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Re: Vitamin C and childhood pneumonia in developing countries

Dear Editor,

In his recent Perspectives article, Bhutta commented that it is important that developing countries look at a combination of strategies for reducing the burden and mortality from pneumonia. As an example of such strategies, he mentioned the control of zinc and vitamin A deficiencies (1). We have published a Cochrane review focusing on the effects of vitamin C on pneumonia (2) and we wish to point out the need to consider the possible effects of vitamin C as well.

In animal studies, vitamin C has protected against various viruses and bacteria; some of the infections were caused by pneumococci and some infections were pneumonias (3). In the early 1900’s, American paediatrician Albert Hess pointed out that vitamin C deficiency increased the risk of pneumonia: “secondary pneumonias, usually broncho-pneumonic in type, are of common occurrence, and in many [scurvy] epidemics constitute the prevailing cause of death” (4).

A controlled trial carried out by Glazebrook and Thomson during World War II in a boarding school in the UK found dramatic reduction in the risk of pneumonia, and also of rheumatic fever, by 50-300 mg/day vitamin C supplementation (Table). The dietary vitamin C intake of the boys was very low, 10 to 15 mg/day, and the incidence of pneumonia was high in the control group, 30 cases per 1,000 person-years (5). Placebo was not used, but vitamin C was added to cocoa or milk in the kitchen and it did not change their taste.

Evidently, the findings by Glazebrook and Thomson are not relevant when considering current British children who do not have such low vitamin C intake levels. Nevertheless, such findings in a controlled trial may be interesting when considering the burden from pneumonia in developing countries in which poor nutrition is prevalent. Vitamin C is inexpensive and safe, and therefore its role in pneumonia and other infections would warrant more research (2,3).

References:

1. Bhutta ZA. Dealing with childhood pneumonia in developing countries: how can we make a difference? Arch Dis Child 2007;92:286-8.

2. Hemilä H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev 2007: CD005532.pub2.

3. Hemilä H. Do vitamins C and E affect respiratory infections? [Dissertation]. Helsinki, Finland: University of Helsinki, 2006. Available: http://ethesis.helsinki.fi/julkaisut/laa/kansa/vk/hemila/.

4. Hess AF. Scurvy: Past and Present. Philadelphia, PA: Lippincott, 1920:99. Available: http://chla.library.cornell.edu/.

5. Glazebrook AJ, Thomson S. The administration of vitamin C in a large institution and its effect on general health and resistance to infection. J Hyg 1942;42:1-19. Available: http://www.ltdk.helsinki.fi/users/hemila/C1.pdf.

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