Vitamin A supplements may interact with diphtheria-tetanus-pertussis (DTP) vaccine causing increased female mortality. In a randomised trial of neonatal vitamin A supplementation (VAS), we examined growth during the first year of life in 808 children, pursuing the hypothesis that a negative interaction between VAS and DTP in girls would be reflected in growth. Length and weight were measured at 6 weekly visits and WHO-growth-reference z-scores derived. Neonatal VAS had no effect on anthropometric measures at 12 months, but may interact sex differentially with routine vaccines. While BCG was the most recent vaccine, neonatal VAS benefitted growth (difference in weight-for-length z-score (dWFL: 0.31(95% CI: 0.03–0.59)). While DTP was the most recent vaccine, VAS tended to affect growth adversely in girls (dWFL = ？0.21 (？0.48–0.06)). After measles vaccine (MV) there was no overall effect of neonatal VAS. The VAS effect differed significantly between the BCG and DTP windows ( ), and the difference was borderline significant between the DTP and MV windows for girls ( ). 1. Introduction Vitamin A deficiency (VAD) has been associated with impaired growth in observational studies [1, 2], but randomised trials of vitamin A supplementation (VAS) have often failed to show an impact on growth [3] in spite of improved vitamin A status in deficient populations [4, 5]. The only study examining the effect of neonatal VAS on growth reported a positive effect on height at 3 years of age in Indonesia [6]. Within a randomised placebo-controlled study of the effect on mortality of providing neonates with 50？000？IU of vitamin A with Bacillus Calmette-Guerin vaccine (BCG) [7] we examined the effect of neonatal VAS on growth during the first year of life in both sexes. The present trial as well as a similar trial of neonatal VAS from Zimbabwe [8] did not find the expected beneficial effect of VAS on mortality observed in Indonesia [9] and India [10] and later in Bangladesh [11]. We have previously hypothesised that VAS and diphtheria-tetanus-pertussis (DTP) vaccines may interact negatively [12, 13], due to amplification of the negative nonspecific effects of DTP vaccines. The nonspecific effects are the effects of vaccines that cannot be ascribed to the protection against the targeted disease(s). For example, observational studies [14, 15] and randomised trials [16, 17] of measles vaccine (MV) indicate reductions in overall mortality far bigger than the reduction due to prevention of measles infection. Similarly for BCG, reductions in mortality that cannot be ascribed to
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