Vitamin A & child mortality citations
Vitamin A citations   Measles  Nutrition and Infection

See: Nutrition and Infection  


Jeffrey K. Griffiths, MD. The vitamin A paradox --- The Journal of Pediatrics. November 2000 . Volume 137 . Number 5

J. B. Ellison M.A., M.D., D.P.H.  Intensive Vitamin Therapy in Measles.  The British Medical Journal Oct 15, 1932,  p708-711

July 1990, New England Med. J. stated that all children with severe measles should be given vitamin A regardless of nutritional status.

September 1994, Clinical Infectious Diseases stated that all acute measles cases should be given vitamin A.

Barclay et al (1987). In the Mvumi hospital in central Tanzania, 180 children admitted with measles were randomely allocated to receive routine treatment alone or with additional large doses of vitamin A (200,000 IU orally, on admission, and again the next day).  Of the 88 children given vitamin A, 6 died, of the 92 controls, 12 died.   In the under 2 age group, out of 46 receiving vitamin A one died, while in the control (receiving no vitamin A) 7 out 42 died. (Scheibner p91)

Barclay AJ, et al.  Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed). 1987 Jan 31;294(6567):294-6. PMID: 3101849; UI: 87129562.
Belamarich PR.  Measles and malnutrition. Pediatr Rev. 1998 Feb;19(2):70-1. No abstract available.PMID: 9473947; UI: 98134216.
Coutsoudis A, et al. Vitamin A supplementation reduces measles morbidity in young African children: a randomized, placebo-controlled, double-blind trial. Am J Clin Nutr. 1991 Nov;54(5):890-5. PMID: 1951162; UI: 92058799.Glasziou PP, et al.  Vitamin A supplementation in infectious diseases: a meta-analysis. BMJ. 1993 Feb 6;306(6874):366-70. PMID: 8461682; UI: 93214390.  

Frieden TR, et al.  Vitamin A levels and severity of measles. New York City. Am J Dis Child. 1992 Feb;146(2):182-6. PMID: 1285727; UI: 92125289.  

Hussey GD, Klein M.  Routine high-dose vitamin A therapy for children hospitalized with measles. J Trop Pediatr. 1993 Dec;39(6):342-5. PMID: 8133555 [PubMed - indexed for MEDLINE]

Herrera MG, et al. Vitamin A supplementation and child survival. Lancet. 1992 Aug 1;340(8814):267-71. PMID: 1353192; UI: 92341843.
Hof H.    [Vitamin A, the "anti-infective" vitamin]? MMW Munch Med Wochenschr. 1976 Nov 12;118(46):1485-8. Review. German. PMID: 825767; UI: 77056164.

Klein M, Hussey GD.  Vitamin A reduces morbidity and mortality in measles. S Afr Med J. 1990 Jul 21;78(2):56-8. No abstract available. PMID: 2371633 [PubMed - indexed for MEDLINE]

Kawasaki Y, Hosoya M, Katayose M, Suzuki H.  [The efficacy of oral vitamin A supplementation for measles and respiratory syncytial virus (RSV) infection] Kansenshogaku Zasshi. 1999 Feb;73(2):104-9. Japanese. PMID: 10213986 [PubMed - indexed for MEDLINE]
Recently, the efficacy of oral vitamin A supplementation for measles and respiratory syncytial (RSV) infection has been evaluated in developing countries. However, in developed countries where vitamin A deficiency is little worth consideration, few studies have been conducted on the effect of vitamin A supplementation. The effect of oral vitamin A (100,000 IU) supplementation was evaluated in 105 children with measles (age 5 months to 4 years) and in 96 children with RSV infection (ages a month to 2.5 years) in Fukushima, Japan. Comparisons were made of clinical signs, duration of hospitalization and complications between treated groups and non-treated groups. Treated group (measles n = 47, RSV n = 54) and non-treated groups (measles n = 58, RSV n = 42) had similar baseline characteristics. Patients with measles given a vitamin A supplementation had a shorter duration of cough (7.2 +/- 1.6 vs 9.2 +/- 1.8 days, p < 0.05) and patients with severe RSV infection given a vitamin A supplementation hada shorter duration of retraction (3.6 +/- 1.4 vs 5.3 +/- 0.8 days, p < 0.05) and wheezing (4.4 +/- 1.7 vs 6.3 +/- 1.5 days, p < 0.05). Toxicities, including excess vomiting and bulging fontanel were not observed. Our findings may suggest the efficacy of oral vitamin A supplementation for measles and severe RSV infection, in children who have no malnutrition.

