Vitamin A Supplementation for Measles
Standard Dosing Protocol
All children with clinical measles should receive 200,000 IU of vitamin A orally for children ≥12 months of age, or 100,000 IU for children <12 months of age, regardless of prior vitamin A supplementation status within the past month. 1, 2
Age-Based Dosing
- Children ≥12 months and adults: 200,000 IU orally 1, 2
- Children <12 months (6-11 months): 100,000 IU orally 1, 2
- Infants <6 months: Generally protected by maternal antibodies, but if measles occurs, use 100,000 IU 1
Repeat Dosing for Complicated Measles
A second dose of vitamin A at the same age-appropriate dose must be administered on day 2 for any child with measles complications. 1, 2
Complications Requiring Day 2 Dosing
- Pneumonia 1, 2
- Otitis media 1
- Croup 1
- Diarrhea with moderate or severe dehydration 1
- Neurological problems (encephalitis, seizures) 1
Extended Treatment for Eye Symptoms
If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer an intensive three-dose regimen to prevent blindness. 1, 2
Eye Symptom Treatment Schedule
- Day 1: 200,000 IU oral vitamin A (100,000 IU if <12 months) 1
- Day 2: 200,000 IU oral vitamin A (100,000 IU if <12 months) 1
- 1-4 weeks later: 200,000 IU oral vitamin A (100,000 IU if <12 months) 1
Critical Implementation Points
Timing Considerations
- Administer vitamin A immediately upon diagnosis of clinical measles 2
- Do not delay treatment waiting for laboratory confirmation 2
- Vitamin A can be given even if the child received supplementation in the previous month when measles is diagnosed 1
Common Pitfalls to Avoid
- Never skip vitamin A supplementation - it is the only evidence-based intervention proven to reduce measles mortality by 64% when given as two 200,000 IU doses 3, 4
- Do not use single-dose regimens for hospitalized children - two doses are significantly more effective than one dose (64% vs. no significant mortality reduction) 3, 4
- Undernutrition is NOT a contraindication - it is actually a strong indication for both measles vaccination and vitamin A treatment 1
- Fever, respiratory infection, and diarrhea are NOT contraindications for vitamin A supplementation 1
Evidence-Based Mortality Reduction
The two-dose regimen (200,000 IU on consecutive days) demonstrates:
- 64% reduction in overall mortality (RR 0.36; 95% CI 0.14-0.82) 3
- 67% reduction in pneumonia-specific mortality (RR 0.33; 95% CI 0.08-0.92) 3, 4
- 82% reduction in mortality for children under 2 years of age (RR 0.18; 95% CI 0.03-0.61) 3
- 47% reduction in croup incidence (RR 0.53; 95% CI 0.29-0.89) 5
Special Population Considerations
Immunocompromised Patients
- Administer standard vitamin A dosing as above 2
- These patients should have already received immune globulin (0.5 mL/kg, maximum 15 mL) if exposed to measles 2
Pregnant Women
- Standard adult dosing (200,000 IU) applies 2
- Measles during pregnancy increases risk of spontaneous abortion, premature labor, and low birth weight 1