Vitamin A

A report in the Cochrane Database of Systematic Reviews (Yang et al., n.d.) concluded that Vitamin A (200,000 IU on each of two consecutive days) reduced mortality from measles in children under the age of two.  In their review, participants who were given Vitamin A had shorter duration of pneumonia, diarrhea, fever, and hospitalization.  The authors note that all of these studies took place in low-income countries. 

 

One of the studies included in this systematic review, an RCT by Barclay et al. (1987), gave the above dose to 46 children under the age of two, and placebo to 42 children under the age of two when they were admitted to the hospital in Tazmania in an area with a high rate of malnutrition.  All had low serum Vitamin A.  Seven children in the placebo group died while only two died in the intervention group.  The Vitamin A was specifically found to be beneficial for croup and laryngotracheobronchitis.  In another one of the studies, Coutsoudis et al. (1992) gave Vitamin A or placebo to 60 African children with measles, 100,000 IU for those under a year and 200,000 IU for those 12-24 months old.  They too saw reduced mortality in the intervention group, and they also saw higher antibodies.

 

Another systematic review and meta-analysis of the same six RCTs by Sudfeld et al. (2010) also concluded that measles mortality was reduced by two doses of Vitamin A; 200,000 IU for children over one year old and 100,000 IU for those under a year. 

 

A study by Butler et al. (1993) found that 72% of 114 children under the age of six who had measles in Milwaukee had low levels of Vitamin A.  Those who had more severe illness, were hospitalized, or had pneumonia were even more likely to have low levels.  They were able to measure serum Vitamin A again in four children two weeks after they got measles when they were recovering.  They found the levels to be three times as high as they had been during their acute illness; these children had not received a supplement.  The authors suggest that the low levels were a temporary condition associated with the measles infection, particularly since they had not observed any signs of Vitamin A deficiency in these children.  They support providing high-dose Vitamin A to children who are hospitalized with severe measles in the United States. 

 

A dose of 200,000 IU is high enough to cause acute toxicity for a child, so I would only recommend this high a dose for a child who was clearly experiencing a severe case of measles where the higher need for the vitamin reduced the likelihood of toxicity. 

 

References

 

Barclay, A. J., Foster, A., & Sommer, A. (1987). Vitamin A supplements and mortality related to measles: a randomised clinical trial. British Medical Journal (Clinical Research Ed.), 294(6567), 294–296. 

 

Butler, J. C., Havens, P. L., Sowell, A. L., Huff, D. L., Peterson, D. E., Day, S. E., Chusid, M. J., Bennin, R. A., Circo, R., & Davis, J. P. (1993). Measles severity and serum retinol (vitamin A) concentration among children in the United States. Pediatrics, 91(6), 1176. 

 

Coutsoudis, A., Kiepiela, P., Coovadia, H. M., & Broughton, M. (1992). Vitamin A supplementation enhances specific IgG antibody levels and total lymphocyte numbers while improving morbidity in measles. The Pediatric Infectious Disease Journal, 11(3), 203–209. 

 

Office of Dietary Supplements.  (n.d.).  Vitamin A and Carotenoids Fact Sheet for Health Professionals.  National Institutes of Health. 

 

Sudfeld, C. R., Navar, A. M., & Halsey, N. A. (2010). Effectiveness of measles vaccination and vitamin A treatment. International Journal of Epidemiology, 39 Suppl 1, i48–i55. 

 

Yang, H. M., Mao, M., Wan, C., & Yang, H. M. (n.d.). Vitamin A for treating measles in children. Cochrane Database of Systematic Reviews, 10.