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Abstract & Commentary
Synopsis: Taking a multivitamin was associated, in a randomized trial, with diminished antibody response to influenza vaccine.
Source: Ender PT, et al. Infect Dis Clin Pract. 2001;10:81-85.
In this study, a group of military physicians studied the effect of multivitamin use on the immunologic response to influenza vaccinations. Seventy-nine adults, age 65 and older, were randomized in a double-blinded manner to receive either a multivitamin or placebo for 100 days prior to flu vaccination. The study drug was continued for an additional 30 days after vaccination. Blood was collected just prior to flu vaccination and 30 days after vaccination. Of those completing the study, there were 32 in the placebo group and 34 in the multivitamin group. Both groups were demographically similar and patient compliance was assessed via telephone interviews twice during the study period.
Sera were tested with a hemagglutination antibody inhibition assay using the A/Beijing/262/95 (A-H1NI), A/Sydney/5/97 (A-H3N2), and B/Beijing/184/93 antigens found in the 1998-1999 vaccine. End points that were analyzed included the development of 2- or 4-fold increase in antibody titer at 4 weeks postvaccination, the postvaccination geometric mean titer (GMT), and the increase in the GMT. Subjects were considered to have 2- or 4-fold increase in titer if they had a 2- or 4-fold increase in titer to any of the antigens tested.
Twelve of the 34 subjects (35%) in the multivitamin group had a 4-fold titer increase, vs. 18 of 32 (56%) in the placebo group (P = .072). Nineteen of 34 (56%) in the multivitamin group had a 2-fold increase in titer, vs. 25 of 32 (78%) in the placebo group (P = .048).
Ender and colleagues cited various articles that have reported the deleterious effects of specific vitamins on the immunologic response and further noted that higher dosages of vitamins may be required to exhibit this response.
Comment by Thomas G. Schleis, MS, RPh
This study is interesting in that it is in contrast to previous studies that suggested an improved response to the influenza vaccine in the elderly. In a 1992 study, Chandra demonstrated that healthy elderly patients, without chronic disease, had improved postvaccination influenza titers if multivitamins were taken.1 This study differs from the one described above in that it had a healthier patient population, baseline titers were not obtained, and that the multivitamin used included minerals. Another study performed in 1999 by Girodon and associates, involving institutionalized elderly patients, showed an improved immunologic response with vitamin use,2 but, again, a multivitamin with minerals was administered.
While the information presented here is insufficient to make a definitive recommendation, it would be prudent to either avoid multivitamin supplements prior to and after flu vaccination, or to only use a multivitamin supplement that includes minerals. Obviously, a larger study that looks at other variables such as prior vaccination responses, serum levels of vitamins and minerals, and clinical outcomes is needed.
1. Chandra RK. Lancet. 1992;340:1124-1127.
2. Girodon F, et al. Arch Intern Med. 1999;159:748-754.
Dr. Schleis, Director of Pharmacy Services, Infections Limited, Tacoma, Wash., is Associate Editor of Infectious Disease Alert.