Vitamin A supplements, routine immunization, and the subsequent risk of Plasmodium infection among children under 5 years in sub-Saharan Africa

Elife. 2015 Feb 3;4:e03925. doi: 10.7554/eLife.03925.


Recent studies, partly based on murine models, suggest childhood immunization and vitamin A supplements may confer protection against malaria infection, although strong evidence to support these theories in humans has so far been lacking. We analyzed national survey data from children aged 6-59 months in four sub-Saharan African countries over an 18-month time period, to determine the risk of Plasmodium spp. parasitemia (n=8390) and Plasmodium falciparum HRP-2 (PfHRP-2)-related antigenemia (n=6121) following vitamin A supplementation and standard vaccination. Bacille Calmette Guerin-vaccinated children were more likely to be PfHRP-2 positive (relative risk [RR]=4.06, 95% confidence interval [CI]=2.00-8.28). No association was identified with parasitemia. Measles and polio vaccination were not associated with malaria. Children receiving vitamin A were less likely to present with parasitemia (RR=0.46, 95% CI=0.39-0.54) and antigenemia (RR=0.23, 95% CI=0.17-0.29). Future studies focusing on climate seasonality, placental malaria and HIV are needed to characterize better the association between vitamin A and malaria infection in different settings.

Keywords: Africa; Plasmodium; child health; epidemiology; global health; human; malaria; vaccination; vitamin A.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa South of the Sahara
  • Age Factors
  • Antigens, Protozoan
  • BCG Vaccine / administration & dosage
  • Child, Preschool
  • Dietary Supplements*
  • Female
  • Humans
  • Immunization*
  • Infant
  • Malaria, Falciparum / diagnosis*
  • Malaria, Falciparum / immunology
  • Malaria, Falciparum / parasitology
  • Malaria, Falciparum / prevention & control
  • Male
  • Measles Vaccine / administration & dosage
  • Parasitemia / diagnosis*
  • Parasitemia / immunology
  • Parasitemia / parasitology
  • Parasitemia / prevention & control
  • Plasmodium falciparum / immunology*
  • Poliovirus Vaccines / administration & dosage
  • Protozoan Proteins
  • Risk
  • Seasons
  • Vitamin A / administration & dosage*


  • Antigens, Protozoan
  • BCG Vaccine
  • HRP-2 antigen, Plasmodium falciparum
  • Measles Vaccine
  • Poliovirus Vaccines
  • Protozoan Proteins
  • Vitamin A