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Depressed Immune Response to Tetanus in Children with Vitamin A Deficiency¹

Richard D. Semba², Muhilal^*, Alan L. Scott, Gantira Natadisastra, Sopandi Wirasasmita, Lisa Mele, Endi Ridwan^*, Keith P. West, Jr. and Alfred Sommer

Dana Center for Preventive Ophthalmology, Wilmer Institute and the Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, ^* Nutrition Research and Development Centre, Ministry of Health, Government of Indonesia, Bogor, Indonesia Cicendo Eye Hospital, Bandung, Indonesia

A randomized, double-masked, placebo-controlled clinical trial was conducted with 236 preschool children, age 3–6 y, in indonesia to assess immune status in mild vitamin A deficiency. The immune response to tetanus immunization was used as a measure of immune competence. Clinically normal children (n = 118) and children with mild xerophthalmia (n = 118) were randomly assigned to receive oral vitamin A (60,000 µg retinol equivalent) or placebo treatment for a total of four study groups. Two weeks after treatment, children were immunized with diphtheria-pertussis-tetanus vaccine. The immunoglobulin G (IgG) responses to tetanus at baseline and 3 wk following immunization were measured by ELISA. After adjusting for previous tetanus immunization, clinically normal and xerophthalmic children receiving vitamin A had a significantly greater IgG response to tetanus than clinically normal and xerophthalmic children receiving placebo (P < 0.05). These results suggest that children with mild vitamin A deficiency have a relative immune depression compared with children who have been supplemented to normal vitamin A levels.

KEY WORDS: • vitamin A deficiency • xerophthalmia • immunodeficiency • tetanus • children

¹ This study was conducted under Cooperative Agreement DNA-0045-A-5094-00 between the Dana Center for Preventive Ophthalmology, the Johns Hopkins University, and the Office of Nutrition, Bureau for Science and Technology, United States Agency for Internatinal Development, with additional financial assistance from the National Institutes of Health grants K11 EY00286, RR-04060, and Task Force Sight and Life, Hoffmann-La Roche Laboratories.

² To whom correspondence should be addressed.

Manuscript received 21 February 1991. Revision accepted 18 June 1991.

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