Vitamin A for measles

Vitamin A reduces the risk of death from measles by 87% for children younger than 2 years. 

Photo Credits: Tran Thi Hoa

  

Why is vitamin A important for treating measles? 

Measles kills up to 10% of people it infects and, while cases are more common in low- and middle-income countries, measles outbreaks happen in all countries. Vitamin A deficiency is common in the world, especially in low- and middle-income countries and is a risk factor for severe measles. Since 1997, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have recommended that 200,000 International Units (IUs) of vitamin A be given twice to all children older than 1 year diagnosed with measles and living in an area where vitamin A deficiency is common.  

Does vitamin A for measles work? 

  • Vitamin A did not have a clear effect on overall mortality rates. However, it reduced the risk of death from measles by 87% for children younger than two years old. In addition, for all children, it reduced the length of time the child suffers from diarrhea by 2 days and shortens the duration of fever by 1 day. 

Equity: does it work in the disadvantaged? 

  • Vitamin A deficiency is more common in low- and middle-income countries putting children with measles in these countries at greater risk of severe infection. Providing children with measles in these countries with vitamin A can prevent measles-related deaths and complications. 

Intervention Delivery 

  • The studies delivered oral vitamin A supplements, either water- or oil-based, to children in hospital or community settings.
  • Vitamin A was given orally in 1-2 doses of 100,000 IU-200,000 IU. 

Population and Setting 

  • 6 of the included studies were conducted in Africa (in Ghana, Kenya, South Africa, Tanzania, and Zambia), one in England and one in Japan.
  • 2 of the studies were conducted in the community setting and the rest were hospital-based.

Summary of Findings [SOF] Table: Vitamin A compared to placebo or no vitamin A for treating measles in children 

Patient or population: children with measles 
Settings: in hospital or in the community 
Intervention: Vitamin A  
Comparison: placebo or no vitamin A 

Outcomes 

Anticipated absolute effects per year 

Relative effect 
(95% CI) 

No of Participants 
(studies) 

Quality of the evidence 
(GRADE) 

Risk without vitamin A (Control) 

Risk with vitamin A (95% CI) 

Mortality (all patients) 

10.27 per 100 

1.12 fewer per 100 (from 3.25 fewer to 1.72 more) 

OR 0.88 (0.66-1.19) 

1974 (7) 

Moderate1 

Mortality (patients under 2 years old) 

10.76 per 100 

8.75 fewer per 100 (from 4.12 to 10.28 fewer) 

OR 0.17 (0.04-0.59) 

309 (3) 

Moderate2 

Mortality (water based vitamin A) 

8.59 per 100 

6.93 fewer per 100 (from 1.44 to 8.22 fewer) 

OR 0.18 (0.04-0.82) 

249 (2) 

Moderate2 

Mortality (areas with case fatality >10%) 

10.45 per 100 

6.63 fewer per 100 (from 2.11 to 8.73 fewer) 

OR 0.34 (0.15-0.78) 

429 (3) 

Moderate2 

Duration of diarrhea  

The intervention group had diarrhea lasting for a mean difference of 1.92 fewer days (from 0.44 to 3.40 fewer days) 

MD -1.92 (-3.40, -0.44) 

249 (2) 

Moderate3 

Duration of fever 

The intervention group had fever for a mean difference of 1.01 fewer days (from 0.13 to 1.89 fewer days) 

MD -1.01 (-1.89, -0.13) 

149 (2) 

Moderate4 

Adverse Events: None of the studies in the review reported on adverse effects. 

1. Inconsistency in results. 
2. Small sample size, rare event, and wide confidence interval. 
3. High heterogeneity (79%) and wide confidence interval. 
4. High heterogeneity (89%). 

 

Relevance of the review for disadvantaged communities 

Vitamin A reduces the risk of death from measles by 87% for children younger than 2 years. 

Vitamin A deficiency is more common in low- and middle-income countries putting children with measles in these countries at greater risk of severe infection. Providing children with measles in these countries with vitamin A can prevent measles-related deaths and complications. 

Findings 

Interpretation 

Equity – Which of the PROGRESS groups examined 

 

Almost all of the included studies were conducted in low-income countries. 

It is unclear whether the results of this review are applicable in high-income countries. Vitamin A is effective for preventing mortality due to measles in low-income studies but policymakers in high-income countries or areas with vitamin A deficiency is rare need to ensure careful monitoring of such an intervention to ensure effectiveness. 

The greatest benefit of vitamin A treatment for measles was in reducing mortality for hospitalized children younger than 2 years of age. 

While no adverse events were reported for children older than 2 years, there was no difference in mortality for those treated or not treated with vitamin A. However, there was a significant reduction in mortality for children younger than 2 years. Vitamin A should be included in low-income countries for children hospitalized due to measles. In children older than 2, vitamin A was effective in reducing the duration of diarrhea and fever. 

The review does not report on differences in outcomes based on child sex or gender, or socioeconomic status. 

There is no indication that vitamin A is less effective for boys or girls. Vitamin A may be more effective among lower income children who may be at greater risk of vitamin A deficiency and therefore benefit more from vitamin A for measles treatment. 

Equity Applicability 

 

Two of the studies examined the effectiveness of vitamin A among children in the community while the rest included hospitalized children. The protective effect of vitamin A was only seen among hospitalized children. This could be due to hospitalized children having more severe illness. 

Vitamin A may be best used for treating measles in hospitalized patients. Community-based children did not experience the same benefit from vitamin A. Policymakers who want to implement a vitamin A program to prevent measles mortality should focus on hospitalized cases. Vitamin A should be given in addition to standard treatment. 

Cost-equity 

 

Vitamin A is cost-saving because it reduces the length of hospitalization while costing only about $0.02 per dose. 

Vitamin A is a cost-effective treatment for treating measles among hospitalized children. 

Vitamin A was effective for measles treatment but only among more severe, hospitalized children. 

Since the children who are most likely to be hospitalized due to measles are often deficient in vitamin A and vitamin A deficiency is more common in disadvantaged children, providing children with vitamin A to treat their measles can help the most disadvantaged children. 

Monitoring & Evaluation for PROGRESS Groups 

 

Two doses of vitamin A are effective in preventing measles-related mortality in children under 2 years living in areas with high case-fatality from measles.  

None of the included studies measured the longer term impact of vitamin A for treating measles. Policymakers adding vitamin A supplementation to measles treatment should consider monitoring longer term outcomes to ensure effectiveness. 

More research is needed to determine whether vitamin A is effective in measles treatment for children older than 2. 

Policymakers should evaluate the effectiveness of vitamin A for treating measles in children older than 2. 

Comments on this summary? Please contact Jennifer Petkovic.