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Vaccine efficacy and iron deficiency: an intertwined pair?
Hal Drakesmith1, Sant-Rayn Pasricha2, Ioav Cabantchik3
1MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK; Haematology Theme, Oxford Biomedical Research Centre, Oxford, UK.
Insights
Iron deficiency impairs adaptive immunity and vaccine responses, particularly in low-income countries. Further research is crucial to understand iron-vaccine interactions and improve vaccine efficacy through nutritional iron interventions.
Area of Science:
- Global Health
- Immunology
- Nutritional Science
Background:
- Vaccine efficacy is lower in low- and middle-income countries (LMICs) and in adults with comorbidities.
- Iron deficiency is a widespread global health issue, affecting over 2 billion people, with increasing prevalence in LMICs.
- Existing research suggests iron deficiency may negatively impact immune responses and vaccine effectiveness.
Purpose of the Study:
- To highlight the under-appreciated role of iron deficiency in limiting adaptive immunity and vaccine responses.
- To propose a framework for urgent studies investigating iron-vaccine interactions.
- To explore the potential of nutritional iron interventions to improve vaccine performance.
Main Methods:
- Retrospective analysis of existing datasets from COVID-19 and other vaccine trials.
- Prospective studies to evaluate the impact of nutritional iron interventions on vaccine efficacy.
- Review of current evidence on iron deficiency and its effects on the immune system.
Main Results:
- Evidence indicates that iron deficiency compromises adaptive immunity.
- Populations with iron deficiency face an additional disadvantage regarding vaccine effectiveness.
- Nutritional iron interventions are commonly used for anemia and may enhance vaccine responses.
Conclusions:
- Iron deficiency is a significant, under-recognized factor affecting vaccine efficacy globally.
- Urgent, detailed studies are needed to elucidate the mechanisms of iron-vaccine interactions.
- Targeted nutritional iron supplementation could be a viable strategy to improve vaccine performance in deficient populations.
Abstract:
Vaccines are the most effective measure to prevent deaths and illness from infectious diseases. Nevertheless, the efficacy of several paediatric vaccines is lower in low-income and middle-income countries (LMICs), where mortality from vaccine-preventable infections remains high. Vaccine efficacy can also be decreased in adults in the context of some common comorbidities. Identifying and correcting the specific causes of impaired vaccine efficacy is of substantial value to global health. Iron deficiency is the most common micronutrient deficiency worldwide, affecting more than 2 billion people, and its prevalence in LMICs could increase as food security is threatened by the COVID-19 pandemic. In this Viewpoint, we highlight evidence showing that iron deficiency limits adaptive immunity and responses to vaccines, representing an under-appreciated additional disadvantage to iron deficient populations. We propose a framework for urgent detailed studies of iron-vaccine interactions to investigate and clarify the issue. This framework includes retrospective analysis of newly available datasets derived from trials of COVID-19 and other vaccines, and prospective testing of whether nutritional iron interventions, commonly used worldwide to combat anaemia, improve vaccine performance.
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