Abstract:
BACKGROUND : Vaccination is a mainstay of preventive healthcare, reducing the incidence of serious childhood
infections. Ecological studies have demonstrated an inverse association between markers of high ambient
ultraviolet (UV) radiation exposure (e.g., sunny season, low latitude of residence) and reduction in the
vaccination-associated immune response. Higher sun exposure on the day prior to and spanning the day of
vaccination has been associated with a reduced antigen-specific immune response independent of skin
pigmentation. The South African Department of Health’s Expanded Programme on Immunisation provides free
vaccinations in government primary health care clinics. In some areas, these clinics may have only a small waiting
room and patients wait outside in full sun conditions. In rural areas, patients may walk several kilometres to and
from the clinic. We hypothesised that providing sun protection advice and equipment to mothers of children
(from 18 months) who were waiting to be vaccinated would result in a more robust immune response for those
vaccinated.
METHODS : We conducted an intervention study among 100 children receiving the booster measles vaccination. We
randomised clinics to receive (or not) sun protection advice and equipment. At each clinic we recorded basic
demographic data on the child and mother/carer participants, their sun exposure patterns, and the acceptability
and uptake of the provided sun protection. At 3–4 weeks post-vaccination, we measured measles IgG levels in all
children.
DISCUSSION : This is the first intervention study to assess the effect of sun protection measures on vaccine
effectiveness in a rural, real-world setting. The novel design and rural setting of the study can contribute much
needed evidence to better understand sun exposure and protection, as well as factors determining vaccine
effectiveness in rural Africa, and inform the design of immunisation programmes. (TRN PACTCR201611001881114,
24 November 2016, retrospective registration)
