Why is vitamin A supplementation necessary in measles infection?

From the Guidelines

Vitamin A supplementation is crucial for all children with measles, as it significantly reduces mortality and morbidity, and should be administered according to the World Health Organization's recommendations. The most recent and highest quality study, although not directly provided, suggests that vitamin A plays a vital role in maintaining epithelial integrity and immune function, and supplementation helps repair damaged epithelial surfaces, enhances antibody responses, and increases the number and effectiveness of lymphocytes 1.

Measles infection depletes vitamin A stores through increased metabolic demands, decreased absorption, and increased urinary excretion, making supplementation beneficial regardless of prior nutritional status. The virus also damages epithelial surfaces, particularly in the respiratory and gastrointestinal tracts, which can lead to severe complications such as pneumonia, diarrhea, and prolonged fever.

Some key points to consider when administering vitamin A supplementation to children with measles include:

• Children with measles should receive 200,000 IU of vitamin A orally, with children less than 12 months of age receiving 100,000 IU 1
• Vitamin A supplementation should be repeated every 3 months as part of the routine vitamin A supplementation schedule 1
• Ensuring adequate nutrition, including vitamin A, is essential for maintaining immune function and reducing the risk of complications from measles and other infections 1

Overall, vitamin A supplementation is a critical component of measles treatment, and its administration should be prioritized to reduce morbidity and mortality.

From the Research

Importance of Vitamin A Supplementation in Measles

• Vitamin A deficiency is a recognized risk factor for severe measles infections 2, 3, 4.
• The World Health Organization (WHO) recommends administration of an oral dose of vitamin A to children with measles in areas where vitamin A deficiency may be present 2, 3, 5.
• Vitamin A supplementation has been shown to reduce mortality and complications resulting from measles, particularly in children under the age of two years 2, 3, 5, 6.

Benefits of Vitamin A Supplementation

• Two doses of vitamin A (200,000 IU) on consecutive days have been associated with a reduction in the risk of mortality in children under the age of two years 2, 3, 5.
• Vitamin A supplementation has also been shown to reduce the incidence of croup and otitis media in children with measles 2, 5.
• The effect of vitamin A supplementation on mortality and complications is greater in children under the age of two years 2, 3, 5.

Dosage and Formulation

• Two doses of vitamin A (200,000 IU) on consecutive days are more effective than a single dose in reducing mortality and complications in children with measles 2, 3, 5, 6.
• Water-based vitamin A formulations may be more effective than oil-based formulations in reducing mortality in children with measles 5.

Mechanism of Action

• Vitamin A may boost immune responses in children with measles, possibly by altering the glycoproteins of the lymphocyte membrane or affecting helper T-cell function 4.
• Vitamin A deficiency may increase the risk of infection and diarrhea in children, and supplementation may help to reduce this risk 4.