International Journal For Multidisciplinary Research

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Vitamin A status and supplementation as modifiers of Measles–Mumps Rubella (MMR) vaccine immunogenicity and clinical outcomes among infants and young children - A Systematic Review

Author(s) Ms. HARSHNA RICHARD QADIR
Country India
Abstract Vitamin A is an essential micronutrient critical for immune competence, epithelial integrity, and antibody production, with deficiency increasing susceptibility to severe infections such as measles. Vitamin A supplementation (VAS) is widely used to reduce measles-related morbidity and mortality, yet its influence on the immunogenicity and clinical effectiveness of measles–mumps rubella (MMR) and measles-containing vaccines remains unclear. This systematic review aimed
to synthesize evidence on the effect of vitamin A status and supplementation on vaccine-induced immune responses and clinical outcomes in infants and young children. Following Joanna Briggs Institute guidelines and PRISMA 2020, comprehensive searches were conducted in PubMed, Embase, CINAHL, Scopus, Web of Science, Cochrane CENTRAL, and WHO Global Index
Medicus up to September 2025. Eligible studies included randomized controlled trials, quasi experimental, cohort, and case–control designs involving children ≤5 years receiving vitamin A supplementation or with baseline vitamin A levels assessed near vaccination. Primary outcomes were seroconversion rates and geometric mean titres for measles, mumps, and rubella; secondary
outcomes included post-vaccination infection, illness severity, and adverse events. Study quality was appraised using RoB 2 for RCTs and ROBINS-I for observational studies. Of 1,874 records identified, 14 studies (8 RCTs, 6 observational) conducted between 1995 and 2019 in Asia and Africa were included. Early trials reported reduced measles seroconversion when high-dose
vitamin A was co-administered at 6 months, likely due to maternal antibody interference, whereas later studies showed no impairment—and in some cases enhancement—of antibody titres when supplementation occurred at or after 9 months. Across studies, vitamin A consistently reduced measles-related morbidity, hospitalizations, and complications, with no detrimental impact on
MMR immunogenicity at WHO-recommended vaccination ages. Overall, vitamin A supplementation at or after 9 months is safe and may enhance vaccine-induced immunity, while early administration requires careful timing. These findings support the continued integration of vitamin A with routine measles immunization programs in deficient populations. Future research should examine dose–response relationships, optimal timing, and potential sex-specific
immunologic effects using standardized assays and multicenter designs to inform global policy.
Keywords Vitamin A, MMR vaccine, immunogenicity, measles, supplementation, children, systematic review
Published In Volume 7, Issue 5, September-October 2025
Published On 2025-10-31
DOI https://doi.org/10.36948/ijfmr.2025.v07i05.57579
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