Elsevier

The Journal of Nutrition

Volume 138, Issue 12, December 2008, Pages 2462-2467
The Journal of Nutrition

Zinc Modifies the Association between Nasopharyngeal Streptococcus pneumoniae Carriage and Risk of Acute Lower Respiratory Infection among Young Children in Rural Nepal12

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Abstract

Nasopharyngeal (NP) carriage is necessary for Streptococcus pneumoniae (Spn) transmission and invasive infection. This study evaluated the effect of zinc prophylaxis on the association between NP colonization with Spn and acute lower respiratory infection (ALRI) in children aged 1–35 mo living in a rural district in southern Nepal. We compared carriage prevalence of Spn in 550 ALRI cases with that of healthy age- and season-matched controls. This study, conducted from December 2003 to July 2005, was nested in a community-randomized trial designed to evaluate the effect of zinc on morbidity and mortality in 1- to 36-mo-old children. They were randomized to receive either 10-mg tablets of zinc or placebo daily until discharge. Approximately 75% of cases and controls were Spn carriers. There was an interaction between zinc and Spn carriage (P = 0.091). Spn carriage increased the risk of ALRI in the placebo group [adjusted matched odds ratio (AMOR) = 2.57; P = 0.025] but not in the zinc group (AMOR = 0.95; P = 0.890). Among the subset of symptomatic cases and their controls, the odds of ALRI for Spn carriers in the placebo group was 30 times greater (AMOR = 78.09; P = 0.006) than in the zinc group (AMOR = 2.77; P = 0.288). These findings suggest that zinc prophylaxis may protect children against ALRI associated with carriage of Spn and that the effect may differ by infectious etiology.

Abbreviations

ALRI
acute lower respiratory tract infection
AMOR
adjusted matched odds ratio
MOR
matched odds ratio
NNIPS4
Nepal Nutrition Intervention Project, Sarlahi-4
NP
nasopharyngeal
Spn
Streptococcus pneumoniae
VDC
village development committee

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1

Supported by grants from the NIH, Bethesda, MD (HD 38753), the Bill & Melinda Gates Foundation, Seattle, WA (810-2054), and a cooperative agreement between Johns Hopkins University and the Office of Health and Nutrition, US Agency for International Development, Washington, DC (HRN-A-00-97-00015-00). Dr. Coles received funding support from a NIH Mentored Research Scientist Development award (K01DK07578).

2

Author disclosures: C. Coles, J. Sherchand, S. Khatry, J. Katz, S. LeClerq, L. Mullany, and J. Tielsch, no conflicts of interest.