Micronutrient supplementation is a primary part of supportive care of EVD; and treatment guidelines for viral hemorrhagic fevers recommending supplementation; when micronutrient deficiencies are present. Micronutrient supplementation including vitamin A; which has well establishing immunological impacts in infectious disease states.
But vitamin A is essential for both innate and adaptive immune functions; and is integral in the maintenance of epithelial integrity, acute phase response; and function of several immune cell types. But by ssessing vitamin A supplementation in a high risk Ebola virus disease outbreak population from a resource limiting African setting.The results demonstrating that oral vitamin A was associating with reducing mortality; among patients infecting with EVD receiving supplementation during the first 2 d of ETU care.
Vitamin A reducing mortality
Although this is the first ever study of the impacts of vitamin A in a population of Ebola virus disease infecting patients; the importance of vitamin A in immunologic responses to infectious diseases is well establishing. Vitamin A plays a role in innate and adaptive immune functions, and supports epithelial integrity, and function of immune cells, including macrophages, natural killer cells, and lymphocytes.
But in relation to Ebola virus disease; vitamin A is knowing to support gastrointestinal epithelial function; and mucosal recovery after diarrheal illnesses; which could being an important protective mechanism in Ebola virus disease; where patients suffering from copious gastrointestinal losses of over 5 L/d. Furthermore, vitamin A derivatives have shown activity against the Ebola virus in vitro and research has demonstrating that an Ebola virus specific protein inhibiting retinoic-acid type 1 interferon immune response; which may contribute to the virulence of EVD infection.
Individual patient characteristics
However, supplementation was not providing to patients in a randomized manner; and as such, there is potential for confounding within the results. However, it should be noting that nontreatment with supplementation was basing solely on supply limitations; and not relating to individual patient characteristics; as provision was a standard part of the clinical protocol at all 5 ETUs.
But the present findings in the study; which are deriving from a large, multisite, epidemic population; are the first ever reporting on the impact of supplementation in a high-risk population; in Africa and demonstrating that early treatment resulting in lower overall mortality in adjusting analyses.