American Journal of Epidemiology Vol. 143, No. 5: 413-422
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Efficacy of a Single Oral Dose of 200,000 IU of Oil-soluble Vitamin A in Measles-associated Morbidity
1Department of International Health, Division of Human Nutrition, Johns Hopkins School of Hygiene and Public Health Baltimore, MD.
2Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health Baltimore, MD.
3Department of Oncology, Johns Hopkins School of Medicine Baltimore, MD.
Reprint requests to Dr. Francisco J. Rosales, Department of Nutrition, Pennsylvania State University, South 126 Henderson Bldg., University Park, PA 16802.
The authors assessed the efficacy of the World Health Organization (WHO) recommendation of 200,000 IU of vitamin A in oil to treat acute non-xerophthalmic measles patients. Acute measles patients who did not require hospitalization were enrolled in a randomized, double-masked, clinical trial of vitamin A (n = 90) versus placebo (n = 110) carried out in Ndola, Zambia, in 1991. Measles-associated morbidity was defined by the presence of signs and symptoms of acute respiratory infection. Daily evaluations for the first 3 days were followed by weekly visits for a month at urban health centers. Baseline demographic, clinical, and biochemical characteristics were similar in both groups. Cross-sectional analysis of morbidity status, by group, at each weekly evaluation showed no significant differences until week 4, when more placebo-treated patients had cough or pneumonia (p = 0.005). However, longitudinal analysis, which looked at changes among individuals and controlled for initial health status, showed more equivocal results. The odds ratio for the development of pneumonia in patients with measles cough in vitamin A-treated subjects was 0.73 (95% confidence interval (Cl) 0.30–1.80). The odds ratio for the development of measles-associated cough or pneumonia in asymptomatic measles patients was 0.52 (95% Cl 0.24%1.13), in favor of vitamin A, but the odds ratio for failing to improve from pneumonia in vitamin A-treated subjects was 1.23(95% Cl 0.68–2.3), a result in favor of placebo. These results suggest that the evidence for the efficacy of one dose of vitamin A in oil to prevent measles complications is not as strong as that previously shown for two 200,000 IU doses of water-miscible vitamin A, and that the WHO recommendation may need to be reexamined. Am J Epidemiol 1996;143:413–22.
clinical trials; logistic models; Markov chains; measles virus; morbidity; regression analysis; retinoids
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