Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2014

Open Access 01-12-2014 | Research article

Vitamin D3and gargling for the prevention of upper respiratory tract infections: a randomized controlled trial

Authors: Emma C Goodall, Andrea C Granados, Kathy Luinstra, Eleanor Pullenayegum, Brenda L Coleman, Mark Loeb, Marek Smieja

Published in: BMC Infectious Diseases | Issue 1/2014

Login to get access

Abstract

Background

We undertook a 2X2 factorial, randomized controlled trial (RCT) to assess whether vitamin D3 supplementation (10,000 international units per week) versus placebo and gargling versus no gargling could prevent viral, clinical upper respiratory tract infection (URTI) in university students.

Methods

We randomized 600 students into 4 treatment arms: 1) vitamin D3 and gargling, 2) placebo and gargling, 3) vitamin D3 and no gargling, and 4) placebo and no gargling. Students completed weekly electronic surveys and submitted self-collected mid-turbinate nasal flocked swabs during September and October in 2010 or 2011. Symptomatic students also completed an electronic symptom diary. The primary and secondary outcomes were the occurrence of symptomatic clinical URTI and laboratory confirmed URTI respectively.

Results

Of 600 participants, 471 (78.5%) completed all surveys while 43 (7.2%) completed none; 150 (25.0%) reported clinical URTI. Seventy participants (23.3%) randomized to vitamin D3 reported clinical URTI compared to 80 (26.7%) randomized to placebo (RR:0.79, CI95:0.61-1.03, p = 0.09). Eighty-five participants (28.3%) randomized to gargling reported clinical URTI compared to 65 participants (21.7%) randomized to the no gargling arm (RR:1.3, CI95:0.92-1.57, p = 0.19). Laboratory testing identified 70 infections (46.7 per 100 URTIs). Vitamin D3 treatment was associated with a significantly lower risk for laboratory confirmed URTI (RR: 0.54, CI95:0.34-0.84, p = 0.007) and with a significantly lower mean viral load measured as log10 viral copies/mL (mean difference: -0.89, CI95: -1.7, -0.06, p = 0.04). Fewer students assigned to gargling experienced laboratory confirmed URTI, however this was not statistically significant (RR:0.82, CI95:0.53-1.26, p = 0.36).

Conclusions

These results suggest that vitamin D3 is a promising intervention for the prevention of URTI. Vitamin D3 significantly reduced the risk of laboratory confirmed URTI and may reduce the risk of clinical infections.

