Vitamin D3 in acute respiratory infections in patients under five years old (Cartagena de Indias, Colombia)
Keywords:Vitamin D3, Acute respiratory infection, Insufficiency, Deficiency
Background and Aim. Low serum levels of 25-hydroxyvitamin D3 are associated with an increased risk of Acute Respiratory Infection (ARI) that is among the most important causes of morbidity and mortality in children under 5 years old. We describe the clinical behavior of acute respiratory infections in patients under five years ago in one sanitary institution in Colombia after VD3 supplementation.
Material and Methods. A case series was conducted on 38 patients of both genders aged less to 5 years ago was included. Participants were supplied 50,000 units of VD3 orally each month for three months. The number of events, consultations for emergency services, and hospitalization due to acute respiratory infections (ARIs) before and after VD3 administration were described.
Results. The average age of the participants was 25.81 ± 17.50 months. The average clinical ARIs per month was 4.02 (95% CI 3.64-4.40) before VD3 administration. Fewer episodes at the end of the three cycles was found at 2.23/month (95% CI 1.81-2.65; p=0.0230). The average consultations for emergency services during the three months before VD3 administration was 2.15 (95% CI 1.77-2.53). After three months of treatment, the average use of emergency services decreased to 0.52 (95% CI 0.37-0.72; p=0.0180). After the administration of the three doses of VD3, only one patient required hospitalization (2.63%; : 0.026 (IC95% 0.02-0.03; p=0.0368)).
Conclusions. The administration of vitamin D3 could have a benefit in decreasing the number of episodes, emergencies, and hospitalization for ARI in children under five years old. Trial studies are required to determine this potential benefit.
Ministry of Health. Acute Respiratory Infections Agudas (ARI). Bogotá, Colombia: Ministry of Health; 2020.
Nair H, Simões EA, Rudan I, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013;381(9875):1380-1390. DOI: https://doi.org/10.1016/S0140-6736(12)61901-1
García JLA, Herrera AM. Infección de vías respiratorias agudas en población pediátrica. Rev Enf Infec Pediatr. 2015;114:966-974.
Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361(9376):2226-2234. DOI: https://doi.org/10.1016/S0140-6736(03)13779-8
You D, Hug L, Ejdemyr S, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN inter-agency group for child mortality estimation. Lancet. 2015;386(10010):2275-2286. DOI: https://doi.org/10.1016/S0140-6736(15)00120-8
Kamal MM, Hasan MM, Davey R. Determinants of childhood morbidity in Bangladesh: evidence from the Demographic and Health Survey 2011. BMJ Open. 2015;5(10):e007538. DOI: https://doi.org/10.1136/bmjopen-2014-007538
Rambaud-Althaus C, Althaus F, Genton B, D'Acremont V. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. Lancet Infect Dis. 2015;15(4):439-450. DOI: https://doi.org/10.1016/S1473-3099(15)70017-4
Qazi S, Were W. Improving diagnosis of childhood pneumonia. Lancet Infect Dis. 2015;15(4):372-373. DOI: https://doi.org/10.1016/S1473-3099(15)70029-0
Ujunwa F, Ezeonu C. Risk factors for acute respiratory tract infections in under-five children in Enugu Southeast Nigeria. Ann Med Health Sci Res. 2014;4(1):95-99. DOI: https://doi.org/10.4103/2141-9248.126610
Alemayehu S, Kidanu K, Kahsay T, Kassa M. Risk factors of acute respiratory infections among under five children attending public hospitals in southern Tigray, Ethiopia, 2016/2017. BMC Pediatr. 2019;19(1):380. DOI: https://doi.org/10.1186/s12887-019-1767-1
Tazinya AA, Halle-Ekane GE, Mbuagbaw LT, Abanda M, Atashili J, Obama MT. Risk factors for acute respiratory infections in children under five years attending the Bamenda Regional Hospital in Cameroon. BMC Pulm Med. 2018;18(1):7. DOI: https://doi.org/10.1186/s12890-018-0579-7
World Health Organization, UNICEF. Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). Geneva, Switzerland: WHO; 2013.
Taylor CE, Camargo CA, Jr. Impact of micronutrients on respiratory infections. Nutr Rev. 2011;69(5):259-269. DOI: https://doi.org/10.1111/j.1753-4887.2011.00386.x
Wang MX, Koh J, Pang J. Association between micronutrient deficiency and acute respiratory infections in healthy adults: a systematic review of observational studies. Nutr J. 2019;18(1):80. DOI: https://doi.org/10.1186/s12937-019-0507-6
Shenkin A. Micronutrients in health and disease. Postgrad Med J. 2006;82(971):559-567. DOI: https://doi.org/10.1136/pgmj.2006.047670
Looman KIM, Jansen MAE, Voortman T, et al. The role of vitamin D on circulating memory T cells in children: the Generation R study. Pediatr Allergy Immunol. 2017;28(6):579-587. DOI: https://doi.org/10.1111/pai.12754
Roth DE, Shah MR, Black RE, Baqui AH. Vitamin D status of infants in northeastern rural Bangladesh: preliminary observations and a review of potential determinants. J Health Popul Nutr. 2010;28(5):458-469. DOI: https://doi.org/10.3329/jhpn.v28i5.6154
Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 2004;58(4):563-567. DOI: https://doi.org/10.1038/sj.ejcn.1601845
Mulrennan S, Knuiman M, Walsh JP, et al. Vitamin D and respiratory health in the busselton healthy ageing study. Respirology. 2018;23(6):576-582. DOI: https://doi.org/10.1111/resp.13239
Solomon O, Odu O, Amu E, et al. Prevalence and risk factors of acute respiratory infection among under fives in rural communities of Ekiti State, Nigeria. Glob J Med Public Health. 2018;7(1):12.
