Vitamin A Supplementation for Measles Treatment
Direct Recommendation
All children with clinical measles should receive 200,000 IU of vitamin A orally (100,000 IU for children <12 months), with a second dose on day 2 for complicated cases. 1, 2, 3
Standard Dosing Protocol
Age-Based Dosing
- Children ≥12 months and adults: 200,000 IU orally on day 1 1, 2, 3
- Children <12 months (infants): 100,000 IU orally on day 1 1, 2, 3
- This applies to all children with clinical measles who have not received vitamin A in the previous month 1, 2
Second Dose Indications
Administer a second dose of vitamin A on day 2 for any of the following complications: 1, 2, 3
- Pneumonia
- Otitis media
- Croup or laryngotracheobronchitis
- Diarrhea with moderate or severe dehydration
- Neurological problems (encephalitis, seizures)
Extended Treatment for Eye Symptoms
If any eye symptoms of vitamin A deficiency are present, use this three-dose regimen: 1, 2
- 200,000 IU oral vitamin A on day 1 (100,000 IU for infants <12 months)
- 200,000 IU oral vitamin A on day 2 (100,000 IU for infants <12 months)
- 200,000 IU oral vitamin A 1-4 weeks later (100,000 IU for infants <12 months)
Eye symptoms requiring this extended protocol include xerosis (conjunctival or corneal dryness), Bitot's spots, keratomalacia, or corneal ulceration. 1, 2
Evidence Supporting This Recommendation
The guideline recommendations are strongly supported by research demonstrating mortality reduction. Two doses of 200,000 IU vitamin A 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 The effect is most pronounced in children under 2 years of age, with an 82% mortality reduction (RR 0.18; 95% CI 0.03-0.61). 4, 5
A landmark trial in South Africa demonstrated that children receiving 400,000 IU total dose (200,000 IU × 2 days) had faster recovery from pneumonia (6.3 vs 12.4 days), shorter diarrhea duration (5.6 vs 8.5 days), less croup (13 vs 27 cases), and reduced mortality (2 deaths vs 10 deaths in placebo group). 6
Important Nuance: Single Dose vs Two Doses
Single-dose vitamin A (200,000 IU once) does NOT reduce mortality (RR 0.77; 95% CI 0.34-1.78). 4, 5 The two-dose regimen is essential for mortality benefit, which is why the second dose on day 2 is critical for complicated cases. 1, 2, 4
Universal Application
This recommendation applies regardless of geographic location or presumed nutritional status. 2, 3, 7 Even in developed countries where clinical vitamin A deficiency is rare, children hospitalized with measles have markedly depressed serum retinol levels (92% with hyporetinemia in one study). 6 The WHO recommends vitamin A for all children with measles in any setting. 2, 3, 4
Safety Considerations
Vitamin A supplementation at these doses is safe and not associated with toxicity. 2 Acute vitamin A toxicity requires >300,000 IU in adults or >60,000 IU in children within hours to days, well above the recommended dosing. 2 No adverse effects were observed in clinical trials using this protocol. 8, 6
Critical Pitfall to Avoid
Do not forget the second dose on day 2 for complicated measles. 1, 2, 3 The mortality benefit is specifically associated with the two-dose regimen, not single-dose administration. 4, 5 Complicated measles includes any child with pneumonia, significant respiratory symptoms, diarrhea with dehydration, or neurological involvement—these children require both doses. 1, 2