Rahmathullah L, et al.   Reduced mortality among children in southern India receiving a small weekly dose of vitamin A. N Engl J Med. 1990 Oct 4;323(14):929-35. PMID: 2205798; UI: 90384516.
Ramakrishnan U, et al.  The role of vitamin A in reducing child mortality and morbidity and improving growth.
Salud Publica Mex. 1998 Mar-Apr;40(2):189-98. Review. PMID: 9617200; UI: 98280186.
Semba RD. Vitamin A as "anti-infective" therapy, 1920-1940. J Nutr. 1999 Apr;129(4):783-91. Review. PMID: 10203551; UI: 99222013.    

Sommer A.(1993) Vitamin A, infectious disease, and childhood mortality: a 2 solution? J Infect Dis. 1993 May;167(5):1003-7. Review. PMID: 8486934; UI: 93253276.

Vitamin A was first discovered in 1913. Its deficiency was soon associated in animal models and case reports with stunting, infection, and ocular changes (xerophthalmia) resulting in blindness. The ocular consequences dominated clinical interest through the early 1980s. A longitudinal prospective study of risk factors contributing to vitamin A deficiency and xerophthalmia revealed a close, dose-response relationship between the severity of mild preexisting vitamin A deficiency and the subsequent incidence of respiratory and diarrheal infection (relative risk [RR], 2.0-3.0) and, most dramatically, death (RR, 3.0-10.0). Subsequent community-based prophylaxis trials of varying design confirmed that vitamin A supplementation of deficient populations could reduce childhood (1-5 years old) mortality by an average of 35%. Concurrent hospital-based treatment trials with vitamin A in children with measles revealed a consistent reduction in measles-associated mortality in Africa of at least 50%. It is now estimated that improving the vitamin A status of all deficient children worldwide would prevent 1-3 million childhood deaths annually. Kawasaki Y, et al (1999). [The efficacy of oral vitamin A supplementation for measles and respiratory syncytial virus (RSV) infection]. Kansenshogaku Zasshi. 1999 Feb;73(2):104-9. Japanese. PMID: 10213986; UI: 99230601.

Yalcin SS, Yurdakok K, Ozalp I, Coskun T. The effect of live measles vaccines on serum vitamin A levels in healthy children. Acta Paediatr Jpn. 1998 Aug;40(4):345-9. PMID: 9745778 [PubMed - indexed for MEDLINE]

OBJECTIVE: Serum retinol levels have been shown to be depressed during measles infection. This study aims to demonstrate whether there is any decrease in serum vitamin A level following immunization with live viral vaccine and its relation with vaccine seroconversion in children with measles. Since many children receive measles vaccine alone or in combination with measles-mumps-rubella vaccine, we studied serum vitamin A levels and antibody levels in healthy, well-nourished children before and after immunization with monovalent and combined live attenuated measles vaccine. METHODS: The first group included 21 healthy children between the ages of 9-11 months who received live measles (Schwarz) vaccine. There were also 21 healthy children (range 14-20 months of age) who received measles-mumps-rubella Trimovax (Pasteur Merieux) vaccine. All children were tested for serum vitamin A levels before vaccination, on days 9-14 and 30-42 following both vaccinations. Measles specific antibody levels were also measured on admission and 30-42 days following vaccinations. RESULTS: In both vaccination groups, mean serum vitamin A levels reduced significantly on days 9-14, but increased slightly on days 30-42 in the measles-mumps-rubella vaccinated group (P < 0.05). The baseline and follow-up levels of mean serum vitamin A did not differ between seroconverted and nonseroconverted cases within the measles vaccinated group. CONCLUSION: Serum vitamin A levels are reduced following vaccination with monovalent and combined live attenuated measles vaccines.

West KP Jr, et al. Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet. 1991 Jul 13;338(8759):67-71. PMID: 1676467; UI: 91287425.