What is the recommended vitamin A supplementation regimen for a pediatric patient with measles?

Vitamin A Supplementation in Measles: Dosing Protocol

All children with clinical measles should receive vitamin A supplementation immediately, as this is the only evidence-based intervention proven to reduce measles mortality and complications. 1, 2

Age-Based Dosing Regimen

Children ≥12 Months and Adults

• Day 1: 200,000 IU orally 1, 2
• Day 2: 200,000 IU orally (for complicated measles) 1, 3

Infants <12 Months

• Day 1: 100,000 IU orally 1, 3, 2
• Day 2: 100,000 IU orally (for complicated measles) 3, 2

When to Give the Second Dose

Administer the second dose on day 2 for any child with complicated measles, which includes: 1, 3

• Pneumonia
• Otitis media
• Croup or laryngotracheobronchitis
• Diarrhea with moderate or severe dehydration
• Neurological complications

The two-dose regimen (200,000 IU × 2 days) reduces overall mortality by 64% and pneumonia-specific mortality by 67%, with even greater benefit (82% mortality reduction) in children under 2 years. 4 In contrast, a single dose of 200,000 IU shows no significant mortality reduction. 5, 4

Third Dose for Eye Symptoms

If any eye symptoms of vitamin A deficiency are present, give a third dose of 200,000 IU (or 100,000 IU for infants) 1-4 weeks after the initial two doses. 1 Eye symptoms requiring this third dose include: 1

• Xerosis (conjunctival or corneal dryness)
• Bitot's spots (foamy conjunctival patches)
• Keratomalacia (corneal softening)
• Corneal ulceration

Critical Implementation Points

Do not delay vitamin A administration waiting for laboratory confirmation—treatment should begin based on clinical diagnosis alone. 3 The standard protocol is safe; acute toxicity requires >300,000 IU in adults or >60,000 IU in children within hours to days, far exceeding the recommended doses. 1

Water-based formulations appear superior to oil-based preparations, showing 81% versus 48% mortality reduction respectively, though both are effective. 4 The benefit is most pronounced in hospitalized children in areas with high case fatality rates and in children under 2 years of age. 5, 4, 6

Common Pitfalls to Avoid

• Never give only a single dose when complications are present—the evidence clearly demonstrates that two doses are required for mortality benefit 5, 4
• Do not withhold vitamin A due to concerns about toxicity at these standard doses 1, 3
• Do not forget the third dose if eye symptoms develop, as this indicates severe vitamin A deficiency requiring extended treatment 1
• Do not assume well-nourished children don't need supplementation—approximately 91% of hospitalized measles patients have vitamin A deficiency regardless of general nutritional status 6

Additional Benefits Beyond Mortality

Vitamin A supplementation reduces: 4

• Croup incidence by 47%
• Otitis media incidence by 74%
• Duration of diarrhea by approximately 2 days
• Hospital length of stay (mean 10 versus 13 days) 7
• Intensive care requirements (4.3% versus 10.5%) 7