Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Aug 31;2016(8):CD007719.
doi: 10.1002/14651858.CD007719.pub4.

Routine vitamin A supplementation for the prevention of blindness due to measles infection in children

Segun Bello  1 , Martin M Meremikwu, Regina I Ejemot-Nwadiaro, Olabisi Oduwole
Affiliations

Routine vitamin A supplementation for the prevention of blindness due to measles infection in children

Segun Bello et al. Cochrane Database Syst Rev. .

Abstract

Background: Reduced vitamin A concentration increases the risk of blindness in children infected with the measles virus. Promoting vitamin A supplementation in children with measles contributes to the control of blindness in children, which is a high priority within the World Health Organization (WHO) VISION 2020 The Right to Sight Program.

Objectives: To assess the efficacy of vitamin A in preventing blindness in children with measles without prior clinical features of vitamin A deficiency.

Search methods: We searched CENTRAL 2015, Issue 11, MEDLINE (1950 to December week 3, 2015), Embase (1974 to December 2015) and LILACS (1985 to December 2015).

Selection criteria: Randomised controlled trials (RCTs) assessing the efficacy of vitamin A in preventing blindness in well-nourished children diagnosed with measles but with no prior clinical features of vitamin A deficiency.

Data collection and analysis: For the original review, two review authors independently assessed studies for eligibility and extracted data on reported outcomes. We contacted trial authors of the included studies for additional information on unpublished data. We included two RCTs which were clinically heterogenous. We presented the continuous outcomes reported as the mean difference (MD) with 95% confidence interval (CI) and dichotomous outcomes as risk ratio (RR) with 95% CI. Due to marked clinical heterogeneity we considered it inappropriate to perform a meta-analysis.

Main results: For the first publication of this review, two RCTs involving 260 children with measles which compared vitamin A with placebo met the inclusion criteria. Neither study reported blindness or other ocular morbidities as end points. One trial of moderate quality suggested evidence of a significant increase in serum retinol levels in the vitamin A group one week after two doses of vitamin A (MD 9.45 µg/dL, 95% CI 2.19 to 16.71; 17 participants, moderate-quality evidence), but not six weeks after three doses of vitamin A (MD 2.56 µg/dL, 95% CI -5.28 to 10.40; 39 participants, moderate-quality evidence). There was no significant difference in weight gain six weeks (MD 0.39 kg, -0.04 to 0.82; 48 participants, moderate-quality evidence) and six months (MD 0.52 kg, 95% CI -0.08 to 1.12; 36 participants, moderate-quality evidence) after three doses of vitamin A.The second trial found no significant difference in serum retinol levels two weeks after a single dose of vitamin A (MD 2.67 µg/dL, 95% CI -0.29 to 5.63; 155 participants, moderate-quality evidence). Percentage of undernutrition between the two groups did not differ significantly at one week (RR 0.93, 95% CI 0.56 to 1.54, 145 participants) and two weeks (RR 0.82, 95% CI 0.52 to 1.29, 147 participants) after a single dose of vitamin A. No adverse event was reported in either study. We did not find any new RCTS for this second update.

Authors' conclusions: We did not find any trials assessing whether or not vitamin A supplementation in children with measles prevents blindness, as neither study reported blindness or other ocular morbidities as end points.

