Vitamin A given to children with measles - Does dose make a difference?

D'Souza R, D'Souza R

Background: The World Health Organization (WHO) in 1987 recommended a single dose of 200,000 IU of vitamin A, at the time of initial measles diagnosis, to non-xerophthalmic children who live in areas where measles case fatality rates were a problem. In 1997, this recommendation was changed to 200,000 IU of vitamin A for two days for all children older than one year of age with measles in populations where vitamin A deficiency may be present. This review aims to determine whether vitamin A given to children after measles has been diagnosed is beneficial in preventing morbidity and mortality

Methods: The search strategy used was developed for the Acute Respiratory Infections Group, which included The Cochrane Library, Issue 1, 1999. Twenty-eight studies were assessed independently by two reviewers using the Jadad method for assessing the quality of trials. In the meta-analysis administration of vitamin A was compared with placebo. Summary estimates of effect (using relative risk or weighted mean difference) were calculated across studies for morbidity (incidence of pneumonia, diarrhoea, croup) and mortality. Five of the 28 studies met the selection criteria and were included in the review. A sixth study was found later. Trialists were contacted for missing data. Data was extracted from each trial for analysis by intention to treat.

Results: Mortality reduction was seen in studies that used the double dose. There were two studies that repeated the dose of 200,000 IU on day two and a third study that gave it on Day 1,2 and 8. When these three studies were pooled there was an overall 60% reduction in mortality, RR=0.40 (95% CI 0.19, 0.87). The reduction in mortality was more pronounced in children under the age of two years ie 79%; RR=0.21 (95% CI=0.07, 0.66). The studies that used the double dose had a 64% reduction in pneumonia specific mortality RR=0.36 (95% CI 0.14, 0.92) and 46% reduction in the incidence of croup, RR=0.54 (95% CI, 0.34, 0.88). When the studies were stratified by formulation, water soluble preparations of vitamin A had a more significant effect on overall mortality reduction than oil-based preparations (77% reduction in mortality) RR 0.23 (0.06, 0.89).

Conclusion: This review has demonstrated that there was a significant reduction in childhood mortality and respiratory morbidity and mortality in children that received the two doses of 200,000 IU vitamin A. This finding supports the WHO recommendation that two doses of 200,000 IU be given to every child with severe measles.