Vitamin A Supplementation with MMR Vaccine
No, individuals who receive the MMR vaccine do not require vitamin A supplementation. The ACIP guidelines for MMR vaccination make no recommendation for vitamin A supplementation in conjunction with the vaccine, and vitamin A is indicated only for treatment of active measles disease, not for vaccine recipients 1.
Key Distinction: Vaccine vs. Disease
The critical point is distinguishing between MMR vaccination (prevention) and measles infection (treatment):
- For MMR vaccine recipients: No vitamin A supplementation is recommended or required 1, 2
- For children with active measles disease: WHO recommends 200,000 IU vitamin A daily for 2 days (or 100,000 IU for infants) in areas where vitamin A deficiency may be present 3
Evidence for Vitamin A in Measles Disease (Not Vaccine)
Vitamin A supplementation is beneficial only when treating active measles infection, not for vaccine recipients:
- Two doses of 200,000 IU vitamin A reduce mortality by 64% in children with measles disease (RR=0.36; 95% CI 0.14 to 0.82) 3
- The effect is strongest in children under 2 years, with 82% mortality reduction (RR=0.18; 95% CI 0.03 to 0.61) 3
- Vitamin A reduces pneumonia-specific mortality by 67% (RR=0.33; 95% CI 0.08 to 0.92) and croup incidence by 47% (RR=0.53; 95% CI 0.29 to 0.89) in children with measles disease 3
Why Vitamin A Is Not Given with MMR Vaccine
The comprehensive ACIP guidelines for MMR vaccination address numerous precautions, contraindications, and special considerations—including tuberculosis screening, egg allergies, gelatin sensitivity, neomycin allergy, thrombocytopenia, immune globulin timing, and immunocompromised states—but make no mention of vitamin A supplementation 1. This absence is deliberate: vitamin A is not part of the vaccination protocol.
Potential Concerns About Combining Vitamin A with Vaccines
Emerging research suggests that combining vitamin A with vaccines may not be benign and could have unexpected effects:
- Vitamin A may amplify both beneficial and harmful non-specific vaccine effects, with different impacts by sex 4
- When vitamin A was given with DTP vaccine, children had higher mortality than those receiving vitamin A alone or nothing 4
- The effect of vitamin A depends on which vaccine is administered concurrently, suggesting complex immunomodulatory interactions 4
Clinical Bottom Line
Do not routinely provide vitamin A supplementation to children receiving MMR vaccine. Vitamin A supplementation is reserved for:
- Children with confirmed measles disease (not vaccine recipients) 3
- Children in areas with documented vitamin A deficiency who have measles infection 3
- The therapeutic dose is 200,000 IU daily for 2 days (100,000 IU for infants under 12 months) 3
The MMR vaccine itself enhances immune responses without requiring vitamin A co-administration 2, 5.