An important paper published in 1987 shed light on the role of vitamin A supplements in preventing mortality from measles. In the Mvumi Hospital in central Tanzania, 180 children admitted with measles were randomly given routine treatment alone or with additional large doses of vitamin A (200,000 IU orally immediately on admission and again the next day). Of the 88 children given vitamin A, 6 died; of the 92 not given vitamin A supplement, twice as many (12) died. This difference in mortality was most obvious for children under 2. In this age group, one child out of 46 receiving vitamin A died, while in the control group 7 out of 42 died.

When vitamin A is deficient, the outer layers of our mucous membranes become squamous (scaly) and the turnover of cells decreases. The measles virus infects and damages these tissues throughout the body; blood concentrations of vitamin A, even in well nourished children, may decrease to less than the levels observed in malnourished children. During measles, children with marginal liver stores of vitamin A may develop an acute vitamin A deficiency, resulting in eye damage and possibly increased deaths from respiratory diseases and diarrhea.One other study demonstrated an increased mortality in children with mild vitamin A deficiency (The Lancet, 1986; 1: 1169-73). Another

documented an increased risk of respiratory disease and diarrhea in children with pre-existing mild vitamin A deficiency (Am J of Clin Nutr, 1984, 40: 1090-5). Measles, coupled with acute vitamin A deficiency, poses an important risk of xerophthalmia (dryness and inflammation of the transparent membrane lining the eyelids and portion of the lower eyeball) in many developing countries.

In 1992, New York researchers measured vitamin A levels in 89 children younger than 2 years with measles and among a control group in New York City. Among the children with measles, the vitamin A levels of 22 per cent were low. Those with low levels were more likely to have fever of 40¡ C or higher, to have fever for seven days or more and to be hospitalized. They also had lower measles specific antibody levels.

The authors suggested that clinicians may wish to consider vitamin A therapy for children younger than 2 years with severe measles. They also felt that more studies of vitamin A should be done in measles and other infectious diseases, and in vaccine efficiency trials.

Children in developed as well as third world countries need improved

vitamin A and general nutritional status, not vaccines.