A randomized, controlled trial of vitamin A in children with severe measles.
BACKGROUND
Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles.


METHODS
We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar.


RESULTS
Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/- 0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level less than 0.7 mumols per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/- 0.5 g per liter) were also low. As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01). Of the 12 children who died, 10 were among those given placebo (P = 0.05). For the group treated with vitamin A, the risk of death or a major complication during the hospital stay was half that of the control group (relative risk, 0.51; 95 percent confidence interval, 0.35 to 0.74).


CONCLUSIONS
Treatment with vitamin A reduces morbidity and mortality in measles, and all children with severe measles should be given vitamin A supplements, whether or not they are thought to have a nutritional deficiency.
Department of Paediatrics and Child Health, University of Cape Town, South Africa.
G D
GD
Hussey
M
M
Klein
D000284:Administration, Oral; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy; D003967:Diarrhea / Q000188:drug therapy; D004224:Diterpenes; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011014:Pneumonia / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012177:Retinol-Binding Proteins / Q000032:analysis; D000084562:Retinyl Esters; D012709:Serum Albumin / Q000032:analysis; D014801:Vitamin A / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use*
D004224:Diterpenes; D012177:Retinol-Binding Proteins; D000084562:Retinyl Esters; D012709:Serum Albumin; D014801:Vitamin A; C014794:retinol palmitate