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Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebo-controlled,
A Coutsoudis1, M Broughton, H M Coovadia
1Department of Paediatrics and Child Health, University of Natal, Durban, South Africa.
Insights
Vitamin A supplementation significantly reduced measles severity and complications in hospitalized children. This supports World Health Organization recommendations for vitamin A during measles treatment.
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Immunology
- Public Health Interventions
Background:
- The impact of vitamin A supplementation on measles-related illness (morbidity) remains incompletely understood.
- Measles is a significant cause of childhood mortality and morbidity, particularly in resource-limited settings.
- Hyporetinemia (low vitamin A levels) is common in children with measles.
Purpose of the Study:
- To evaluate the efficacy of vitamin A supplementation in reducing measles morbidity among hospitalized children.
- To assess the impact of vitamin A on integrated morbidity scores and specific complications like respiratory tract infections.
Main Methods:
- A randomized, placebo-controlled trial involving 60 hospitalized children aged 4-24 months with complicated measles.
- Participants received either WHO-recommended vitamin A doses or a placebo.
- Morbidity was assessed using integrated scores at 8 days, 6 weeks, and 6 months, considering factors like diarrhea and respiratory infections.
Main Results:
- Vitamin A supplementation led to substantial reductions in integrated morbidity scores: 82% at 8 days, 61% at 6 weeks, and 85% at 6 months.
- The primary driver of this reduction was a significant decrease in respiratory tract infections.
- The supplemented group showed significant weight gain at 6 weeks, and only one death occurred in the placebo group.
Conclusions:
- Vitamin A supplementation effectively reduces measles morbidity and severity, particularly respiratory complications, in hospitalized children.
- The findings strongly support current World Health Organization recommendations for vitamin A administration during measles.
- The study highlights the importance of addressing hyporetinemia in measles management.
Abstract:
The effects of vitamin A supplementation on measles morbidity are unclear. Sixty hospitalized children aged 4-24 mo with complicated measles received a World Health Organization--(WHO) recommended dose of vitamin A or placebo. The two groups were comparable in known covariants of measles severity: weight-for-age percentiles, overcrowding, rash, total lymphocytes, and serum concentrations of zinc, albumin, prealbumin, retinol-binding protein, and vitamins A and E. Ninety percent of the patients had hyporetinemia. Integrated morbidity scores, determined by severity of condition (eg, diarrhoea, herpes, and respiratory-tract infection) were assigned on day 8 and 6 wk and 6 mo; these were reduced by 82%, 61%, and 85%, respectively, in the supplemented group, which was mainly due to reduced respiratory-tract infection. There was one death in the placebo group. At 6 wk weight gain was significant in the supplemented group. Despite the selected sample, attention to multiple covariates enhances the validity of the data obtained and supports the current WHO recommendations for vitamin A supplementation during measles.