A randomized, controlled trial of vitamin A in children with severe measles

N Engl J Med. 1990 Jul 19;323(3):160-4. doi: 10.1056/NEJM199007193230304.


Background: Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles.

Methods: We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar.

Results: Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [+/- SEM], 0.405 +/- 0.021 mumols per liter [11.6 +/- 0.6 micrograms per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level less than 0.7 mumols per liter [20 micrograms per deciliter]). Serum concentrations of retinol-binding protein (mean, 30.1 +/- 2.0 mg per liter) and albumin (mean, 33.4 +/- 0.5 g per liter) were also low. As compared with the placebo group, the children who received vitamin A recovered more rapidly from pneumonia (mean, 6.3 vs. 12.4 days, respectively; P less than 0.001) and diarrhea (mean, 5.6 vs. 8.5 days; P less than 0.001), had less croup (13 vs. 27 cases; P = 0.03), and spent fewer days in the hospital (mean, 10.6 vs. 14.8 days; P = 0.01). Of the 12 children who died, 10 were among those given placebo (P = 0.05). For the group treated with vitamin A, the risk of death or a major complication during the hospital stay was half that of the control group (relative risk, 0.51; 95 percent confidence interval, 0.35 to 0.74).

Conclusions: Treatment with vitamin A reduces morbidity and mortality in measles, and all children with severe measles should be given vitamin A supplements, whether or not they are thought to have a nutritional deficiency.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Child, Preschool
  • Croup / drug therapy
  • Diarrhea / drug therapy
  • Diterpenes
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Male
  • Measles / blood
  • Measles / complications
  • Measles / drug therapy*
  • Pneumonia / drug therapy
  • Randomized Controlled Trials as Topic
  • Retinol-Binding Proteins / analysis
  • Retinyl Esters
  • Serum Albumin / analysis
  • Vitamin A / administration & dosage
  • Vitamin A / analogs & derivatives
  • Vitamin A / blood
  • Vitamin A / therapeutic use*


  • Diterpenes
  • Retinol-Binding Proteins
  • Retinyl Esters
  • Serum Albumin
  • Vitamin A
  • retinol palmitate