Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers. We conducted a prospective, controlled trial at a tertiary university hospital. A random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare system workers served as controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved. Incidence rates were compared between the vitamin D and control groups. Workers in the intervention group were included in the analysis if they completed at least 2 months of supplementation to ensure adequate vitamin D levels. The primary analysis compared the incidence rate of all ILI, while secondary analyses examined incidence rates of COVID-19 ILI and non-COVID-19 ILI. Between October 2020 and November 2021, 255 healthcare workers (age 47 ± 12 years, 199 women) completed at least two months of vitamin D3 supplementation. The control group consisted of 2827 workers. Vitamin D3 5000 IU supplementation was associated with a lower risk of ILI (incidence rate difference: −1.7 × 10⁻⁴/person-day, 95%-CI: −3.0 × 10⁻⁴ to −3.3 × 10⁻⁵/person-day, p = 0.015) and a lower incidence rate for non-COVID-19 ILI (incidence rate difference: −1.3 × 10⁻⁴/person-day, 95%-CI −2.5 × 10⁻⁴ to −7.1 × 10⁻⁶/person-day, p = 0.038). COVID-19 ILI incidence was not statistically different (incidence rate difference: −4.2 × 10⁻⁵/person-day, 95%-CI: −10.0 × 10⁻⁵ to 1.5 × 10⁻⁵/person-day, p = 0.152). Daily supplementation with 5000 IU vitamin D3 reduces influenza-like illness in healthcare workers.

Importance: Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. Objective: The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers. Design: We conducted an open label, randomized clinical trial wherein a random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare workers served as passive controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved. Setting: The trial was conducted at a tertiary university hospital. Participants: Out of 7,600 healthcare workers, two groups of 4,708 and 2,892 subjects were pre-randomized to the vitamin D3 intervention and passive control groups, respectively. Out of 4,708 intervention subjects approached, 299 with no history of hypercalcemia or nephrolithiasis were enrolled. Subjects who completed at least 2 months of supplementation to ensure adequate vitamin D levels were included in the analysis (n=255). Intervention: Daily oral vitamin D3 gel capsules at 5000 IU for 9 months. Main Outcome and Measure: The primary analysis compared the incidence rate of all ILI, while secondary analyses examined incidence rates of COVID-19 ILI and non-COVID-19 ILI. Incidence rates were compared between the vitamin D and control groups. Results: Between October 2020 and November 2021, 255 healthcare workers (age 47±12 years, 199 women) completed at least two months of vitamin D3 supplementation. Five subjects were withdrawn due to adverse effects. The control group consisted of 2,827 workers. Vitamin D3 5000 IU supplementation was associated with lower risk of ILI (incidence rate difference: - 1.7×10 ^-4 /person-day, 95%-CI: -3.0×10 ^-4 to -3.3×10 ^-5 /person-day, P = 0.015) and a lower incidence rate for non-COVID-19 ILI (incidence rate difference: -1.3×10 ^-4 /person-day, 95%-CI - 2.5×10 ^-4 to -7.1×10 ^-6 /person-day, P = 0.038). COVID-19 ILI incidence was not statistically different (incidence rate difference: -4.2×10 ^-5 /person-day, 95%-CI: -10.0×10 ^-5 to 1.5×10 ^-5 /person-day, P = 0.152). An intention-to-treat analysis could not be performed due to low enrollment in the pre-randomized intervention group. Conclusion and Relevance: Daily supplementation with 5000 IU vitamin D3 reduces influenza-like illness in healthcare workers. Trial Registration: Clinicaltrials.gov , NCT04596657 Key Points: Question: Can 5,000 IU of daily vitamin D3 prevent influenza-like illness in healthcare workers? Findings: In this randomized controlled trial, 5,000 IU of once daily vitamin D3 over a 9-month period revealed that vitamin D3 supplementation was associated with a statistically significant lower risk of influenza-like illness (incidence rate difference -1.7 × 10 ^-4 / person-day, 95%-CI - 3.0 × 10 ^-4 to -3.3 × 10 ^-5 / person-day, P = 0.0147). Meaning: Daily supplementation with 5,000 IU vitamin D3 reduces influenza-like illness in healthcare workers.

Introduction: Designing and conducting clinical trials is challenging for some institutions and researchers due to associated time and personnel requirements. We conducted recruitment, screening, informed consent, study product distribution, and data collection remotely. Our objective is to describe how to conduct a randomized clinical trial using remote and automated methods. Methods: A randomized clinical trial in healthcare workers is used as a model. A random group of workers were invited to participate in the study through email. Following an automated process, interested individuals scheduled consent/screening interviews. Enrollees received study product by mail and surveys via email. Adherence to study product and safety were monitored with survey data review and via real-time safety alerts to study staff. Results: A staff of 10 remotely screened 406 subjects and enrolled 299 over a 3-month period. Adherence to study product was 87%, and survey data completeness was 98.5% over 9 months. Participants and study staff scored the System Usability Scale 93.8% and 90%, respectively. The automated and remote methods allowed the study maintenance period to be managed by a small study team of two members, while safety monitoring was conducted by three to four team members. Conception of the trial to study completion was 21 months. Conclusions: The remote and automated methods produced efficient subject recruitment with excellent study product adherence and data completeness. These methods can improve efficiency without sacrificing safety or quality. We share our XML file for researchers to use as a template for learning purposes or designing their own clinical trials.

Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Comparisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups differed but were not statistically significant. Vitamin D3 supplementation reduced healthcare utilization in four major categories: hospitalizations for any reason (rate difference: −0.19 per 1000 person-days, 95%-CI: −0.21 to −0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate difference: −0.06 per 1000 person-days, 95%-CI: −0.08 to −0.04 per 1000 person-days, p < 0.0001); emergency room visits for any reason (rate difference: −0.26 per 1000 person-days, 95%-CI: −0.46 to −0.05 per 1000 person-days, p = 0.0131; and hospitalizations due to COVID-19 (rate difference: −8.47 × 10⁻³ per 1000 person-days, 95%-CI: −0.02 to −1.05 × 10⁻³ per 1000 person-days, p = 0.0253). Appropriately powered studies of longer duration are recommended for replication of these utilization findings and analysis of cost differences.

Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Comparisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups were not statistically different. Vitamin D3 supplementation reduced healthcare utilization in four major categories: hospitalizations for any reason (rate difference: -0.19 per 1000 person-days, 95%-CI: -0.21 to -0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate difference: -0.06 per 1000 person-days, 95%-CI: -0.08 to -0.04 per 1000 person-days, p < 0.0001); emergency room visits for any reason (rate difference: -0.26 per 1000 person-days, 95%-CI: -0.46 to -0.05 per 1000 person-days, p = 0.0131; and hospitalizations due to Covid-19 (rate difference: -8.47X10 ⁻³ per 1000 person-days, 95%-CI: -0.02 to -1.05X10 ⁻³ per 1000 person-days, p = 0.0253). Appropriately powered studies of longer duration are recommended for replication of these utilization findings and analysis of cost differences.

Five patients with standard medical treatment-resistant symptoms of skin lesions, ear infections, allergic rhinitis, nasal congestion, asthma, heartburn, and failure to thrive were success- fully treated with an integrative medicine assessment and integrative medicine treatment approach. The integrative medicine assessment method of autonomic response testing enabled the identifica- tion of nickel sensitivity as a common element in these patients. It guided the use of the integrative medicine therapies of low dose immunotherapy, gamma linoleic acid supplementation, chelation, dietary nickel restriction, and removal of nickel containing dental and cosmetic appliances. A chart review of 151 patients indicated a strong association of nickel and the simultaneous presence of skin lesions.