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

Abstract

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. To assess the efficacy of vitamin A in preventing blindness in children with measles without prior clinical features of vitamin A deficiency. We searched CENTRAL 2013, Issue 2, MEDLINE (1950 to November week 2, 2013), EMBASE (1974 to November 2013) and LILACS (1985 to November 2013). 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. 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 We contacted trial authors of the included studies for additional information on unpublished data.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). Due to marked clinical heterogeneity we considered it inappropriate to perform a meta-analysis. 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) but not six weeks after three doses of vitamin A (MD 2.56 µG/dL, 95% CI -5.28 to 10.40; 39 participants). There was no significant difference in weight gain six weeks (MD 0.39 kg, -0.04 to 0.82; 48 participants) and six months (MD 0.52 kg, 95% CI -0.08 to 1.12; 36 participants) 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). No adverse event was reported in either study. We did not find any new randomised controlled trials for this update. 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. However, vitamin A use in children should be encouraged for its proven clinical benefits.