Globally, it is estimated that 140250 million
children under five years of age are affected by vitamin A deficiency. These children
suffer a dramatically increased risk of death, blindness and illness, especially from
measles and diarrhoea. As part of the global call to action, the UN Special Session on
Children in 2002 set as one of its goals the elimination of vitamin A deficiency and
its consequences by the year 2010. The strategy to achieve this goal is to ensure that
young children living in areas where the intake of vitamin A is inadequate receive the
vitamin through a combination of breast feeding, dietary improvement, food fortification,
Combining the administration of vitamin A supplements
with immunization is an important part of this effort. Since 1987, WHO has advocated the
routine administration of vitamin A with measles vaccine in countries where vitamin A
deficiency is a problem. Great success and many millions of children have been reached by
including vitamin A with National Immunization Days (NIDs) to eradicate polio. Providing
immunization-linked high-dose supplementation to new mothers soon after delivery has
provided a further benefit to young infants through enriched breast milk.
Provision of vitamin A supplements every four to six
months is an inexpensive, quick, and effective way to improve vitamin A status and save
children's lives. The Beaton Report concluded that all-cause mortality among
children aged 659 months was reduced by 23% through vitamin A supplementation in
areas where vitamin A deficiency was a public health problem. However, comprehensive
control of vitamin A deficiency must include dietary improvement and food fortification in
the long term.
Vitamin A is essential for the functioning of the immune
system and the healthy growth and development of children. Immunization contacts offer
unrivalled opportunities for delivering vitamin A to children who suffer from deficiency.
Studies show that vitamin A does not have any negative effect on seroconversion of
As well as routine immunization services, national
immunization days for polio eradication, measles, and multi-antigen campaigns have been
used safely and successfully to provide vitamin A to a wide age range of children at risk.
High-dose vitamin A should be avoided during pregnancy
because of the theoretical risk of teratogenisis (birth defects). From a programmatic
perspective, high-dose vitamin A supplementation must occur during the safe infertile
period immediately after delivery. Accordingly, high-dose vitamin A supplementation can be
provided safely to all postpartum mothers within six weeks of delivery, when the chance of
pregnancy is remote. For breastfeeding mothers, the safe infertile period extends up to
eight weeks after delivery. The first contact with the infant immunization services
provides an excellent opportunity to supplement postpartum mothers and improve the vitamin
A content of their breast milk.
There is a well-established scientific basis for the
treatment of measles cases with vitamin A supplementation that is recommended by WHO as
part of the integrated management of childhood illness.
The recommended doses of vitamin A supplementation for
the prevention of vitamin A deficiency are indicated in the following table.
Field trials are in progress with a view to confirming
the suitability of administering vitamin A with the DTP doses during infancy.
Potential target groups and immunization contacts in
countries with vitamin A deficiency
Vitamin A dose
|All mothers irrespective of
their mode of infant feeding up to six weeks postpartum if they have not received vitamin
A supplementation after delivery
||BCG, OPV-0 or DTP-1 contact up
to six weeks
||200 000 IU
|Infants aged 911 months
Children aged 12 months and older
|Measles vaccine contact
||100 000 IU
200 000 IU
|Children aged 14 years
Delayed primary immunization doses*
|200 000 IU
* The optimal interval between doses is four
to six months. A dose should not be given too soon after a previous dose of vitamin A
supplement: the minimum recommended interval between doses for the prevention of vitamin A
deficiency is one month (the interval can be reduced in order to treat clinical vitamin A
deficiency and measles cases).
Beaton GH, Martorell R, L'Abbé, et al.
Effectiveness of vitamin A supplementation in the control of young child morbidity and
mortality in developing countries. UN, ACC/SCN State-of-the-art Series, Nutrition policy
Discussion Paper No. 13, 1993.
Ching P, Birmingham M, et al. Childhood mortality impact
and costs of integrating vitamin A supplementation into immunization campaigns. American
Journal of Public Health, 2000, 90(10):15261529.
Distribution of vitamin A during national immunization
days. A generic addendum to the Field guide for supplementary activities aimed at
achieving polio eradication, 1996 revision. Geneva, 1998 (unpublished document
WHO/EPI/GEN/98.06; available from Vaccines and Biologicals, World Health Organization,
1211 Geneva 27, Switzerland and on the Internet at www.who.int/vaccines-documents/DocsPDF/www9836.pdf).
Goodman T, Dalmiya N, et al. Polio as a platform: using
national immunization days to deliver vitamin A supplements. Bulletin of the World Health
Organization, 2000, 78(3):
Helen Keller International and WHO. Integrating vitamin A
with immunization: An information and training package (CD-ROM) 2000.
Integrated management of childhood illness: a WHO
initiative. Bulletin of the World Health Organization, 1997, 75 (Suppl 1: 119128).
Integration of vitamin A supplementation with
immunization. Weekly Epidemiological Record, 1999, 74:16 and on the Internet at http://www.who.int/wer/pdf/1999/wer7401.pdf.
Integration of vitamin A supplementation with
immunization: policy and programme implications. Report of a meeting, 12-13 January 1998,
UNICEF, New York. Geneva, 1998 (unpublished document WHO/EPI/GEN/98.07; available from
Vaccines and Biologicals, World Health Organization, 1211 Geneva 27, Switzerland and on
the Internet at www.who.int/vaccines-documents/DocsPDF/www9837.pdf).
WHO/UNICEF/IVACG. Vitamin A supplements: a guide to their
use in the treatment and prevention of vitamin A deficiency and xerophthalmia (2nd
edition.) Geneva: World Health Organization; 1997.
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