The role of zinc supplementation in humoral immune response to hepatitis B vaccination in infants: a double-blind randomized placebo-controlled trial
Keywords:
zinc supplementation, serum zinc level, hepatitis B vaccination, anti-HBs titer
Abstract
Background Suboptimal zinc intake may depress thymus function,lymphoproliferation, and T cell-dependent B-cell proliferation,
which can impair antibody production. Zinc supplementation can
improve immune function and reduce morbidity.
Objective To assess the effect of zinc supplementation on infants'
anti-HBs titer after hepatitis B vaccination.
Methods A double-blind randomized control trial of 66 healthy
infants in Pustu Dauh Puri, Denpasar Barat was conducted. Subjects
were followed from birth to three months of age and were placed
into two treatment groups using block randomization. One group
received zinc supplements with a standard hepatitis B vaccination
(zinc group, n=33) and the other group received placebo
supplements with standard hepatitis B vaccination (placebo group,
n=33). The serum zinc levels were measured at baseline and at
three months. The difference in levels of anti-HBs titer between the
zinc and placebo groups was the primary endpoint of this study.
Results The serum zinc levels were significantly higher in the zinc
group compared to the placebo group (P = 0.017), with a mean
difference of 18.76 miU/ml (95% CI 3.45 to 34.07). Regardless
of baseline serum zinc levels, the mean anti-HBs titers were
significantly higher in the zinc group compared to the placebo
group (P <0.0001; mean difference = 495.8 miU/mL; 95%
CI 362.32 to 629.44). Multivariate analysis showed that zinc
supplementation was the only variable that influenced anti-HBs
titer levels (P < 0.0001).
Conclusion Regardless of their initial zinc serum level, infants
receiving zinc supplements along with standard hepatitis B
vaccination have significantly higher levels of anti-HBs titers
than infants receiving hepatitis B vaccination without zinc
supplements.
References
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Nutr. 1998;68:447S-63S.
14. TurkS, Bozfakioglu S, Ecder ST, Kahraman T, Gurel N, Erkoc
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concentrations of prepubertal children: a meta-analysis
of randomized controlled trials. Am J Clin Nutr. 2002;
75:1062-71.
24. Raqib R, Roy SK, Rahman MJ, Azim T, Ameer SS, Chisti, et
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responses in pediatric patiens with shigellosis. Am J Clin N utr.
2004; 79:444-50.
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Roy SK, et al. Therapeutic effects of oral zinc in acute and
persistent diarrhea in children in developing countries:
pooled analysis of randomized controlled trial. Am J Clin
Nutr. 2000; 72:1516-22.
26. Darma Artana IW Efek suplementasi seng oral pada bayi
dengan diare akut: suatu uji klinis acak terkontrol tersamar
ganda [Thesis]. Denpasar: Bagian/SMF Ilmu Kesehatan
Anak FK Unud-RS Sanglah; 2005.
27. Krebs N F, Hambridge K M. Trace elements in human
nutrition. In: Walker W A. Watkins J B. editors. Nutri-
tion in Pediatrics Basic science and clinical app lications.
2nd ed. Halmilton: B.C. Decker Inc Publisher, 1997; p.
91-9.
28. Sazawal S, Black RE, Jalla S, Mazumblar S, Sinha A, Bhan
MLC. Zinc supplementation reduces the incidence of
acute lower respiratory infections in infants and preschool
children: A double blind. controlled trial. Pediatrics. 1998;
102:1-3.
29. Igic PG, Lee E, Harper W, Roach KW. Toxic effects
associated with consumption of zinc. Mayo Clin Proc. 2002;
77:713-16.
zinc supplementation in developing countries: An unresolved
issue. J Nutr. 2003; 133:817S-827S.
2. Osendarp SJM, Santosham M, Black RE, Wahed MA, Raaij
JMA, Fuchs GJ. Effect of zinc supplementation between 1 and
6 mo of life on growth and morbidity of Bangladesh infants
in urban slums. AmJ Clin Nutr. 2002;76:1401-8
3. Caulfield LE, Zavaleta N, Shankar AH, Merialdi M. Potential
contribution of maternal zinc supplementation during
pregnancy to maternal and child survival. Am J Clin Nutr.
1998(68) :499S-508S.
4. Dijkhuizen MA,Wieringa FT, West CE, Muherdiyantiningsih.
Muhilal. Concurrent micronutrient deficiencies in lactating
mothers and their infants in Indonesia. AmJ Clin Nutr. 2001;
73:786-91.
5. Dorea JG. Zinc Deficiency in nursing infants. Journal of
American College of Nutrition. 2002;21:84-87.
6. Walker CF, Black RE. Zinc and the risk for infectious disease.
Ann Rev Nutr. 2004;24:255-75.
7. Karlsen TH, Sommerfelt H, Klomstad S, Andersen PK,
Strand TA, Ulvik RJ, et al. Intestinal and systemic immune
responses to an oral cholera toxoid B subunit whole-cell
vaccine administered during zinc supplementation. Infect
Immun. 2003;71 (7):3909-13.
8. Shrimpton R, Gross R, Darnton-Hill I, Young M. Zinc
deficiency: what are the most appropriate interventions?
BMJ. 2005;330:347-9.
