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Measles severity and serum retinol (vitamin A) concentration among children in the United States
J C Butler1, P L Havens, A L Sowell
1Section of Acute and Communicable Disease Epidemiology, Wisconsin Division of Health, Madison.
Insights
Children with measles in the US often have low vitamin A (retinol) levels, which are linked to more severe illness. Vitamin A therapy may be beneficial for hospitalized children with measles in the United States.
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Science
- Public Health
Background:
- Previous studies in developing nations indicate low serum retinol in children with measles, correlating with increased mortality.
- Vitamin A supplementation has demonstrated efficacy in reducing measles-related mortality in African children.
Purpose of the Study:
- To investigate serum retinol concentrations in children with measles in the United States.
- To determine the association between retinol levels and measles illness severity in this population.
Main Methods:
- A study was conducted at a pediatric hospital in Milwaukee, WI, during the 1989-1990 measles outbreak.
- Serum retinol was measured in 114 children (<= 5 years) with confirmed measles within 5 days of rash onset.
- Illness severity was assessed using a modified Pediatric Risk of Mortality (PRISM) score.
Main Results:
- 72% of the children exhibited low serum retinol concentrations (<= 0.70 mumol/L).
- Lower median retinol levels were observed in hospitalized patients and those with pneumonia.
- Higher modified PRISM scores, indicating greater instability, were significantly associated with lower retinol concentrations, even after multivariate analysis.
Conclusions:
- Measles in this US urban cohort is associated with depressed retinol levels, correlating with illness severity.
- Vitamin A therapy should be considered for hospitalized children diagnosed with measles in the United States.
Background:
Studies in developing countries have shown that children with measles have low serum retinol concentrations and that lower retinol levels are associated with measles-related mortality. Vitamin A therapy has been shown to reduce mortality among African children with acute measles.
Objectives:
To determine whether serum retinol concentration is low among children with measles in the United States and to determine whether retinol concentration is associated with illness severity.
Setting:
Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990.
Patients:
One hundred fourteen patients < or = 5 years of age evaluated for serologically confirmed measles with serum obtained within 5 days following rash onset.
Methods:
Serum retinol concentration was determined by high-performance liquid chromatography. Clinical data were collected by hospital record review. A modified Pediatric Risk of Mortality (PRISM) score was used to assess physiologic instability as a measure of illness severity.
Results:
Retinol concentrations ranged from 0.25 to 1.18 mumol/L (median 0.58 mumol/L); 82 (72%) patients had low retinol concentration (< or = 0.70 mumol/L). Median retinol concentrations were lower among hospitalized patients (0.56 vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02) but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher modified PRISM scores, reflecting greater physiologic instability, were associated with lower retinol concentration (beta coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associated with lower retinol concentration (beta coefficient -.0144, P = .025) even after controlling for hospitalization, presence of complications, race, age, receipt of Aid to Families With Dependent Children, gender, and interval from rash onset until serum was collected.
Conclusions:
Among these children with measles in an urban United States community, retinol concentrations were depressed, and the degree of depression was associated with illness severity. Vitamin A therapy should be considered for children with measles in the United States who require hospitalization.
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