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A randomized, controlled trial of vitamin A in children with severe measles
1Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Insights
Vitamin A supplementation significantly reduced complications and deaths in children hospitalized with measles. This treatment is recommended for severe measles cases, regardless of nutritional status.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Measles causes millions of child deaths annually with no specific treatment.
- Vitamin A supplementation is being investigated as a potential therapy for measles.
Purpose of the Study:
- To evaluate the efficacy of vitamin A in treating measles complications in children.
Main Methods:
- A randomized, double-blind trial was conducted with 189 hospitalized children with measles.
- Children received either vitamin A (retinyl palmitate) or a placebo orally within five days of rash onset.
Main Results:
- Vitamin A treatment led to faster recovery from pneumonia, diarrhea, and croup.
- The vitamin A group had significantly lower rates of death and major complications compared to placebo.
- Despite low baseline retinol levels in most children, vitamin A showed clear benefits.
Conclusions:
- Vitamin A supplementation effectively reduces morbidity and mortality in children with severe measles.
- All children with severe measles should receive vitamin A supplements, irrespective of perceived nutritional deficiency.
Background:
Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles.
Methods:
We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar.
Results:
Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/- 0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level less than 0.7 mumols per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/- 0.5 g per liter) were also low. As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01). Of the 12 children who died, 10 were among those given placebo (P = 0.05). For the group treated with vitamin A, the risk of death or a major complication during the hospital stay was half that of the control group (relative risk, 0.51; 95 percent confidence interval, 0.35 to 0.74).
Conclusions:
Treatment with vitamin A reduces morbidity and mortality in measles, and all children with severe measles should be given vitamin A supplements, whether or not they are thought to have a nutritional deficiency.