Trial registration

Clinical Trials Registration: NCT01158560.
Appendix
Available only for authorised users
Literature
1.
Proud D: Upper airway viral infections. Pulm Pharmacol Ther. 2008, 21 (3): 468-473. 10.1016/j.pupt.2007.06.004.CrossRefPubMed
2.
3.
Heikkinen T, Jarvinen A: The common cold. Lancet. 2003, 361 (9351): 51-59. 10.1016/S0140-6736(03)12162-9.CrossRefPubMed
4.
Kwong JC, Crowcroft NS, Campitelli MA, Ratnasingham S, Daneman N, Deeks SL, Manuel DG: Ontario Burden of Infectious Disease Study (ONBOIDS): An OAHPP/ICES Report. In. 2010, Toronto: Ontario Agency for Health Protection and Promotion, Institute for Clinical and Evaluative Sciences
5.
Ginde AA, Mansbach JM, Camargo CA: Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009, 169 (4): 384-390. 10.1001/archinternmed.2008.560.CrossRefPubMedPubMedCentral
6.
Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A: Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009, 63 (4): 473-477. 10.1038/sj.ejcn.1602960.CrossRefPubMed
7.
Laaksi I, Ruohola JP, Tuohimaa P, Auvinen A, Haataja R, Pihlajamaki H, Ylikomi T: An association of serum vitamin D concentrations < 40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr. 2007, 86 (3): 714-717.PubMed
8.
McNally JD, Leis K, Matheson LA, Karuananyake C, Sankaran K, Rosenberg AM: Vitamin D deficiency in young children with severe acute lower respiratory infection. Pediatr Pulmonol. 2009, 44 (10): 981-988. 10.1002/ppul.21089.CrossRefPubMed
9.
Roth DE, Shah R, Black RE, Baqui AH: Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh. Acta Paediatr. 2010, 99 (3): 389-393. 10.1111/j.1651-2227.2009.01594.x.CrossRefPubMed
10.
Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML: Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One. 2010, 5 (6): e11088-10.1371/journal.pone.0011088.CrossRefPubMedPubMedCentral
11.
Wayse V, Yousafzai A, Mogale K, Filteau S: Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 2004, 58 (4): 563-567. 10.1038/sj.ejcn.1601845.CrossRefPubMed
12.
Rehman PK: Sub-clinical rickets and recurrent infection. J Trop Pediatr. 1994, 40 (1): 58-10.1093/tropej/40.1.58-a.CrossRefPubMed
13.
Avenell A, Cook JA, Maclennan GS, Macpherson GC: Vitamin D supplementation to prevent infections: a sub-study of a randomised placebo-controlled trial in older people (RECORD trial, ISRCTN 51647438). Age Ageing. 2007, 36 (5): 574-577. 10.1093/ageing/afm091.CrossRefPubMed
14.
15.
Li-Ng M, Aloia JF, Pollack S, Cunha BA, Mikhail M, Yeh J, Berbari N: A randomized controlled trial of vitamin D3 supplementation for the prevention of symptomatic upper respiratory tract infections. Epidemiol Infect. 2009, 137 (10): 1396-1404. 10.1017/S0950268809002404.CrossRefPubMed
16.
Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamäki H: Vitamin D supplementation for the prevention of acute respiratory tract infection: a randomized, double-blinded trial among young Finnish men. J Infect Dis. 2010, 202 (5): 809-814. 10.1086/654881.CrossRefPubMed
17.
Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H: Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010, 91 (5): 1255-1260. 10.3945/ajcn.2009.29094.CrossRefPubMed
18.
Camargo CA, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, Sumberzul N, Rich-Edwards JW: Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics. 2012, 130 (3): e561-e567. 10.1542/peds.2011-3029.CrossRefPubMed
19.
Murdoch DR, Slow S, Chambers ST, Jennings LC, Stewart AW, Priest PC, Florkowski CM, Livesey JH, Camargo CA, Scragg R: Effect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial. JAMA. 2012, 308 (13): 1333-1339. 10.1001/jama.2012.12505.CrossRefPubMed
20.
Bergman P, Norlin AC, Hansen S, Rekha RS, Agerberth B, Björkhem-Bergman L, Ekström L, Lindh JD, Andersson J: Vitamin D3 supplementation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012, 2 (6): e001663-doi:10.1136/bmjopen-2012-001663CrossRefPubMedPubMedCentral
21.
Rees JR, Hendricks K, Barry EL, Peacock JL, Mott LA, Sandler RS, Bresalier RS, Goodman M, Bostick RM, Baron JA: Vitamin D3 supplementation and upper respiratory tract infections in a randomized, controlled trial. Clin Infect Dis. 2013, 57 (10): 1384-1392. 10.1093/cid/cit549.CrossRefPubMedPubMedCentral
22.
Satomura K, Kitamura T, Kawamura T, Shimbo T, Watanabe M, Kamei M, Takano Y, Tamakoshi A: Prevention of upper respiratory tract infections by gargling: a randomized trial. Am J Prev Med. 2005, 29 (4): 302-307. 10.1016/j.amepre.2005.06.013.CrossRefPubMed
23.
Smieja M, Castriciano S, Carruthers S, So G, Chong S, Luinstra K, Mahony JB, Petrich A, Chernesky M, Savarese M, Smieja M, Castriciano S, Carruthers S, So G, Chong S, Luinstra K, Mahony JB, Petrich A, Chernesky M, Savarese M, Triva D: Development and evaluation of a flocked nasal midturbinate swab for self-collection in respiratory virus infection diagnostic testing. J Clin Microbiol. 2010, 48 (9): 3340-3342. 10.1128/JCM.02235-09.CrossRefPubMedPubMedCentral
