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Vitamin A Levels and Measles Severity and Mortality
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Topics: Vitamin A

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Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA. Division of Field Epidemiology, Centers for disease Control. Vitamin A levels and severity of measles. New York City. Am J Dis Child. 1992 Feb;146(2):182-6.

Recent studies show that Vitamin A levels decrease during measles and that Vitamin A therapy can improve measles outcome in children in the developing world. Vitamin A levels of children with measles have not been studied in developed countries. We therefore measured Vitamin A levels in 89 children with measles younger than 2 years and in a reference group in New York City, NY. Vitamin A levels in children with measles ranged from 0.42 to 3.0 mumol/L; 20 (22%) were low. Children with low levels were more likely to have fever at a temperature of 40 degrees C or higher (68% vs 44%), to have fever for 7 days or more (54% vs 23%), and to be hospitalized (55% vs 30%). Children with low Vitamin A levels had lower measles-specific antibody levels. No child in the reference group had a low Vitamin A level. Our data show that many children younger than 2 years in New York City have low Vitamin A levels when ill with measles, and that such children seem to have lower measles-specific antibody levels and increased morbidity. Clinicians may wish to consider Vitamin A therapy for children younger than 2 years with severe measles. Additional studies of Vitamin A in measles and other infectious diseases, and in vaccine efficacy trials, should be done.

A J Barclay, A Foster, and A Sommer. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed). 1987 January 31; 294(6567): 294296.

One hundred and eighty children admitted with measles were randomly allocated to receive routine treatment alone or with additional large doses of Vitamin A (200,000 IU orally immediately and again the next day). Baseline characteristics of the two groups were virtually identical for age, severity of measles, and Vitamin A and general nutritional states. In 91% of the children serum Vitamin A concentrations were less than 0.56 mumol/l. Of the 88 subjects given Vitamin A supplements, six (7%) died; of the 92 controls, 12 (13%) died (p = 0.13). This difference in mortality was most obvious for children aged under 2 years (one death out of 46 children receiving supplements versus seven deaths out of 42 controls; p less than 0.05) and for cases complicated by croup or laryngotracheobronchitis. Mortality was several times higher in marasmic than in better nourished children, regardless of study allocation (p less than 0.01).

Bishai D, Kumar K C S, Waters H, Koenig M, Katz J, Khatry SK, West KP Jr. Department of Population and Family health Sciences, Johns Hopkins University, Bloomberg School of Public health, 615 N Wolfe St, Baltimore, MD 21205, USA. The impact of Vitamin A supplementation on mortality inequalities among children in Nepal. Health Policy Plan. 2005 Jan;20(1):60-6.

OBJECTIVE: This paper examines gender, caste and economic differentials in child mortality in the context of a cluster-randomized trial of Vitamin A distribution, in order to determine whether or not the intervention narrowed these differentials. DESIGN: The study involved secondary analysis of data from a placebo-controlled randomized field trial of Vitamin A supplements. The study took place between 1989-1991 in rural Sarlahi District of Nepal, with 30,059 children age 6 to 60 months. The main outcome measures were differences in mortality between boys and girls, between highest Hindu castes and others, and between the poorest quintile and the four other quintiles. RESULTS: Without Vitamin A, girls in rural Nepal experience 26.1 deaths per 1000, which is 8.3 deaths more than the comparison population of boys. With Vitamin A the mortality disadvantage of girls is nearly completely attenuated, at only 1.41 additional deaths per 1000 relative to boys. Vitamin A supplementation also narrowed mortality differentials among Hindu castes, but did not lower the concentration of mortality across quintiles of asset ownership. The vitamin A-related attenuation in mortality disadvantage from gender and caste is statistically significant. CONCLUSIONS: We conclude that universal supplementation with Vitamin A narrowed differentials in child death across gender and caste in rural Nepal. Assuring high-coverage Vitamin A distribution throughout Nepal could help reduce inequalities in child survival in this population.

The next study is related to mortality in general and not tied specifically to measles.

Daulaire NM, Starbuck ES, Houston RM, Church MS, Stukel TA, Pandey MR. International Center for the Prevention and Treatment of Major Childhood disease (INTERCEPT), Hanover, New Hampshire 03755. Childhood mortality after a high dose of Vitamin A in a high risk population. BMJ. 1992 Jan 25;304(6821):207-10.

OBJECTIVES--To determine whether a single high dose of Vitamin A given to all children in communities with high mortality and malnutrition could affect mortality and to assess whether periodic community wide supplementation could be readily incorporated into an ongoing primary health programme. DESIGN--Opportunistic controlled trial. SETTING--Jumla district, Nepal. SUBJECTS--All children aged under 5 years; 3786 in eight subdistricts given single dose of Vitamin A and 3411 in remaining eight subdistricts given no supplementation. MAIN OUTCOME MEASURES--Mortality and cause of death in the five months after supplementation. RESULTS--Risk of death for children aged 1-59 months in supplemented communities was 26% lower (relative risk 0.74, 95% confidence interval 0.55 to 0.99) than in unsupplemented communities. The reduction in mortality was greatest among children aged 6-11 months: death rate (deaths/1000 child years at risk) was 133.8 in supplemented children and 260.8 in unsupplemented children (relative risk 0.51, 0.30 to 0.89). The death rate from diarrhoea was also reduced (63.5 supplemented v 97.5 unsupplemented; relative risk 0.65, 0.44 to 0.95). The extra cost per death averted was about $11. CONCLUSION--The results support a role for Vitamin A in increasing child survival. The supplementation programme was readily integrated with the ongoing community health programme at little extra cost.

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