Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
J Nutr. 2009 Nov;139(11):2154S-218S. doi: 10.3945/jn.109.105312. Epub 2009 Sep 30.
The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested. This report provides a critical review of the published interactions between nutritional status and/or supplementation and vaccine responses in children. Due to an absence of evidence for most nutrients, this analysis focused on protein-energy, vitamins A and D, and iron and zinc. All vaccines were considered. Both observational studies and clinical trials that led to peer-reviewed publications in English or French were included. These criteria led to a pool of 58 studies for protein-energy malnutrition, 43 for VA, 4 for vitamin D, 10 for iron, and 22 for zinc. Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses. Evidence for definitive adjunctive effects of micronutrient supplementation at the time of vaccination is also weak. Overall, the paucity, poor quality, and heterogeneity of data make it difficult to draw firm conclusions. The use of simple endpoints that may not correlate strongly with disease protection adds uncertainty. A detailed examination of the immunological mechanisms involved in potential interactions, employing modern methodologies, is therefore required. This would also help us understand the proposed, but still unproven, negative interactions between VAS and vaccine safety, a resolution of which is urgently required.
世界上最贫困的儿童在接种儿童疫苗时可能会营养不良。目前尚不清楚这是否会影响疫苗的效果，以及同时给儿童接种营养补充剂是否会产生有益或有害的影响。最近，有人提出维生素 A（VA）补充剂（VAS）与儿童早期接种的灭活白喉-破伤风-百日咳疫苗之间存在有害相互作用。本报告对已发表的有关儿童营养状况和/或补充剂与疫苗反应之间相互作用的研究进行了批判性评价。由于大多数营养素缺乏证据，因此该分析主要集中在蛋白质能量、维生素 A 和 D 以及铁和锌上。所有疫苗都被考虑在内。包括了以英语或法语发表的同行评审出版物的观察性研究和临床试验。这些标准导致了 58 项关于蛋白质能量营养不良、43 项关于 VA、4 项关于维生素 D、10 项关于铁和 22 项关于锌的研究。我们的分析表明，营养不良对疫苗反应的影响很小或没有。在接种疫苗时补充微量营养素的明确辅助作用的证据也很薄弱。总体而言，数据的缺乏、质量差和异质性使得很难得出明确的结论。使用可能与疾病保护相关性不强的简单终点也增加了不确定性。因此，需要采用现代方法学对潜在相互作用涉及的免疫机制进行详细检查。这也将帮助我们理解 VAS 与疫苗安全性之间提出但尚未得到证实的负面相互作用，迫切需要解决这一问题。
