Vitamin A Dosing for Children with Measles
All children with clinical measles should receive 200,000 IU of oral vitamin A on day 1 (100,000 IU for children under 12 months), with a second dose on day 2 for those with complicated measles. 1, 2
Standard Dosing Protocol
Uncomplicated Measles
- Children ≥12 months: 200,000 IU oral vitamin A as a single dose on day 1 1, 2
- Children <12 months: 100,000 IU oral vitamin A as a single dose on day 1 1, 2
Complicated Measles
For children with any of the following complications, administer a second dose on day 2 at the same dosage as day 1: 1, 2
- Pneumonia
- Otitis media
- Croup/laryngotracheobronchitis
- Diarrhea with moderate or severe dehydration
- Neurological problems
Special Circumstances: Clinical Vitamin A Deficiency
If eye signs of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), use an extended treatment schedule: 1, 3
- Day 1: 200,000 IU oral vitamin A (100,000 IU if <12 months)
- Day 2: 200,000 IU oral vitamin A (100,000 IU if <12 months)
- 1-4 weeks later: 200,000 IU oral vitamin A (100,000 IU if <12 months)
Evidence Supporting Two-Dose Regimen
The two-dose regimen (200,000 IU × 2 days) demonstrates superior outcomes compared to single-dose therapy. Research shows that two doses of 200,000 IU reduce overall mortality by 64% (RR 0.36; 95% CI 0.14-0.82) and pneumonia-specific mortality by 67% (RR 0.33; 95% CI 0.08-0.92). 4, 5 In contrast, a single 200,000 IU dose shows no significant mortality reduction (RR 0.77; 95% CI 0.34-1.78). 4
The mortality benefit is most pronounced in children under 2 years of age, with an 82% reduction in mortality risk (RR 0.18; 95% CI 0.03-0.61). 4, 5
Clinical Benefits Beyond Mortality
Vitamin A supplementation in measles provides multiple benefits: 6
- Faster recovery from pneumonia (6.3 vs 12.4 days without treatment)
- Shorter duration of diarrhea (5.6 vs 8.5 days)
- Reduced incidence of croup by 47% (RR 0.53; 95% CI 0.29-0.89) 4
- Decreased hospital stay (10.6 vs 14.8 days)
- 74% reduction in otitis media incidence (RR 0.26; 95% CI 0.05-0.92) 4
Important Clinical Considerations
When to Administer
- Give vitamin A if the child has not received it within the previous month 1
- Administer as soon as measles is clinically diagnosed—do not wait for laboratory confirmation 2
- Continue routine vitamin A supplementation every 3 months after acute treatment 1
Why This Matters
Even in populations without clinically apparent vitamin A deficiency, children with measles demonstrate marked hyporetinemia (92% with serum retinol <0.7 μmol/L). 6 Measles itself depletes vitamin A stores, making supplementation critical regardless of baseline nutritional status. 6
Common Pitfall
Do not withhold vitamin A based on perceived adequate nutritional status. The CDC explicitly states that vitamin A deficiency increases measles severity and mortality, and supplementation is critical for all children with clinical measles. 2 Studies demonstrate benefit even in well-nourished populations. 6, 7
Formulation Considerations
Water-based vitamin A formulations show greater mortality reduction (81% reduction, RR 0.19; 95% CI 0.02-0.85) compared to oil-based preparations (48% reduction, RR 0.52; 95% CI 0.16-1.40), though both are effective. 4