ReviewThe Lancet. Haematology2021
Vaccine efficacy and iron deficiency: an intertwined pair?
Review in The Lancet. Haematology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Baseline host determinants of robust human HIV-1 vaccine-induced immune responses: A meta-analysis of 26 vaccine regimens.EBioMedicine · 2022Pooled it
- Circulating trace elements status in COVID-19 disease: A meta-analysis.Frontiers in nutrition · 2022Pooled it
- Effect of correcting iron deficiency on the risk of serious infection in heart failure: Insights from the IRONMAN trial.European journal of heart failure · 2025Trial
- Ferric carboxymaltose and SARS-CoV-2 vaccination-induced immunogenicity in kidney transplant recipients with iron deficiency: The COVAC-EFFECT randomized controlled trial.Frontiers in immunology · 2022Trial
- Micronutrients and omega-3 PUFAs to promote healthy ageing: informing a physiology-based complementation strategy.GeroScience · 2026Review
- A narrative review of heterogeneity in SARS-CoV-2 infection outcomes and vaccine efficacy: strategizing pandemic preparedness in Africa.Frontiers in public health · 2026Review
- Association of plasma ferritin and plasma iron at time of vaccination with the immune response to SARS-CoV-2 vaccination: a longitudinal cohort study.Frontiers in immunology · 2026Article
- Iron deficiency and vaccine efficacy: A mini-review of immunological interplay and evidence across vaccine types.Human vaccines & immunotherapeutics · 2025Review
- Iron and the immune system.Nature reviews. Immunology · 2025Review
- Disease-modifying effects of iron deficiency in mouse models of chronic renal failure.Blood red cells & iron · 2025Article
- Iron Deficiency Anemia.Advances in experimental medicine and biology · 2025Review
- Iron, Hepcidin, and Immunity.Advances in experimental medicine and biology · 2025Review
- Four oral iron supplements for treating iron-deficiency anemia during pregnancy in China: a cost-effectiveness and budget analysis.Frontiers in public health · 2025Article
- Why cells need iron: a compendium of iron utilisation.Trends in endocrinology and metabolism: TEM · 2024Review
- Early life stress and iron metabolism in developmental psychoneuroimmunology.Brain, behavior, & immunity - health · 2024Article
- Oral iron supplementation: new formulations, old questions.Haematologica · 2024Review
- Effects of Iron Status on Adaptive Immunity and Vaccine Efficacy: A Review.Advances in nutrition (Bethesda, Md.) · 2024Review
- Altered transcriptomic immune responses of maintenance hemodialysis patients to the COVID-19 mRNA vaccine.eLife · 2024Article
- Immunological factors linked to geographical variation in vaccine responses.Nature reviews. Immunology · 2024Review
- Clinical outcome and humoral immune responses of β-thalassemia major patients with severe iron overload to SARS-CoV-2 infection and vaccination: a prospective cohort study.EClinicalMedicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 5 institutions in 5 countries.
Funding
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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.