Vitamin A Dosing for Measles in Children
All children with clinical measles should receive 200,000 IU of oral vitamin A for children ≥12 months of age, or 100,000 IU for children <12 months of age, given on two consecutive days. 1
Age-Based Dosing Protocol
The World Health Organization and CDC recommend the following vitamin A supplementation for all children with measles 1, 2:
- Children ≥12 months: 200,000 IU orally on day 1, repeated on day 2 1, 2
- Children <12 months: 100,000 IU orally on day 1, repeated on day 2 1, 2
This two-dose regimen reduces 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) compared to placebo 2, 3. The mortality benefit is even greater in children under 2 years of age, with an 82% reduction in death risk (RR 0.18; 95% CI 0.03-0.61) 2, 3.
Additional Dosing for Complicated Cases
If eye symptoms of vitamin A deficiency are present (xerophthalmia), administer a third dose of 200,000 IU (or 100,000 IU for infants) 1-4 weeks after the initial two doses. 1, 4
For children with measles complications including pneumonia, otitis media, croup, diarrhea with dehydration, or neurological problems, the second dose on day 2 is particularly critical 1.
Evidence Supporting Two-Dose Regimen
The superiority of the two-dose protocol over single-dose treatment is well-established 2, 3:
- Single dose (200,000 IU once): No significant mortality reduction (RR 0.77; 95% CI 0.34-1.78) 2
- Two doses (200,000 IU × 2 days): Significant 64% mortality reduction 2
Water-based vitamin A formulations show greater efficacy than oil-based preparations, with an 81% mortality reduction versus 48% respectively, though both are effective 2.
Clinical Benefits Beyond Mortality
Vitamin A supplementation in measles reduces 2, 5:
- Croup incidence: 47% reduction (RR 0.53; 95% CI 0.29-0.89) 2
- Otitis media: 74% reduction (RR 0.26; 95% CI 0.05-0.92) 2
- Duration of diarrhea: Nearly 2 days shorter (WMD -1.92 days; 95% CI -3.40 to -0.44) 2
- Hospital stay: 4.2 days shorter on average (10.6 vs 14.8 days, P=0.01) 5
- Pneumonia recovery: Twice as fast (6.3 vs 12.4 days, P<0.001) 5
Critical Implementation Points
Do not wait for laboratory confirmation of vitamin A deficiency before treating. In hospitalized children with measles, 92% have biochemical vitamin A deficiency (serum retinol <0.7 μmol/L) even in populations where clinical deficiency is rare 5. The WHO recommends vitamin A for ALL children with clinical measles regardless of suspected nutritional status or country of residence 1, 6, 2.
The 15,000 IU dose mentioned in your question is inadequate and should not be used. This dose is approximately 13-fold lower than the evidence-based recommendation and will not provide mortality benefit 1, 2.
Common Pitfalls to Avoid
- Using single-dose regimens: Single doses lack proven mortality benefit 2
- Underdosing: Doses below 100,000-200,000 IU (age-dependent) are ineffective 1, 2
- Delaying treatment: Vitamin A should be administered immediately upon measles diagnosis 1
- Restricting to malnourished children only: All children with measles benefit, regardless of apparent nutritional status 5
The evidence is strongest for hospitalized children in areas with high case fatality, but the WHO recommendation applies universally to all children with clinical measles 1, 2, 3.