Prevention of pediatric viral infections of the upper respiratory tract

reference

AGLIPAY M., Birch CS, Parkin PC, et al. Effect of a vitamin D supplementation with a high dose compared to a standard dose in winter on viral infections of the upper respiratory tract in small healthy children. Jama . 2017; 318 (3): 245-254.

objective

Comparison of a high-dose and standard-dose-dose-dose vitamin D supplementation in the prevention of viral infections of the upper respiratory tract (URIS) in winter in small children

draft

randomized, double -blind clinical study

participant

703 Healthy children (57.7 % male) between the ages of 1 and 5 were recruited from a practice -oriented research network in Toronto, Canada.

Intervention

The participants received either 2,000 IE or 400 IE additional vitamin d.

primary result dimensions

The number of viral urtis confirmed in the laboratory was the primary study result. The secondary endpoints included the number of influenza infections, the number of non-influenza infections, patients reported by patients, the time to the first Urti and the vitamin D serum mirror after completion of the study.

important knowledge

There was no difference in the number of laboratory-confirmed urtis between the high dose group (1.05; 95 % confidence interval [CI]: 0.91-1.19) and the group with standard dose (1.03; 95 % KI: 0.90-1.16) and no difference in the primal urtis reported by the parents or the first Urti. At the end of the study, the high-dose group had higher vitamin D levels in the serum (48.7 ng/ml; 95 %-KI: 46.9–50.5 ng/ml vs. 36.8 ng/ml; 95 %-KI: 35.4–38.2 ng/ml). The incidence of influenza was 50 % lower (incidence rate ratio [IRR]: 0.50; 95 % KI: 0.28–0.89) in the high-dose vitamin D group, although the number of influenza infections was low.

The study had a final rate of 99.4 %.

practice implications

In the past ten years, there has been considerable excitement and interest in connection with the potential extraskeletal effects of vitamin D, especially in areas such as cancer, mental health and immune function. ^{1 The awareness of the prevalence of vitamin D deficiency increases. Inadequate vitamin D levels can be attributed to a combination of factors, e.g. B. on a trend towards increased activity indoors and concerns about the risks of solar exposure.}

vitamin D is involved in the synthesis of antimicrobial components in the respiratory tract epithelium 3 and plays many roles in regulating the innate and adaptive immunity. ^{4 The results of observation and clinical studies indicate a connection between low serum vitamin D mirror and higher rates of respiratory infections However, not all results were consistent. A meta-analysis of 25 randomized clinical studies (RCTS) carried out in 2017, which was carried out on infants, children and adults, showed that a vitamin D supplementation reduced the risk of acute respiratory infections without increasing the risk of undesirable events. Vitamin D supplementation had no influence on the risk of acute respiratory infections in pediatric populations.}

No side effects were reported in this study and the serum vitamin D levels of the participants of the high-dose vitamin D group remained in a safe area.

This paper describes the results of a randomized placebo-controlled study in which a high-dose and a standard dose-dose vitamin D supplement for prevention viral urtis is compared in children, using a laboratory confirmation of the infection. This study showed no influence on the primary endpoint - the incidence of laboratory -confirmed viral primal urtis. A statistically significant reduction in the incidence of influenza infections was found; However, these only made up a small part of the total number of infections. The authors found that further studies in a population or season are justified with a higher influenza prevalence before conclusions are drawn.

There are some possible explanations for the lack of effect observed in this study. First, the vitamin D standard dose may have offered sufficient protection against Uris, which prevented a distinction between the two doses. The research ethics authority involved in this study prohibited the use of placebo based on the recommendations of the American Academy of Pediatrics.

Secondly, vitamin D can bring more use in a population with lower serum vitamin D levels. It has been reported that a vitamin D supplement that reaches a serum level of 30 ng/ml is sufficient to reduce the appearance of URTIs in healthy adults. 9 At the beginning of the study, both the high dose and the standard dose group had medium vitamin D serum levels of more than 30 ng/ml (medium value [SD] = 35.9 ng/ml [12.3] and 36.9 ng/ml [11.7], or). About 60 % of the participants regularly took vitamin D before the start of their studies, and about 67 % were European descent, a factor that is known to have a positive impact on the endogenous vitamin D synthesis.

A third explanation for the lack of effect is the size of the study sample. The sample size of 300 children was determined on the basis of a performance calculation, the an average of 4 laboratory-confirmed URTIs per 4-month winter season. However, both groups in this study only had one URTI per child per child and season (standard dose group 1.03; high dose group 1.05), with the majority of children not suffering any infections during the study period. This small number of infections may have restricted the ability to demonstrate a statistically significant reaction.

The authors recognize that certain subpopulation of children may rather benefit from a vitamin D supplement, and indicate that low vitamin D levels have been associated with the risk of asthma examinations. benefit from a vitamin D supplement.

No side effects were reported in this study and the serum vitamin D levels of the participants of the high-dose vitamin D group remained in a safe area. This indicates that the high -dose supplementation scheme was safe in this pediatric population.

Overall, these results do not support the use of routine high-dose vitamin D supplementation in the general pediatric population. In view of the fact that high-dose vitamin D is safe and has the potential to reduce influenza incidence, it seems reasonable to consider higher doses. In addition, this study underlines how important it is to ensure that pediatric population groups meet the standard dose guidelines for the vitamin D supplement.