Did You Know... 200,000 IU of vitamin A given for two days was studied on mortality from measles and...
Did You Know... 200,000 IU of vitamin A given for two days was studied on mortality from measles and...
"was associated with a reduced risk of overall mortality and pneumonia specific mortality. The effect was greater in children under the age of two years."
“200,000 IU of vitamin A per day… given for two days was associated with a reduced risk of overall mortality and pneumonia specific mortality. The effect was greater in children under the age of two years.” (Source: D'Souza and D'Souza, 2002; Updated 2005)
Vitamin A for treating measles in children
Abstract
Background: Measles is a leading cause of childhood morbidity and mortality. Vitamin A deficiency is a recognised risk factor for severe measles. The World Health Organization (WHO) recommends administration of an oral dose of 200,000 IU (or 100,000 IU in infants) of vitamin A per day for two days to children with measles in areas where vitamin A deficiency may be present.
Objectives: The purpose of this review is to determine whether vitamin A when commenced after measles has been diagnosed, is beneficial in preventing mortality, pneumonia and other complications in children.
Search strategy: MEDLINE and the Cochrane Library, Issue 4, 1999 were searched.
Selection criteria: Only randomized controlled trials in which children with measles were given vitamin A or placebo along with standard treatment were considered.
Data collection and analysis: Studies were assessed independently by two reviewers. The analysis of dichotomous outcomes was done using the StatXact software package. Sub-group analyses were done for dose, formulation, age, hospitalisation and pneumonia specific mortality. Weighted mean difference with 95% CI were calculated for continuous outcomes.
Main results: The relative risks (RR) and 95% Confidence Intervals (CI) are based on the estimates from the StatXact software package. There was no significant reduction in mortality in the vitamin A group when all the studies were pooled together (RR 0.60; 95% CI 0.32 to 1.12)(StatXact estimate). There was a 64% reduction in the risk of mortality in children who were given two doses of 200,000 IU of vitamin A (RR=0.36; 95% CI 0.14 to 0.82) as compared to placebo. Two doses of water based vitamin A were associated with a 81% reduction in risk of mortality (RR=0.19; 95% CI 0.02 to 0.85) as compared to 48% seen in two doses of oil based preparation (RR=0.52; 95% CI 0.16 to 1.40). Two doses of oil and water based vitamin A were associated with a 82% reduction in the risk of mortality in children under the age of 2 years (RR=0.18; 95% CI 0.03 to 0.61) and a 67% reduction in the risk of pneumonia specific mortality (RR=0.33; 95% CI 0.08 to 0.92). There was no evidence that vitamin A in a single dose of 200,000 IU was associated with a reduced risk of mortality among children with measles (RR=0.77; 95% CI 0.34 to 1.78). Sub-groups like age, dose, formulation, hospitalisation and case fatality in the study area were highly correlated and there were not enough studies to separate out the individual effects of these factors. There was a 47% reduction in the incidence of croup (RR=0.53; 95% CI 0.29 to 0.89), while there was no significant reduction in the incidence of pneumonia (RR=0.92; 95% CI 0.69 to 1.22) or of diarrhoea (RR=0.80; 95% CI 0.27 to 2.34). Duration of diarrhoea was measured in days and there was a reduction in its duration of almost two days WMD -1.92, 95% CI -3.40 to -0.44. Only one study evaluated otitis media and found a 74% reduction in its incidence (RR=0.26, 95% CI, 0.05 to 0.92). We did not find evidence that a single dose of 200,000 IU of vitamin A per day, given in oil-based formulation in areas with low case fatality, was associated with reduced mortality among children with measles. However, there was evidence that the same dose given for two days was associated with a reduced risk of overall mortality and pneumonia specific mortality.
Reviewer's conclusions: Although we did not find evidence that a single dose of 200,000 IU of vitamin A per day was associated with reduced mortality among children with measles, there was evidence that the same dose given for two days was associated with a reduced risk of overall mortality and pneumonia specific mortality. The effect was greater in children under the age of two years. There were no trials that compared a single dose with two doses, although the precision of the estimates of trials that used a single dose were similar to the trials that used two doses.
D'Souza RM, D'Souza R. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2002;(1):CD001479. doi: 10.1002/14651858.CD001479. Update in: Cochrane Database Syst Rev. 2005;(4):CD001479. PMID: 11869601.
Yes, I knew. Also learned from Neil Z Miller.
When I was a child in the 1950s, we all got measles, mumps and chicken pox. These were a normal part of childhood and not feared. We had “chicken pox parties,” to ensure kids got these when young. Parents and doctors observed that afterwards, kids had growth spurts and were more resilient.
As Denise Ward's comment indicates, with each normal childhood “disease,” our immune systems matured. These “diseases” were part of the process of development of our immune systems, and not a bad thing in those days. We acquired natural immunity for life and contributed to herd immunity. There was an episode of the Brady Bunch in which all 6 kids were happy to get measles and miss school and said, something like "if you have to get sick, at least it's only the measles." I'm guessing they had enough vitamin A. Later one of the actors who played the daughter dismissed that comment and told everyone to get vaccines.
Furthermore, I recently learned that viruses are part of our evolution. Zach Bush and others described how we have evolved for millennia with viruses and the “virome.” We continually adapt to our environment. When the environment changes enough, it throws off a virus. When we deal with the virus, our immune systems evolve to adapt to the changing environment. On and on …
Btw, the introduction of childhood vaccines has altered what we had, messing with our evolutionary biology. See https://coronawise.substack.com/p/new-diagnosis-artificially-induced
The premise that measles is a cause of morbidity and fighting that is knuckle-headed because it doesn't consider other possibilities such as the possibility that measles is a form of necessary stress for the body to expand its capability against inhospitable invaders is never even given the light of day. Yes a few children die of it but let's look at why - are they malnourished? Is it a form of "natural selection" (though I don't espouse Darwinism) but something of that nature where nature automatically cleans the gene pool? This and so much more is completely ignored in $cience today. And people are sicker than ever before, even within my own lifetime I can see that. However this makes me feel like superwoman compared to everyone around me who take pills and don't care what they put in or on their body. My body can take a beating every now and then without any adverse effects. This is what a healthy body is about. But everyone is so fixated on sickness that they never really understand that true health means you can get on with life, your body will support what you want to do with your life.