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.