Vitamin D deficiency as a risk factor for COVID-19 infection in children


  • Adarsh E. Department of Paediatrics, RajaRajeshwari Medical College and Hospital, Bangalore, Karnataka, India
  • Malavika Jayanna Department of Paediatrics, RajaRajeshwari Medical College and Hospital, Bangalore, Karnataka, India
  • Neethu N. Reddy Department of Paediatrics, RajaRajeshwari Medical College and Hospital, Bangalore, Karnataka, India



COVID 19, Vitamin D deficiency, Children, Immunomodulatory effects, Risk factor, Retrospective study


Background: Vitamin D deficiency is a major public health problem in all age groups. Through its immunomodulatory, anti-inflammatory and antioxidant effects it is shown to have a protective effect in COVID affected children. The objective of the study was to evaluate vitamin D deficiency as a risk factor for developing COVID-19 infection in children and to study the relationship between vitamin D deficiency and the clinical findings in COVID-19 positive children.

Methods: A retrospective study of all COVID positive children aged 1 month to 15 years admitted to COVID Paediatric ward of Rajarajeshwari Medical hospital from July 2020-November 2020. All COVID positive children confirmed with RTPCR of age group 1 month to 15 years will be included in the study the age at admission, clinical and laboratory data, and 25‐hydroxycholecalciferol (25‐OHD) levels will be recorded. Patients diagnosed with COVID 19 are divided into 2 groups those with deficient and insufficient vitamin D levels were determined as group 1 and patients with normal vitamin D levels as Group 2. Those with vitamin D Levels below 20ng/ml were determined as group 1 and those with >20 ng/ml as group 2. The various clinical outcomes and laboratory parameters were compared between the two groups.

Results: Patients with COVID 19 had significantly lower vitamin D levels 22.39±6.27 (p≤0.0001). Patients in group A that is vitamin D deficient and insufficient group had higher levels of ferritin (p≤0.0001).

No significant difference was found between other clinical and laboratory parameters between group 1 and group 2.

Conclusions: This is one of the first to evaluate vitamin D levels and its relationship with clinical findings in paediatric patients with covid-19. Although vitamin D does not play a role in the pathogenesis of COVID-19 we do believe its putative role in preventing and treating the disease The results suggest that vitamin D levels may be associated with the occurrence and management of the COVID-19 disease by modulating the immunological mechanism to the virus in paediatric population.


Grant WB, Lahore H, McDonnell SL. Evidence that vitamin D supplementation could reduce risk of influenza and COVID‐19 infections and deaths. Nutrients. 2020;12(4):988.

Caccialanza R, Laviano A, Lobascio F. Early nutritional supplementation in non‐critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID‐19): rationale and feasibility of a shared pragmatic protocol. Nutrition. 2020;74:110835.

Zhang Y. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID‐19)—China, 2020. Chinese J Epidemiol. 2020.

Yuanyuan D, Xi M, Yabin H, Xin Q, Fan J, Zhongyi J. Epidemiology of COVID‐19 Among Children in China. Pediatrics. 2020;145:6.

Stephanie B, Ryan G, Michelle H, Lucy MA. Coronavirus disease 2019 in children — United States. Morb Mortal Wkly Rep. 2020;69(14):422‐6.

Marik PE, Kory P, Varon J. Does vitamin D status impact mortality from SARS‐CoV‐2 infection? Medicine in drug discovery. 2020;6:100041.

Hoffmann M, Kleine‐Weber H, Schroeder S. SARS‐CoV‐2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271‐80.

Bombardini T, Picano E. Angiotensin‐converting enzyme 2 as the molecular bridge between epidemiologic and clinical features of COVID‐19. Can J Cardiol. 2020;36(5):784e1‐2.

Hughes D, Norton R. Vitamin D and respiratory health. Clin Experiment Immunol. 2009;158(1):20‐5.

Hansdottir S, Monick MM. Vitamin D effects on lung immunity and respiratory diseases. Vitam Horm. 2011;86:217‐37.

Zhou J, Du J, Huang L, Wang Y, Shi Y, Lin H. Preventive effects of vitamin D on seasonal influenza A in infants: a multicenter, randomized, open, controlled clinical trial. Pediatr Infect Dis J. 2018;37:749‐54.

