There is insufficient evidence to draw conclusions regarding effectiveness in preventing pneumonia or other complications in children. They used two doses, hospitalized participants, children under the age of two and were carried out in areas where the casefatality rate is high. A Randomized, Controlled Trial of Vitamin A in Children with Severe Measles For continuous outcomes we will use the test proposed by Egger 1997, and for dichotomous outcomes we will use the test proposed by Harbord 2006. High-dose Vitamin A Supplementation for Children | SPRING We believe it is imperative that the Cochrane Collaboration examine the Vitamin A for treating measles in children review by Huiming Y, Chaomin W, and Meng M.The review incorrectly includes a study by Dollimore et al. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue The DOH, in a Viber message to the Philippine News Agency (PNA), said 7,541,867 or 77.72 percent of the target have received the vaccines for measles and rubella as of May 30. #10. Houston RM, Reddy V. Effect of massive dose vitamin A on morbidity and mortality in Indian children. The .gov means its official. Relationship between measles, malnutrition, and blindness: a prospective study in Indian children. West KP Jr, Tarwotjo I, Mild vitamin A deficiency and risk of respiratory tract diseases and diarrhea in preschool and school children in northeastern Thailand. She remarked that this could be attributed to the absence of emergency and malnourished cases. The Cochrane Collaboration. What Is the Safe Dose of Vitamin A in Children With Measles? We used the scores from this assessment in a sensitivity analysis (that is, including and excluding studies of low quality to determine how robust the summary effect measures were). If your child has missed a dose, we will contact you. Aronson KJ, We used odds ratios (ORs) and their 95% confidence intervals (CIs) to calculate the risk ratio (RR) and 95% CI. We contacted trial authors for missing data. New citation required but conclusions have not changed. As all studies did not report on all possible morbidity outcomes the conclusions we were able to draw about the effect of vitamin A on measlesrelated morbidity are limited. Neal Halsey, MD, Protocol first published: Issue 1, 1999 Broughton M, Waterbased preparations showed no statistically significant reduction in the risk of pneumoniaspecific mortality. We calculated mean differences (MDs) with 95% CIs for continuous outcomes using the randomeffects model. For these reasons it is the latter that is recommended by WHO. Effect of Vitamin A supplementation on childhood morbidity and mortality, Overcrowding and intensive exposure as determinants of measles mortality. Searches conducted. Day SE, The evidence for oilbased vitamin A having a protective effect on mortality was demonstrated when an old study by Ellison with a lower quality score was included as part of the sensitivity analysis. Vitamin A for measles in children | Cochrane In Barclay's study, which used two doses, there was a 65% reduction in risk of developing diarrhea while there was no evidence of reduction in Ogaro's study, which used a single dose. WHO Guideline1 Vitamin A supplementation in infants and children 6-59 months of age Summary Vitamin A deficiency affects about 19 million pregnant women and 190 million preschool-age children, mostly from the World Health Organization (WHO) regions of Africa and South-East Asia. Measles - Diagnosis and treatment - Mayo Clinic Measles | NEJM - The New England Journal of Medicine This could be the reason for hyporetinemia in children with severe measles in areas where vitamin A deficiency is uncommon, such as the Democratic Republic of Congo (Markowitz 1989), Cape Town (Hussey 1990) and Nairobi (Ogaro 1993). The small number of studies and sample sizes have made it difficult to stratify or do a metaregression. Vitamin A and Carotenoids - Health Professional Fact Sheet Where more than one trial included similar participants and interventions, without significant clinical or methodological diversity or statistical heterogeneity, we used a fixedeffect model. the contents by NLM or the National Institutes of Health. Measles is still a major cause of childhood morbidity and mortality in some lowincome countries. et al. Vitamin A (Retinol) Information | Mount Sinai - New York Bhaskaram P, Hussey (Hussey 1990) reported the number of participants who had pneumonia for more than 10 days. Herrera MG, There was a significant decrease in the incidence of croup with vitamin A supplementation while there was no significant reduction in the incidence of pneumonia, although a reduction was observed in the duration of diarrhea, pneumonia, fever, hospital stay and cough. Cleveland Clinic is a non-profit academic medical center. The study by Rosales (Rosales 1996) used a single dose of vitamin A and did not show any benefit on pneumonia continuing for two weeks. The only outcome reported by all eight studies was death. None of the studies included in this review reported any adverse effects. 