Daily Zinc Supplementation for Infection Prevention in Children With Sickle Cell Anemia: The ZIPS-2 Randomized Clinical Trial.
Ruth Namazzi, Kagan A Mellencamp, Irene Bagala et al.
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In 30 seconds
The ZIPS-2 randomized, double-blind, placebo-controlled trial evaluated daily zinc for infection prevention in children aged 1 to 4.99 years with sickle cell anemia in Uganda. One hundred children received zinc sulfate 20 mg daily or placebo for 6 months, alongside hydroxyurea. The zinc group had a lower all-cause infection rate: 305.7 (95% CI, 242.4-380.4) infections per 100 person-years vs 480.7 (95% CI, 399.8-573.1) with placebo; the adjusted incidence rate ratio was 0.62 (95% CI, 0.45-0.86). No adverse events required stopping the intervention.
Key findings
- All-cause infection rates were 305.7 (95% CI, 242.4-380.4) vs 480.7 (95% CI, 399.8-573.1) infections per 100 person-years with zinc and placebo, respectively.
- The adjusted incidence rate ratio for infection was 0.62 (95% CI, 0.45-0.86).
- No adverse events requiring discontinuation of the study intervention occurred in either group.
Why it matters
Infections remain an important source of morbidity and mortality for children with sickle cell anemia in Africa despite existing prevention strategies. This trial provides randomized evidence that daily zinc may reduce infection burden in children younger than 5 years in Uganda, while reporting no intervention-related discontinuations. Confirmation across multiple sites and assessment in older children are needed before the findings can be generalized more broadly.
What to keep in mind
The trial was conducted at a single hospital in Uganda, included 100 children, and followed participants for 6 months; the authors call for multisite trials and evaluation in older children.