Zinc Supplementation Reduces Infections in Young Children With Sickle Cell Anemia: Study
Researchers have found in a randomized clinical trial of 100 Ugandan children younger than 5 years with sickle cell anemia that daily 20-mg zinc supplementation reduced all-cause infections over 6 months compared with placebo. No adverse events requiring treatment discontinuation were reported. The authors recommend larger, multisite trials to confirm these findings. The study was published in JAMA by Ruth N. and colleagues.
In order to assess the efficacy and safety of oral zinc, a double-blind randomized control trial was conducted at Jinja Regional Referral Hospital in Jinja, Uganda, among children with sickle cell anemia who were 1.00 to 4.99 years old. Of the 118 pediatric patients who were eligible and screened for the study between February 10, 2025 and April 30, 2025, a total of 100 subjects were randomized in a 1:1 ratio to receive either 20 mg of oral zinc sulfate daily (n = 50) or a placebo (n = 50) for 6 months, with full follow-up until November 7, 2025.
At baseline enrollment, 45 subjects (45%) were on disease modifying hydroxyurea treatment, and all patients continued hydroxyurea treatment during the duration of the study. The primary endpoint used for evaluating the efficacy of the treatment was all-cause infectious events per 100 person years using strict and rigorous clinical diagnostic criteria. There was 100% retention rate of participants throughout the 6-month study period.
Key findings:
- The randomized population comprised 100 children (mean age 36.0 ± 13.2 months; 45% female [45 of 100]), divided evenly between the zinc (n = 50) and placebo (n = 50) intervention arms.
- Over the 6-month follow-up period, investigators documented 80 total all-cause infections in the zinc group compared to 124 infections in the placebo group.
- Zinc supplementation resulted in a significantly lower infection rate of 305.7 (95% CI, 242.4–380.4) infections per 100 person-years compared to 480.7 (95% CI, 399.8–573.1) infections per 100 person-years in the placebo group, representing an absolute rate difference of −176.0 (95% CI, −300.8 to −51.3).
- After adjusting for baseline age, sex, and hydroxyurea use, zinc supplementation achieved a statistically significant 38% reduction in all-cause infection risk (adjusted IRR 0.62; 95% CI, 0.45–0.86).
- Daily zinc sulfate was exceptionally well tolerated, with zero observed adverse events requiring discontinuation of the study intervention in either group.
In summary, daily zinc oral supplementation of 20 mg/day is both safe and efficacious in reducing all-cause infections among children under five years old with sickle cell anemia in Uganda. Daily zinc achieves a statistically significant reduction of 38% in infections without any adverse effects in safety and tolerability. Daily zinc, therefore, emerges as a potent prophylactic therapy. These convincing results point to the immediate need for multisite randomized trials to confirm the results and test its efficacy among older pediatric patients.
Reference:
Namazzi R, Mellencamp KA, Bagala I, et al. Daily Zinc Supplementation for Infection Prevention in Children With Sickle Cell Anemia: The ZIPS-2 Randomized Clinical Trial. JAMA. Published online August 19, 2026. doi:10.1001/jama.2026.14190
