Abstract
The synergistic relationship between measles and vitamin A deficiency has long been recognized: deficient children suffer increased morbidity and mortality rates during measles, and the infection leads to hyporetinolemia, increased urinary losses of vitamin A, and sometimes to the development of overt ocular signs of vitamin A deficiency.
An early therapeutic attempt to give vitamin A during measles, conducted by Ellison in London, lowered mortality, but was largely forgotten until Barkley, Foster, and Sommer generated comparable data in a controlled, blinded Tanzanian study published in 1987. These findings were then supported in a Cape Town study by Hussey and Klein.
Our research in Durban also studied the value of vitamin A supplementation in 60 children with measles, but its focus was on the effects of supplementation on measles morbidity. The supplemented group recovered from measles within 8 days, a significantly faster time than the unsupplemented controls. Supplementation also led to a marked reduction in morbidity, and an increased rate of weight gain, for up to 6 months. Because many animal studies had shown positive immunological effects from supplementation, we studied its effects on measles IgG production, on lymphocyte counts, and on plasma IL-2 and C3 concentrations. In supplemented children, the duration of lymphopenia was shortened (p = .06), and measles IgG production was significantly increased, but concentrations of IL-2 and C3 did not differ between groups.
Severe lymphopenia on admission often (77%) led to protracted pneumonia and/or death. Also, all deaths were associated with a failure to produce measles-specific IgG. The positive immunological effects of vitamin A supplementation may have been important factors in reducing the morbidity caused by measles.