9. Wapnir RA. Zinc deficiency. malnutrition and the
gastrointestinal tract. J Nutr. 2000; 130: 1388s-92s.
10. Anonym. Introduction of hepatitis B vaccine into Childhood
immunization services. Department ofVaccines and Biological
World Health Organization 2001; WHON&B/01.31.
11. Rink L, Gabriel P. Zinc and the immune system. In: Proceeding
of the Nutrition Society 2000;59:issue 4.
12. Ibs KH, Rink L. Zinc-altered immune function. J Nutr. 2003;
133: 1452S-56S.
13. Shankar AH, Prasad AS. Zinc and immune function: the
biological basis of altered resistance to infection. Am J Clin
Nutr. 1998;68:447S-63S.
14. TurkS, Bozfakioglu S, Ecder ST, Kahraman T, Gurel N, Erkoc
R, et al. Effect of zinc supplementation on the immune system
and antibody response to multivalent influenza vaccinein he-
modialysis patients. Int J Artif Organs. 1998;21 (5) :274-8.
15. Kouw PM, Konings CH, de Vries PM, van der Meulen J,
Oe PL. Effects of zinc supplementation on zinc status and
immunity in haemodialysis patients. J Trace Elem Electrolytes
Health Dis. 1991 ;5(2): 115-9.
16. Deloria-Knoll M, SteinhoffM, Semba RD, Nelson K, Vlahov
D, Meinert CL. Effect of zinc and vitamin A supplementation
on antibody responses to pneumococcal conjugate vaccine in
HIV-positive injection drug users: A randomized trial. Vaccine.
2006;24: 1670-79.
17. Kumar T.S, Abraham P, Raguhuraman S, Cherian T.
Immunogenicity of indigenous recombinant hepatiits B vaccine
in infants following a 0.1.2 month vaccination schedule. Indian
Pediatrics. 2000;37:75-80.
18. Provinciali M, Montenovo A, Di-Stefano G, Colombo M,
Daghetta L, Cairati M, et al. Effect of zinc or zinc plus arginine
supplementation on antibody titre and lymphocyte subsets
after influenza vaccination in elderly subjects: a randomized
controlled trial. Age Aging. 1998; 27:715-22.
19. Bhandari N, Bahl R, Taneja S, Strand T, Molbak K, Ulvik RJ,
et al. Substanstial reduction in severe diarrheal morbidity by
daily zinc supplementation in young North Indian children.
Pediatrics. 2002; 1 09:e86.
20. Sien L, Krebs N. Westcott JE. Zinc homeostsis during
lactation in a population with a low zinc intake. Am] Nutr.
2002;75:99-103.
21. Krebs NF. Zinc supplementation during lactation. Am J Clin
Nutr. 1998;68:509S-16.
22. Bhutta ZA. The role of zinc in child health in developing
countries: taking the science where it matters. Indian
Pediatrics. 2004;41:429-33.
23. Brown KH, Peerson JM, Rivera J, Allen LH. Effect
of supplemental zinc on the growth and serum zinc
concentrations of prepubertal children: a meta-analysis
of randomized controlled trials. Am J Clin Nutr. 2002;
75:1062-71.
24. Raqib R, Roy SK, Rahman MJ, Azim T, Ameer SS, Chisti, et
al. Effect of zinc supplementation immune and inflammatory
responses in pediatric patiens with shigellosis. Am J Clin N utr.
2004; 79:444-50.
25. Bhutta ZA, Bird SM, Shankar A, Sazawal S, Hidayat Adi,
Roy SK, et al. Therapeutic effects of oral zinc in acute and
persistent diarrhea in children in developing countries:
pooled analysis of randomized controlled trial. Am J Clin
Nutr. 2000; 72:1516-22.
26. Darma Artana IW Efek suplementasi seng oral pada bayi
dengan diare akut: suatu uji klinis acak terkontrol tersamar
ganda [Thesis]. Denpasar: Bagian/SMF Ilmu Kesehatan
Anak FK Unud-RS Sanglah; 2005.
27. Krebs N F, Hambridge K M. Trace elements in human
nutrition. In: Walker W A. Watkins J B. editors. Nutri-
tion in Pediatrics Basic science and clinical app lications.
2nd ed. Halmilton: B.C. Decker Inc Publisher, 1997; p.
91-9.
28. Sazawal S, Black RE, Jalla S, Mazumblar S, Sinha A, Bhan
MLC. Zinc supplementation reduces the incidence of
acute lower respiratory infections in infants and preschool
children: A double blind. controlled trial. Pediatrics. 1998;
102:1-3.
29. Igic PG, Lee E, Harper W, Roach KW. Toxic effects
associated with consumption of zinc. Mayo Clin Proc. 2002;
77:713-16.
Published
2016-09-15
How to Cite
1.
Suarca K, S H, Arhana B, Suandi IK. The role of zinc supplementation in humoral immune response to hepatitis B vaccination in infants: a double-blind randomized placebo-controlled trial. PI [Internet]. 15Sep.2016 [cited 23Dec.2024];48(6):374-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/632
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Received 2016-09-14
Accepted 2016-09-14
Published 2016-09-15
Accepted 2016-09-14
Published 2016-09-15
