Vitamin A is essential for the functioning of the immune system and the healthy growth and development of children, and is usually acquired through a healthy diet. Yet, vitamin A deficiency is the leading cause of preventable childhood blindness and increases the risk of death from common childhood infections, such as measles and those causing diarrhoea. In 2013, the World Health Organization classified vitamin A deficiency as a public health problem, as it was affecting about one in three children aged 6 to 59 months, with the highest rates in sub-Saharan Africa and South-East Asia 1,2 .
Provision of vitamin A supplements every four to six months is an inexpensive, quick, and effective way to improve vitamin A status and reduce child morbidity and mortality in the long term. In areas where vitamin A deficiency is a public health problem, routine vitamin A supplementation is recommended in infants and children 6-59 months of age as a public health intervention, 3 and has been shown to reduce the risk of all-cause mortality by 12-24%. 4 Comprehensive control of vitamin A deficiency should also include strategies for dietary improvement and food fortification.
In many countries, vitamin A supplementation in infants and children has been successfully integrated with routine immunization services and vaccination campaigns. In addition, providing high-dose supplementation to mothers at immunization contacts soon after delivery provides a further benefit to young infants through enriched breast milk.
Routine immunization provides an efficient and sustainable delivery platform for administration of vitamin A supplementation. Studies show that combining delivery of vitamin A supplementation with immunization is safe, and does not interfere with the seroconversion of childhood vaccines.
Routine immunization services and vaccination campaigns have been used safely and successfully to provide vitamin A to a wide age range of children at risk of vitamin A deficiency.
Vitamin A is safe in the recommended doses listed below (see Table 1).
Table 1: Target groups, dosage, immunization contacts and route of administration for prevention of vitamin A deficiency*
*Vitamin A can be stored in the liver, therefore, it is recommended to give high-dose vitamin A once every 4-6 months to prevent vitamin A deficiency. For safety, the minimum interval between doses should be one month. It is important to remember that the interval between doses is reduced to treat clinical vitamin A deficiency and measles cases. The appropriate treatment schedules should be followed.
When the correct age specific dose of vitamin A is given with immunizations, some mild symptoms of intolerance such as loose stools, headache, fever and irritability may be experienced by less than 10% of children who receive supplements. These side effects disappear within 24 to 48 hours without special treatment.
Vitamin A supplements are also given to treat sick children. 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. Vitamin A capsules are also given to treat xerophthalmia, and are recommended in the treatment of malnutrition.
High-dose vitamin A supplementation should be avoided during pregnancy because of the theoretical risk of teratogenesis (birth defects), but can be provided safely to all postpartum mothers within six weeks of delivery, when the chance of pregnancy is remote. The first infant immunization contact provides an opportunity to supplement postpartum mothers and improve the vitamin A content of their breast milk.