Opportunities to link vitamin A supplementation with immunization
In countries where vitamin A deficiency is a problem, combining the delivery of vitamin A supplements with immunization is a safe and effective strategy. Routine immunization services provide an efficient and sustainable delivery channel for vitamin A supplements. Studies show that vitamin A supplementation linked to immunization is safe and does not have a negative effect on seroconversion of childhood vaccines. Routine immunization services, national immunization days for polio eradication, measles, and multi-antigen campaigns have been used safely and successfully to provide vitamin A to a wide age range of children at risk.
Vitamin A is safe in the recommended doses (see Table 1 below).
High-dose vitamin A should be avoided during pregnancy because of the theoretical risk of teratogenisis (birth defects). High-dose vitamin A supplementation can be provided safely to all postpartum mothers within six weeks of delivery, when the chance of pregnancy is remote. The first contact with the infant immunization services provides an opportunity to supplement postpartum mothers and improve the vitamin A content of their breast milk.
When the correct age specific dose of vitamin A is given with immunizations some mild side effects may be observed, but they are rare and transient. Mild symptoms of intolerance such as loose stools, headache, fever and irritability may be experienced by less than 10% of children who receive supplements. These side effects disappear within 24 to 48 hours without special treatment.
Table 1: Potential target groups and immunization contacts for prevention of VAD in countries with vitamin A deficiency
Note 1: Because vitamin A can be stored in the liver, it is recommended to give high-dose vitamin A once every 4-6 months to prevent vitamin A deficiency. For safety, the minimum interval between doses should be one month. It is important to remember that the interval between doses is reduced to treat clinical vitamin A deficiency and measles cases. Follow the appropriate treatment schedules.
Note 2: During campaigns it is difficult to carefully screen women or adolescent girls for pregnancy. It is safer not to give women or adolescent girls vitamin A supplements during mass distribution campaigns, but to provide supplements through routine services.
Vitamin A supplements are given to treat sick children. There is a well-established scientific basis for the treatment of measles cases with vitamin A supplementation that is recommended by WHO as part of the integrated management of childhood illness. Vitamin A capsules are also given to treat xerophthalmia, and recommended in the treatment of malnutrition. Information on recommended treatment schedules can be found in the documents section of this web page.
Countries providing vitamin A supplementation
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