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Routine high-dose vitamin A therapy for children hospitalized with measles
1Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Insights
High-dose vitamin A therapy significantly reduces measles complications and mortality in hospitalized children. This cost-effective treatment should be standard care for all children with measles.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Measles is a significant global cause of childhood mortality.
- No specific antiviral therapy exists for measles.
- High-dose vitamin A therapy (Hi-VAT) has shown promise in reducing measles severity in controlled studies.
Purpose of the Study:
- To evaluate the effectiveness of Hi-VAT in routine hospital practice.
- To assess the applicability of research findings to real-world measles case management.
- To determine the impact of Hi-VAT on hospital stay, intensive care needs, and mortality rates.
Main Methods:
- Retrospective study of 1720 children hospitalized for measles.
- Comparison of outcomes between children receiving standard therapy and those receiving Hi-VAT (400,000 IU).
- Analysis of data from two non-consecutive 2-year periods, with Hi-VAT implemented in the interim.
Main Results:
- Children receiving Hi-VAT had a shorter hospital stay (10 vs. 13 days, P < 0.001).
- Hi-VAT group showed lower intensive care requirements (4.3% vs. 10.5%, P < 0.001).
- Mortality rate was significantly lower in the Hi-VAT group (1.6% vs. 5%, P < 0.001).
- No adverse effects of Hi-VAT were observed.
Conclusions:
- Hi-VAT provides benefits in routine practice equivalent to controlled trials.
- High-dose vitamin A supplementation is highly cost-effective for measles management.
- Hi-VAT should be integrated into the routine care of all hospitalized children with measles.
Abstract:
Measles is without specific therapy and remains important globally as a cause of childhood death. In controlled studies, high-dose vitamin A therapy (Hi-VAT)--with 400,000 IU vitamin A--has been demonstrated to markedly reduce measles-associated morbidity and mortality. We performed a retrospective study of the hospital records of 1720 children < 15 years of age who were hospitalized for measles, to determine the extent to which these findings, in research settings, are applicable to the case management of measles under conditions of routine hospital practice. The outcomes were studied of children hospitalized during two non-consecutive 2 year periods (1985-6 and 1989-90). A policy of Hi-VAT for all children hospitalized with measles was started during the intervening period. As compared with the group of children on standard therapy (n = 1061), children receiving Hi-VAT (n = 651) had a shorter hospital stay (mean 10 versus 13 days; P < 0.001), a lower requirement for intensive care (4.3 versus 10.5 per cent; P < 0.001), and a lower death rate (1.6 versus 5 per cent; P < 0.001). No adverse effects of Hi-VAT therapy were observed. We conclude that a policy of high dose oral vitamin A (400,000 IU) supplementation in measles provides benefits which are equivalent to those previously observed only in controlled research trials, that it is highly cost effective, and that it should form part of the routine case management of all children hospitalized with measles.