PubMed Disclaimer

Conflict of interest statement

Segun Bello: none known. Martin M Meremikwu: none known. Regina I Ejemot‐Nwadiaro; none known. Olabisi Oduwole: none known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 1 Serum retinol 2 weeks post‐intervention.
1.2
1.2. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 2 Serum retinol 1 week post‐intervention.
1.3
1.3. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 3 Serum retinol 6 weeks post‐intervention.
1.4
1.4. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 4 Serum retinol mean change day 8 (1 week post‐intervention).
1.5
1.5. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 5 Weight gain 6 weeks post‐intervention.
1.6
1.6. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 6 Weight gain 6 months post‐intervention.
1.7
1.7. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 7 Undernutrition 1 week post‐intervention.
1.8
1.8. Analysis
Comparison 1 Vitamin A versus placebo, Outcome 8 Undernutrition 2 weeks post‐intervention.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Coutsoudis 1991 {published data only}
    1. Coutsoudis A, Broughton M, Coovadia HM. Vitamin A supplementation reduces measles morbidity in young African children: a randomized placebo‐controlled, double‐blind trial. American Journal of Clinical Nutrition 1991;54:890‐5. - PubMed
    1. Coutsoudis A, Coovadia HM, Broughton M, Salisbury RT, Elison I. Micronutrient utilization during measles treated with vitamin A or placebo. Internet Journal for Vitamin and Nutrition Research 1990;61(1991):199‐204. - PubMed
Rosale 1996 {published data only (unpublished sought but not used)}
    1. Rosale FJ. Vitamin A supplementation of vitamin A deficient measles patients lowers the risk of measle‐related pneumonia in Zambian children. Journal of Nutrition 2002;132(12):3700‐3. - PubMed
    1. Rosale FJ, Kjolhede C, Goodman S. Efficacy of a single oral dose of 200,000 IU of oil‐soluble vitamin A in measles‐associated morbidity. American Journal of Epidemiology 1996;143(5):413‐22. - PubMed
    1. Rosales FJ, Kjolhede C. A single 210‐μmol oral dose of retinol does not enhance the immune response in children with measles. Journal of Nutrition 1994;124:1604‐14. - PubMed

References to studies excluded from this review

Dollimore 1997 {published data only}
    1. Dollimore N, Cutts F, Binka FN, Ross DA, Morris SS, Smith PG. Measles incidence, case fatality, and delayed mortality in children with or without vitamin A supplementation in rural Ghana. American Journal of Epidemiology 1997;146(8):646‐53. - PubMed
Hussey 1990 {published data only}
    1. Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. New England Journal of Medicine 1990;323(3):160‐4. - PubMed

Additional references

Al‐Kubaisy 2002
    1. Al‐Kubaisy W, Al‐Rubaiy MG, Nassief HA. Xerophthalmia among hospitalised Iraqi children. Eastern Mediterranean Health Journal 2002;8:485. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck‐Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Chan 1990
    1. Chan M. Vitamin A and measles in the third world children. BMJ 1990;301:1230‐1. - PMC - PubMed
CID 1993
    1. Committee on Infectious Diseases. Vitamin A treatment of measles. Pediatrics 1993;91:1014‐5. - PubMed
Gilbert 2001
    1. Gilbert C, Allen F. Childhood blindness in the context of vision 2020 ‐ the right to sight. Bulletin of the World Health Organization 2001;79:3. - PMC - PubMed
Gilbert 2003
    1. Gilbert C. Blindness in children: half of it is avoidable and suitable cost effective interventions are available. BMJ 2003;327(7418):760‐1. - PMC - PubMed
GRADEproGDT 2015 [Computer program]
    1. GRADEproGDT. Guideline Development Tool. www.guidelinedevelopment.org. Evidence Prime, Inc. Hamilton: McMaster University, 2015.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.handbook‐cochrane‐org.
Nemer 2001
    1. Nemer L, Gelband H, Jha P. The evidence base for interventions to reduce malnutrition in children under‐5 and school‐age children in the low and middle income countries. Commission on Macroeconomics and Health (Working paper series) WHO, Geneva 2001;WGS 11:11‐2.
Potter 1997
    1. Potter AR. Reducing vitamin A deficiency. BMJ 1997;314(7077):317. - PMC - PubMed
Sommer 1990
    1. Sommer A. Xerophthalmia, keratomalacia and nutritional blindness. International Ophthalmology 1990;14(3):195‐9. - PubMed
Yang 2011
    1. Yang HM, Mao M, Wan C. Vitamin A for treating measles in children. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD001479.pub3] - DOI

References to other published versions of this review

Bello 2009
    1. Bello S, Meremikwu MM, Ejemot RI. Routine vitamin A supplementation for the prevention of blindness due to measles infection in children. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD007719] - DOI
Bello 2011
    1. Bello S, Meremikwu MM, Ejemot‐Nwadiaro RI, Oduwole O. Routine vitamin A supplementation for the prevention of blindness due to measles infection in children. Cochrane Database of Systematic Reviews 2011, Issue 4. [DOI: 10.1002/14651858.CD007719.pub2] - DOI - PubMed
Bello 2014
    1. Bello S, Meremikwu MM, Ejemot‐Nwadiaro RI, Oduwole O. Routine vitamin A supplementation for the prevention of blindness due to measles infection in children. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD007719.pub3] - DOI - PubMed

Publication types

LinkOut - more resources