According to recent guidance provided by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), measles treatment is primarily supportive. To help reduce the risk of complications, the WHO recommends that all children and adults with acute measles receive two doses of vitamin A, administered 24 hours apart. The recommended oral dosing is based on age: infants younger than 6 months should receive 50,000 IU once daily for 2 days; those 6 to 11 months old should receive 100,000 IU once daily for 2 days; and children 12 months and older should receive 200,000 IU once daily for 2 days. For children showing clinical signs or symptoms of vitamin A deficiency, a third age-appropriate dose should be administered 2 to 4 weeks after the initial treatment. In general, the guidance notes that measuring vitamin A levels is typically not necessary. No other recommendations specific to adults are noted. [1], [2]
Much of the other literature for treatment of measles is specific to children and pediatric patients. A 2011 Cochrane systematic review evaluated the efficacy of vitamin A supplementation as an adjunctive treatment for measles in children. The investigators conducted a comprehensive search through early 2011 to identify randomized controlled trials enrolling children under the age of 15 years with clinically diagnosed measles who received vitamin A or placebo alongside standard treatment. Eight randomized controlled trials (RCTs; n= 2,574) met eligibility criteria, including both community-based and hospital-based studies conducted in low-income and middle-income countries, with varying baseline population risks and vitamin A formulations. Pooled analyses from these trials demonstrated no statistically significant reduction in overall mortality associated with vitamin A therapy when all studies were included (risk ratio [RR] 0.70; 95% confidence interval [CI] 0.42 to 1.15). However, a predefined subgroup analysis revealed that two consecutive daily doses of 200,000 IU vitamin A significantly reduced measles-associated mortality in children under two years of age (RR 0.21; 95% CI 0.07 to 0.66), particularly in hospitalized settings and regions with case-fatality rates exceeding 10%. Additionally, vitamin A administration was associated with a reduced risk of developing post-measles croup (RR 0.53; 95% CI 0.29 to 0.89), and modest but statistically significant reductions in the duration of pneumonia, diarrhea, and fever were observed. No adverse effects were reported across the studies, and the overall quality of evidence was rated as moderate. These findings suggest that high-dose, two-day vitamin A therapy is effective in reducing measles-related mortality and selected complications in high-risk pediatric populations, particularly in resource-limited healthcare settings. [3]
Due to the lack of specific antiviral treatment for measles, management primarily focuses on supportive care. Available review articles emphasize the importance of preventing dehydration, correcting nutritional deficiencies, and promptly identifying and treating secondary bacterial infections such as pneumonia and otitis media. High-dose vitamin A has been shown to reduce mortality and complications in hospitalized children with measles in developing countries. In the United States, children with measles often have low serum retinol levels, particularly in more severe cases. The American Academy of Pediatrics recommends vitamin A supplementation for all children with severe measles, using age-specific dosing: 200,000 IU for children 12 months and older, 100,000 IU for those 6 to 11 months, and 50,000 IU for infants younger than 6 months; a third dose should be administered 2 to 4 weeks later for children showing signs of vitamin A deficiency. Vitamin A is also recommended for children who are immunosuppressed, have clinical evidence of deficiency, or are recent immigrants from areas with high measles mortality. [4], [5]
A 2010 systematic review assessed the effectiveness of measles vaccination and vitamin A treatment on measles-related morbidity and mortality using data collated for the Lives Saved Tool (LiST). Investigators conducted a comprehensive literature search of publications from 1960 to 2008. A meta-analysis incorporating three RCTs and two quasi-experimental studies concluded that a single dose of measles vaccine conferred 85% effectiveness (95% CI 83 to 87) in preventing measles disease. This estimate was applied as a proxy for measles-specific mortality among children vaccinated before 12 months of age. Serologic data supported higher efficacy when vaccination was administered at older ages, with effectiveness increasing to 95% when the first dose was given at ≥12 months and up to 98% for two-dose regimens. Regarding vitamin A, six high-quality RCTs were analyzed, with overall results showing no significant reduction in measles mortality (RR 0.63; 95% CI 0.37 to 1.08). However, when stratified by dosing regimen, three studies using at least two recommended doses (100,000 to 200,000 IU depending on age) reported a 62% reduction in mortality (RR 0.38; 95% CI 0.18 to 0.81). These findings reinforce WHO strategies incorporating two-dose measles vaccination schedules and standardized vitamin A treatment protocols as critical mortality-reducing interventions in pediatric populations, especially in regions with high measles burden. [6]
A 2020 review discusses the re-emergence of measles and emphasizes the role of vitamin A in the treatment of children and immunocompromised patients. While there are anecdotal reports suggesting that adults may also benefit from vitamin A, the exact dosage for this population is not well-established. However, the authors emphasize that repeated doses of 200,000 IU of vitamin A have shown clinical effects. [7]
A 2012 case series examined the relationship between severe measles, vitamin A deficiency, and the Roma community in Europe. The study focused on six adults from the Roma community in Marseille, France, who had measles and low vitamin A levels, with two of these adults experiencing severe complications. Case patients 1 and 2 were male, aged 21 and 25 years of age, respectively. Case patient 1 developed acute meningoencephalitis and required intensive care, while case patient 2 presented with severe hepatitis and keratitis. Notably, all six patients presented with vitamin A deficiency (0.16 to 0.34 mg/L, reference range: 0.5 to 0.8 mg/L), and two additional Roma individuals without measles also exhibited low vitamin A levels. Vitamin A supplementation was administered to all measles patients following World Health Organization guidelines (200,000 IU intramuscularly; followed by a second dose the next day), and all patients recovered. This case report may demonstrate a potential role for the use of vitamin A deficiency in patients with severe measles complications, particularly in underprivileged populations with limited healthcare access. Overall, the authors concluded that improved vaccination coverage is essential in reducing measles transmission in the Roma community. [8]