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Effect of Zinc Supplementation on Response to Oral Polio Vaccine in Infants in Pakistan

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01229579
Recruitment Status : Completed
First Posted : October 28, 2010
Last Update Posted : February 18, 2021
World Health Organization
Information provided by (Responsible Party):
Dr Zulfiqar Ahmed Bhutta, Aga Khan University

Brief Summary:

Pakistan is one of the 4 developing countries where cases of poliomyelitis are still being identified. Despite the incessant efforts by WHO and UNICEF, this disease is far from control. There is a need to develop new and innovative strategies to contain the disease and eradicate it from the countries where new cases continue to be identified.

Zinc is an essential component of scores of enzymes in the human body. Recent reports have indicated that this trace element along with other micronutrients enhances the protective functions of immune cells. Moreover, zinc deficiency leads to dysregulation of balanced host responses to infection resulting into decreased antibody production and suppressed immunity. Zinc is also an essential cofactor for thymulin which is known to modulate cytokine release and induce immune cell proliferation. Zinc deficiency is also found to impair an individual's epithelial barrier function, which may further depress the vaccine entry into the mucosal cells.

Role of zinc in the prevention of diarrheal diseases and other infections in children is well documented. However, there are very few reports about its contribution to enhanced immunity by supporting body's natural defense system.

Zinc insufficiency is widespread in socioeconomically deprived children in South Asia and the recent most national nutrition survey (2003) . Moreover, diarrhea is also very common in infants in Pakistan. Such diarrheal episodes can limit entry of attenuated polio virus into the mucosal cells, thereby, leading to inadequate immune response. Association between recent diarrheal history and increased vaccine failure in infants has been shown in a study from Brazil. The recent Lancet Nutrition series has also recommended regular zinc supplementation to address child undernutrition and stunting and underscored the need to treat diarrheal episodes with zinc to expedite recovery. Other recent studies of zinc supplementation in low birth weight infants in South Asia have also shown significant improvement in diarrheal disease burden and mortality.

On the basis of these lines of evidence, it is possible that some of the cases of vaccine failure in this region could be a consequence of compromised immunity and, hence, diminished response to OPV. This could potentially be reversed by addressing such gross undernutrition and micronutrient deficiencies. It can thus be hypothesized that zinc supplementation at community scale would enhance the immune response in infants to OPV.

In order to test this research question, the investigators propose to undertake 12-month randomized controlled trial among a cohort of Pakistani infants of 0-14 days of age. Such a trial would enable us to understand the synergistic role of zinc (if any) with OPV in enhancing immune response against polio and sero-conversion rates.

Condition or disease Intervention/treatment Phase
Poliomyelitis Drug: Zinc Sulfate Other: Placebo Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 320 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Basic Science
Official Title: Effect of Zinc Supplementation on Response to Oral Polio Vaccine in Infants in Pakistan: a Randomized, Controlled Trial
Study Start Date : May 2010
Actual Primary Completion Date : January 2011
Actual Study Completion Date : January 2011

Arm Intervention/treatment
Experimental: Zinc Supplement
2.5 ml Zinc supplement syrup daily containing 10 mg of elemental zinc
Drug: Zinc Sulfate
2.5 ml Zinc supplement syrup daily containing 10 mg of elemental zinc from day 14 to 18 weeks of age.

Placebo Comparator: Placebo
2.5 ml supplement syrup daily without elemental zinc
Other: Placebo
2.5 ml placebo syrup daily with containing no elemental zinc from day 14 to 18 weeks of age.

Primary Outcome Measures :
  1. Seroconversion rates of polio virus (type 1 and type 3), from blood samples collected at the time of recruitment, at 6 weeks and 18 weeks. [ Time Frame: From birth to 18 weeks ]

Secondary Outcome Measures :
  1. Prevalence of excretion of poliovirus serotypes 1, 3 at 0 and 7 days after the administration of bOPV [ Time Frame: 18 and 19 Weeks ]
  2. Effect of zinc supplementation on growth of infants [ Time Frame: Day 14 to 18 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   up to 14 Days   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 0 to 14 days of healthy newborns

Exclusion Criteria:

  • Infants beyond 14 days of age
  • Preterm infants (< 37 weeks gestation or < 2 kg birth weight).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01229579

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Project Office, Aga Khan University, Matiari
Matiari, Sindh, Pakistan, 71000
Sponsors and Collaborators
Aga Khan University
World Health Organization
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Responsible Party: Dr Zulfiqar Ahmed Bhutta, Founding Director, Centre of Excellence in Women and Child Health, Aga Khan University Identifier: NCT01229579    
Other Study ID Numbers: 1291-Peds/ERC-09
First Posted: October 28, 2010    Key Record Dates
Last Update Posted: February 18, 2021
Last Verified: February 2021
Keywords provided by Dr Zulfiqar Ahmed Bhutta, Aga Khan University:
zinc supplement
double blind randomized control trial
elemental zinc
Additional relevant MeSH terms:
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Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Virus Diseases
Central Nervous System Infections
Central Nervous System Diseases
Nervous System Diseases
Spinal Cord Diseases
Neuromuscular Diseases
Zinc Sulfate
Physiological Effects of Drugs
Dermatologic Agents