Effect of maternal vitamin D supplementation on nasal pneumococcal acquisition, carriage dynamics and carriage density in infants in Dhaka, Bangladesh

Mahgol Taghivand, Lisa G Pell, Mohammed Z Rahman, Abdullah A Mahmud, Eric O Ohuma, Eleanor M Pullangyeum, Tahmeed Ahmed, Davidson H Hamer, Stanley H Zlotkin, Jonathan B Gubbay, Shaun K Morris, Daniel E Roth, Mahgol Taghivand, Lisa G Pell, Mohammed Z Rahman, Abdullah A Mahmud, Eric O Ohuma, Eleanor M Pullangyeum, Tahmeed Ahmed, Davidson H Hamer, Stanley H Zlotkin, Jonathan B Gubbay, Shaun K Morris, Daniel E Roth

Abstract

Background: Invasive pneumococcal disease is a major cause of infant morbidity and death worldwide. Vitamin D promotes anti-pneumococcal immune responses in vitro, but whether improvements in infant vitamin D status modify risks of nasal pneumococcal acquisition in early life is not known.

Methods: This is a secondary analysis of data collected in a trial cohort in Dhaka, Bangladesh. Acute respiratory infection (ARI) surveillance was conducted from 0 to 6 months of age among 1060 infants of women randomized to one of four pre/post-partum vitamin D dose combinations or placebo. Nasal swab samples were collected based on standardized ARI criteria, and pneumococcal DNA quantified by qPCR. Hazards ratios of pneumococcal acquisition and carriage dynamics were estimated using interval-censored survival and multi-state modelling.

Results: Pneumococcal carriage was detected at least once in 90% of infants by 6 months of age; overall, 69% of swabs were positive (2616/3792). There were no differences between any vitamin D group and placebo in the hazards of pneumococcal acquisition, carriage dynamics, or carriage density (p > 0.05 for all comparisons).

Conclusion: Despite in vitro data suggesting that vitamin D promoted immune responses against pneumococcus, improvements in postnatal vitamin D status did not reduce the rate, alter age of onset, or change dynamics of nasal pneumococcal colonization in early infancy. Trial registration Registered in ClinicalTrials.gov with the registration number of NCT02388516 and first posted on March 17, 2015.

Keywords: Bangladesh; Infants; Maternal supplementation; Pneumococcal carriage; Vitamin D.

Conflict of interest statement

All authors: No reported conflicts. All authors have submitted the ICMJE Form for Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Vitamin D Interventions for Trial Arms and Enrolment of Eligible Infants for Sub-Studies1. 1Inclusion in current sub-study required the infant to have at least 1 swab taken during the study period. The inclusion/exclusion criteria for the MDIG & MDARI studies have been published elsewhere
Fig. 2
Fig. 2
Weekly number and proportion of nasal swabs positive for pneumococcal carriage in infants up to 6 months of age in the MDARI cohort, including all maternal vitamin D supplementation groups (N = 1060)

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