24.
Luinstra K, Petrich A, Castriciano S, Ackerman M, Chong S, Carruthers S, Ammons B, Mahony JB, Smieja M: Evaluation and clinical validation of an alcohol-based transport medium for preservation and inactivation of respiratory viruses. J Clin Microbiol. 2011, 49 (6): 2138-2142. 10.1128/JCM.00327-11.CrossRefPubMedPubMedCentral
25.
Granados A, Luinstra K, Chong S, Goodall E, Banh L, Mubareka S, Smieja M, Mahony J: Use of an improved quantitative polymerase chain reaction assay to determine differences in human rhinovirus viral loads in different populations. Diagn Microbiol Infect Dis. 2012, 74 (4): 384-387. 10.1016/j.diagmicrobio.2012.08.023.CrossRefPubMed
26.
Barrett B, Brown RL, Mundt MP, Thomas GR, Barlow SK, Highstrom AD, Bahrainian M: Validation of a short form Wisconsin Upper Respiratory Symptom Survey (WURSS-21). Health Qual Life Outcomes. 2009, 7: 76-10.1186/1477-7525-7-76.CrossRefPubMedPubMedCentral
27.
Knol MJ, Le Cessie S, Algra A, Vandenbroucke JP, Groenwold RH: Overestimation of risk ratios by odds ratios in trials and cohort studies: alternatives to logistic regression. CMAJ. 2012, 184 (8): 895-899. 10.1503/cmaj.101715.CrossRefPubMedPubMedCentral
28.
Groenwold RH, Donders AR, Roes KC, Harrell FE, Moons KG: Dealing with missing outcome data in randomized trials and observational studies. Am J Epidemiol. 2012, 175 (3): 210-217. 10.1093/aje/kwr302.CrossRefPubMed
29.
Charan J, Goyal JP, Saxena D, Yadav P: Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012, 3 (4): 300-303. 10.4103/0976-500X.103685.CrossRefPubMedPubMedCentral
30.
Bergman P, Lindh ÅU, Björkhem-Bergman L, Lindh JD: Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2013, 8 (6): e65835-10.1371/journal.pone.0065835.CrossRefPubMedPubMedCentral
31.
Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, Tavera-Mendoza L, Lin R, Hanrahan JW, Mader S, Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, Tavera-Mendoza L, Lin R, Hanrahan JW, Mader S, White JH: Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol. 2004, 173 (5): 2909-2912. 10.4049/jimmunol.173.5.2909.CrossRefPubMed
32.
Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, et al: Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006, 311 (5768): 1770-1773. 10.1126/science.1123933.CrossRefPubMed
33.
Webb AR, Kline L, Holick MF: Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988, 67 (2): 373-378. 10.1210/jcem-67-2-373.CrossRefPubMed
34.
Rucker D, Allan JA, Fick GH, Hanley DA: Vitamin D insufficiency in a population of healthy western Canadians. CMAJ. 2002, 166 (12): 1517-1524.PubMedPubMedCentral
35.
Gozdzik A, Barta JL, Wu H, Wagner D, Cole DE, Vieth R, Whiting S, Parra EJ: Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation. BMC Public Health. 2008, 8: 336-10.1186/1471-2458-8-336.CrossRefPubMedPubMedCentral
36.
Stoll D, Dudler J, Lamy O, Hans D, Krieg MA, Aubry-Rozier B: Can one or two high doses of oral vitamin D3 correct insufficiency in a non-supplemented rheumatologic population?. Osteoporos Int. 2013, 24 (2): 495-500. 10.1007/s00198-012-1962-5.CrossRefPubMed
37.
Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hypponen E, Berry J, Vieth R, Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hypponen E, Berry J, Vieth R, Lanham-New S: Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012, 95 (6): 1357-1364. 10.3945/ajcn.111.031070.CrossRefPubMedPubMedCentral
Metadata
Title
Vitamin D3and gargling for the prevention of upper respiratory tract infections: a randomized controlled trial
Authors
Emma C Goodall
Andrea C Granados
Kathy Luinstra
Eleanor Pullenayegum
Brenda L Coleman
Mark Loeb
Marek Smieja
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2014
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-14-273

Other articles of this Issue 1/2014

BMC Infectious Diseases 1/2014 Go to the issue

Erratum

Erratum to: Population movement can sustain STI prevalence in remote Australian indigenous communities

Research article

Clinical and treatment-related risk factors for nosocomial colonisation with extensively drug-resistant Pseudomonas aeruginosa in a haematological patient population: a matched case control study

Research article

Inflammatory and myeloid-associated gene expression before and one day after infant vaccination with MVA85A correlates with induction of a T cell response

Research article

Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery – a pilot study

Research article

Genetic diversity of Schistosoma haematobium parasite IS NOT associated with severity of disease in an endemic area in Sudan

Research article

Twenty-five-year changing pattern of gonococcal antimicrobial susceptibility in Shanghai: surveillance and its impact on treatment guidelines
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits