( 202 points ) compared with the placebo group ( 249 points ; adjusted relative score 0.771 , 95 % CI 0.604 to 0.985 , p=0.04 ) . Limitations A single study centre , small sample size and a selected group of patients . The sample size calculation was performed using p=0.02 as the significance level whereas the primary and secondary endpoints were analysed using the conventional p=0.05 as the significance level . Conclusions Supplementation with vitamin D3 may reduce disease burden in patients with frequent RTIs Background Early infancy is a high-risk period for severe acute respiratory infection ( ARI ) , particularly in low-income countries with re source -limited health systems . Lower respiratory tract infection ( LRTI ) is commonly preceded by upper respiratory infection ( URTI ) , and often caused by respiratory syncytial virus ( RSV ) , influenza and other common community-acquired viral pathogens . Vitamin D status is a c and i date modifiable early-life determinant of the host antiviral immune response and thus may influence the risk of ARI-associated morbidity in high-risk population s. Methods / Design In the Maternal Vitamin D for Infant Growth ( MDIG ) study in Dhaka , Bangladesh ( NCT01924013 ) , 1300 pregnant women are r and omized to one of five groups : placebo , 4200 IU/week , 16,800 IU/week , or 28,000 IU/week from 2nd trimester to delivery plus placebo from 0–6 months postpartum ; or , 28,000 IU/week prenatal and until 6-months postpartum . In the Maternal Vitamin D for ARI in Infancy ( MDARI ) sub- study nested within the MDIG trial , trained personnel conduct weekly postnatal home visits to inquire about ARI symptoms and conduct a st and ardized clinical assessment . Supplementary home visits between surveillance visits are conducted when caregivers make phone notifications of new infant symptoms . Mid-turbinate nasal swab sample s are obtained from infants who meet st and ardized clinical ARI criteria . Specimens are tested by polymerase chain reaction ( PCR ) for 8 viruses ( influenza A/B , parainfluenza 1/2/3 , RSV , adenovirus , and human metapneumovirus ) , and nasal carriage density of Streptococcus pneumoniae . The primary outcome is the incidence rate of microbiologically-positive viral ARI , using incidence rate ratios to estimate between-group differences . We hypothesize that among infants 0–6 months of age , the incidence of microbiologically-confirmed viral ARI will be significantly lower in infants whose mothers received high-dose prenatal/postpartum vitamin D supplements versus placebo . Secondary outcomes include incidence of ARI associated with specific pathogens ( influenza A or B , RSV ) , clinical ARI , and density of pneumococcal carriage . Discussion If shown to reduce the risk of viral ARI in infancy , integration of maternal prenatal/postpartum vitamin D supplementation into antenatal care programs in South Asia may be a feasible primary preventive strategy to reduce the burden of ARI-associated morbidity and mortality in young infants . Trial registration NCT02388516 , registered March 9 , 2015
Due to the small number of included studies and very low quality of the existing evidence , we are uncertain of the effect of vitamin C supplementation for the prevention and treatment of pneumonia .
BACKGROUND According to the Global Burden of Disease Study 2015 , lower respiratory tract infection is the leading cause of infectious disease death , and the fifth most common cause of death overall .
Vitamin C has a role in modulating resistance to infectious agents , therefore vitamin C supplementation may be important in preventing and treating pneumonia .
OBJECTIVES To assess the impact of vitamin C supplementation to prevent and treat pneumonia in children and adults .