Rondanelli M, Miccono A, Lamburghini S, et al. Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc, and echinacea in three main immune interactive clusters (physical barriers, innate and adaptive immunity) involved during an episode of common colds-practical advice on dosages and on the time to take these nutrients/botanicals in order to prevent or treat common colds. Evid Based Complement Alternat Med. 2018;2018:5813095. DOI: https://doi.org/10.1155/2018/5813095
Gysin DV, Dao D, Gysin CM, Lytvyn L, Loeb M. Effect of vitamin D3 supplementation on respiratory tract infections in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2016;11(9):e0162996. DOI: https://doi.org/10.1371/journal.pone.0162996
Hewison M. Vitamin D and the immune system: new perspectives on an old theme. Rheum Dis Clin North Am. 2012;38(1):125-139. DOI: https://doi.org/10.1016/j.rdc.2012.03.012
Esposito S, Baggi E, Bianchini S, Marchisio P, Principi N. Role of vitamin D in children with respiratory tract infection. Int J Immunopathol Pharmacol. 2013;26(1):1-13. DOI: https://doi.org/10.1177/039463201302600101
Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010;10(4):482-496. DOI: https://doi.org/10.1016/j.coph.2010.04.001
Baeke F, Korf H, Overbergh L, et al. The vitamin D analog, TX527, promotes a human CD4+CD25highCD127low regulatory T cell profile and induces a migratory signature specific for homing to sites of inflammation. J Immunol. 2011;186(1):132-142. DOI: https://doi.org/10.4049/jimmunol.1000695
Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-886. DOI: https://doi.org/10.2310/JIM.0b013e31821b8755
Chirumbolo S, Bjorklund G, Sboarina A, Vella A. The role of vitamin D in the immune system as a pro-survival molecule. Clin Ther. 2017;39(5):894-916. DOI: https://doi.org/10.1016/j.clinthera.2017.03.021
Stelmach I, Jerzynska J, Podlecka D. Immunomodulatory effect of vitamin D in children with allergic diseases. In: Gowder S, ed. A Critical Evaluation of Vitamin D - Basic Overview. London, UK: IntechOpen; 2017:161-176. DOI: https://doi.org/10.5772/65072
Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis. 2015;15:487. DOI: https://doi.org/10.1186/s12879-015-1196-1
World Health Organization. Acute Respiratory Infections in Children: Case Management in Small Hospitals in Developing Countries. Geneva, Switzerland: WHO; 1990.
Luis O, Ricardo P, Felipe R. Guía de Bolsillo. Medellín, Colombia: AIEPI; 2004.
Departamento Administrativo Nacional de Estadísticas DANE. Estratificación Socioeconómica en Colombia. Bogotá, Colombia: Departamento Administrativo Nacional de Estadísticas DANE; 2020.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-1930. DOI: https://doi.org/10.1210/jc.2011-0385
Merker M, Amsler A, Pereira R, et al. Vitamin D deficiency is highly prevalent in malnourished inpatients and associated with higher mortality: a prospective cohort study. Medicine (Baltimore). 2019;98(48):e18113. DOI: https://doi.org/10.1097/MD.0000000000018113
Mehta S. Vitamin D levels among children with severe acute malnutrition. World J Pharm Res. 2017. doi: 10.20959/wjpr20175-8334. DOI: https://doi.org/10.20959/wjpr20175-8334
Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M, Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398-417. DOI: https://doi.org/10.1542/peds.2007-1894
Acosta B, Sánchez L, Fonseca J, Sarmiento L. Estado de la 25-hidroxivitamina D sérica en niños sanos menores de 10 años del área metropolitana de Barranquilla. Salud Pública Méx. 2017;59:657-664. DOI: https://doi.org/10.21149/8362
Nabeta HW, Kasolo J, Kiggundu RK, Kiragga AN, Kiguli S. Serum vitamin D status in children with protein-energy malnutrition admitted to a national referral hospital in Uganda. BMC Res Notes. 2015;8:418. DOI: https://doi.org/10.1186/s13104-015-1395-2
Sassi F, Tamone C, D'Amelio P. Vitamin D: nutrient, hormone, and immunomodulator. Nutrients. 2018;10(11):1656. DOI: https://doi.org/10.3390/nu10111656
Battersby AJ, Kampmann B, Burl S. Vitamin D in early childhood and the effect on immunity to Mycobacterium tuberculosis. Clin Dev Immunol. 2012;2012:430972. DOI: https://doi.org/10.1155/2012/430972
Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. DOI: https://doi.org/10.1136/bmj.i6583
Aydin S, Aslan I, Yildiz I, et al. Vitamin D levels in children with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol. 2011;75(3):364-367. DOI: https://doi.org/10.1016/j.ijporl.2010.12.006
Bergman P, Norlin AC, Hansen S, et al. Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012;2(6):e001663. DOI: https://doi.org/10.1136/bmjopen-2012-001663
Singh N, Kamble D, Mahantshetti NS. Effect of vitamin D supplementation in the prevention of recurrent pneumonia in under-five children. Indian J Pediatr. 2019;86(12):1105-1111. DOI: https://doi.org/10.1007/s12098-019-03025-z
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