3 morbilli virus.tw. Ogaro (Ogaro 1993) reported on the development of otitis media with a 74% reduction in the incidence of otitis media in vitamin Atreated participants, which was statistically significant. Four studies specified the cause of death. Meng Mao (MM) supervised the review update and was involved in the data analysis, along with HY. Edmoinston B, We described for each included study the method used to conceal the allocation sequence in sufficient detail and determined whether intervention allocation could have been foreseen in advance of, or during recruitment, or changed after assignment. 1 exp MEASLES/ MEDLINE (OVID) H&F Council on Twitter: "RT @NHSEnglandLDN: Has your child missed an There were no trials comparing mortality reductions in children with measles who were given a single dose compared to two doses of vitamin A. Applies to the following strengths: 10000 intl units; 25000 units; 50000 units/mL; 50000 units; 8000 units Usual Adult Dose for: Vitamin A Deficiency Vitamin/Mineral Supplementation Usual Pediatric Dose for: Vitamin A Deficiency The incidence for five trials that excluded highrisk participants was 9.8% and the incidence for the two trials that recruited highrisk participants (with at least one risk factor) was 10.7%. Vitamin A - Mayo Clinic 2 exp MEASLES VIRUS/ Measles - Pediatrics - MSD Manual Professional Edition In addition, the number of deaths and morbidity conditions should be reported in each of these subgroups. Hussey (Hussey 1990) showed a statistically significant reduction in hospital stay by almost five days in the vitamin Atreated group (MD 4.72; 95% CI 7.22 to 2.22) while Kawasaki (Kawasaki 1999) showed a reduction by almost half a day but this was not statistically significant (MD 0.40; 95% CI 1.08 to 0.28). There were 651 children in the latter time period who received two doses of vitamin A (200,000 IU) and had a shorter hospital stay, lower requirement for intensive care and lower death rate as compared to 1069 children during 1985 to 1986 who received a single dose of 3000 IU. Learn about this vaccine-preventable disease that used to be common in childhood and is well known for a characteristic red, splotchy rash and high fever. The pooled estimate of these studies suggests the risk of pneumoniaspecific mortality (RR 0.57; 95% CI 0.24 to 1.37); none of these studies showed statistically significant reductions on their own. We analyzed data on all participants with available data in the group to which they were allocated, regardless of whether or not they received the allocated intervention. Stanford University School of Medicine, Stanford, CA. Two review authors (HY, CW) independently selected trials for inclusion. Vitamin A deficiency can cause vision loss and blindness. This evaluates the value of measurement on experimental intervention (E) minus measurement on control intervention (C) separately for each participant. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Also, none of the studies reported malaria as a coinfection with measles. HHS Vulnerability Disclosure, Help This reflects the patientcare conditions under which the majority of measles cases are diagnosed and treated in lowincome countries (Dollimore 1997; Rosales 1996). For Healthcare Professionals - Diagnosing and Treating Measles | CDC In a number of community studies in Asia, vitamin A deficiency has been linked to an increased risk of childhood morbidity (Bloem 1990; Milton 1987; Sommer 1984) and mortality (Sommer 1983). Details of previous searches are in Appendix 1. We analyzed dichotomous outcomes and expressed results as risk ratios (RRs) with 95% confidence intervals (CIs). Kawasaki showed a one and a half day statistically significant reduction in the duration of fever (MD 1.5; 95% CI 2.04 to 0.96) while Coutsoudis showed a little over half a day (MD 0.60; 95% CI 0.81 to 0.39). In these trials it was not always apparent as to which day after the onset of measles vitamin A was administered. In the current version of the review, however, there were not enough trials reporting on the same outcomes to present a meaningful analysis. Dose 1 is to be administered at age 9 months and Dose 2 at age 15 months. Measles severity and serum retinol (vitamin A) concentration among children in the United States, Vitamin A deficiency: key resources in its prevention and elimination, The Micronutrient Initiative Information Paper, Vitamin A and measles in Third World children. The Rosales study was a communitybased study and, therefore, the protective effect of vitamin A may not have been as great as seen in the more severe hospitalbased cases.
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