Vitamin A in Children Hospitalized for Measles in a High-Income Country

Abstract

Background: Worldwide medical authorities recommend vitamin A supplementation for severe measles requiring hospitalization; however, evidence supporting its use in high-income countries is lacking. A nationwide vitamin A shortage reported in concomitance with a recent measles outbreak in Italy provided an opportunity to test the effectiveness of vitamin A in a high-income setting, simulating a random allocation to treatment. Methods: We conducted a prospective controlled cohort study involving children admitted to a tertiary-care hospital in Southern Italy. The primary outcome was the duration of fever· Secondary outcomes included the length of hospitalization, rate of complications, need for antibiotic treatment, and body temperature. The study has been registered to the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance ( EU PAS 31805). Findings: A total of 108 inpatient children (36% females, median age 16·3 months) were enrolled; 36 received two doses of oil-based vitamin A according to age, and 72 matched controls received standard care. There were no significant differences between the study groups in the duration of fever (7·03±2·67 vs· 6·82±3·27, p=0·74), length of hospitalization (median, 5·5 vs· 5·0 days, p=0·36), maximum body temperature (median, 39°C in both groups, p=0·90), rate of organ (69·4% vs· 63·9%, p=0·56) and hematological complications (41·7% vs· 59·7%, p=0·07), or the need for antibiotic treatment (66·7% vs· 61·1%, p=0·57). Overall, vitamin A supplementation did not reduce the risk of any complications (relative risk, 1·33; 95% confidence intervals 0·59 to 2·96). Sub-group analysis in children with chronic conditions, weight-for-age <2 SD, known measles contact, or receiving care within 48h of fever did not demonstrate effectiveness of vitamin A over standard care. Interpretation: Vitamin A does not change the clinical course of measles virus infection or the rate of complications in children hospitalized in a high-income country. Trial Registration: The study has been registered to the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP®). Funding Statement: Department of Translational Medical Sciences, University of Naples Federico II. Declaration of Interests: The authors stated that there were no conflicts of interest to declare. Ethics Approval Statement: The study protocol was approved by the “Ethical Committee Federico II” of the University of Naples, Italy. Patients’ caregivers signed specific informed consent, and all patients’ data were analyzed and reported anonymously by using a single patient code.