Aglipay M, Birken CS, Parkin PC. Effect of high‐dose vs standard‐dose wintertime vitamin d supplementation on viral upper respiratory tract infections in young healthy children. JAMA. 2017;318(3):245‐54.

Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240‐70.

Baqui AH, Black RE, Arifeen S. Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull World Health Organ. 1998;76(2):161.

Martineau AR, Jolliffe DA, Hooper RL. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta‐analysis of individual participant data. BMJ. 2017;356:i6583.

23. Li W, Cheng X, Guo L. Association between serum 25‐hydroxyvitamin D concentration and pulmonary infection in children. Medicine. 2018;97(1):e9060.

Daneshkhah A, Eshein A, Subramanian H. The role of vitamin D in suppressing cytokine storm in COVID‐19 patients and associated mortality. medRxiv. 2020

McCartney DM, Byrne DG. Optimisation of vitamin D status for enhanced immuno-protection against Covid-19. Ir Med J. 2020;113(4):58. Bethesda (MD): National Library of Medicine (US). 2020 Apr 3—Identifer NCT04334005, Efect of Vitamin D Administration on Prevention and Treatment of Mild Forms of Suspected Covid-19 (COVITD-19). 2020. Accessed on 13 April 2020.

Panarese A, Shaini E. Letter: Covid-19, and vitamin D. Aliment Pharmacol Ther.

Caccialanza R, Laviano A, Lobascio F. Early Nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): rationale and feasibility of a shared pragmatic protocol. Nutrition.

Panfli FM, Roversi M, Argenio PD, Rossi P, Cappa M, Fintini D. Possible role of vitamin D in Covid 19 infection in pediatric population.

Alipio M. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with coronavirus‐2019 (COVID‐19).

Lau F. Vitamin D insufficiency is prevalent in severe COVID‐19. medRxiv. 2020.

Raharusun P, Priambada S, Budiarti C. Patterns of COVID‐19 mortality and vitamin D: an Indonesian study. 2020.

Stagi S, Rigante D, Lepri G, Cerinic M, Falcini F. Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities? Clin Rheumatol. 2016;35(7):1865‐72.

Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clinical and Experimental Research. 2020:1. Clin Experiment Res. 2020;1.

Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol. 2020;92(5):479-90.

Nonnecke BJ, McGill JL, Ridpath JF, Sacco RE, Lippolis JD, Reinhardt TA (2014) Acute phase response elicited by experimental bovine diarrhea virus (BVDV) infection is associated with decreased vitamin D and E status of vitamin-replete preruminant calves. J Dairy Sci. 2014;97:5566-79.

Del-Rio-Navarro BE, Espinosa Rosales F, Flenady V, SienraMonge JJ. Immunostimulants for preventing respiratory tract infection in children. Cochrane Database Syst Rev. 2006.

Aglipay M, Birken CS, Parkin PC. Efect of highdose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. JAMA. 2017;318(3):245-54.

Pletz MW, Terkamp C, Schumacher U. Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity. Respir Res. 2014;15(1):53.

Miroliaee AE, Salamzadeh J, Shokouhi S, Sahraei Z. The study of vitamin D administration efect on CRP and interleukin-6 as prognostic biomarkers of ventilator associated pneumonia. J Crit Care. 2018;44:300-05.

Lemire JM. Immunomodulatory role of 1,25-dihydroxyvitamin D3. J Cell Biochem. 1992;49(1):26-31.

Chen S, Sims GP, Chen XX, Gu YY, Chen S, Lipsky PE. Modulatory efects of 1,25-dihydroxyvitamin D3 on human B cell diferentiation. J Immunol. 2007;179:1634-47.

New room fact sheet: pneumonia. Accessed on 2nd August 2019.

San V, Yilmaz K. Is vitamin D deficiency a risk factor for COVID‐19 in children?

Rossi P, Chini L, Fattorossi A. 1,25-Dihydroxyvitamin D3 and phorbol esters (TPA) may induce select in vitro differentiation pathways in the HL60 promyelocytic cell line. Clin Immunol Immunopathol. 1987;44(3):308-16.

Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis. 2015;15:487.

Das RR, Singh M, Naik SS. Vitamin D as an adjunct to antibiotics for the treatment of acute childhood pneumonia. Cochrane Database Syst Rev. 2018;7(7):CD011597.






Original Research Articles