Vitamin A and Measles
NSCI 5373
Mugdha Jog
Vitamin A deficiency
Primary Vit A deficiency: prolonged dietary
deprivation, South and East Asia
Secondary Vit A deficiency: interference
with absorption, storage, transport of Vit A
Defective absorption and storage: cystic
fibrosis, celiac disease, pancreatic disease,
giardiasis, cirrhosis
Defective storage and transport: PEM
Signs and symptoms
Increased susceptibility to infections
Growth retardation in children
Keratomalacia
Xeropthalmia
Night blindness
Xerosis of cornea and conjuctiva
Bitots spots
Diagnosis
Sub-clinical stage: No evidence; history of
inadequate intake
Consequences of deficiency in pre-clinical
stage: Increased risk of mortality from
common childhood infections like diarrhea
and measles
Diagnosis contd
Clinical stage: Shows common symptoms
like xerophthalmia,etc
Plasma retinol levels: good indicator
Mild: 20-30 micro.gm/dl
Moderate: 10-19 micro.gm/dl
Severe: < 10 micro.gm/dl
Diagnosis contd
Plasma RBP levels: indicator
Children less than or up to 10yrs: 20-30
micro.gm/ml
Adult females: 42micro.gm/ml
Adult males: 47micro.gm/ml
Both plasma retinol and plasma RBP fall in
deficient populations
WHO Figures
In 1995, 28 million children <5yrs of age
with clinical VAD
251 million with sub-clinical VAD
Under 5 mortality over 70 per 1,000 live
births
Xerophthalmia afflicts 2-3 million children
each yr, of which 250,000 go permanently
blind
Recommendations
Infants less than 1 yrs age:100,000 IU
Children between 1-4 yrs of age:200,000 IU
( 66,000 micrograms Vitamin A palmitate in
oil taken orally once every 3-6 months ).
Dietary Sources
Dark green leafy vegetables
Yellow orange fruits: mango, papaya
Liver, eggs, milk
Red palm oil, cod liver oil
Vitamin A fortified products: Bread, sugar,
MSG, Margarine, biscuits, rice
Measles
Highly contagious air borne viral illness
Infected children worldwide in prevaccination era
Still frequent and often fatal in developing
countries
Measles: Pathogenesis
Primary infection site- respiratory
epithelium
Replication in nasopharynx and regional
lymph nodes
Viremia- spreads to other tissues and organs
Measles: Clinical Features
Incubation Period: 10-12 days
Prodrome: Fever, runny nose, cough,
conjunctivitis
Koplik’s spots
Clinical Features contd
Rash: 14 days after exposure
Maculopapular eruptions
Begins on head and face, proceeds
downwards and outwards
Persists 5-6 days
Fades in order of appearance
Other Complications
Diarrhea (8%), Otitis media (7%),
Pneumonia (6%), Encephalitis (0.1%),
Death (0.2%)
Hospitalization rate (18%)
30% cases have one or more of above
Risk of death higher among children < 5yrs
Treatment
Medications
ORT
Vitamin A supplementation
Immunization
Immunization
Live attenuated vaccine
WHO recommends:
1St vaccine between 9 to 12 months of birth
2nd vaccine a month after the first one
Measles in U.S
Measles resurgence in U.S between 19891991
55,000 cases
45% under 5 yrs; 35% between 5-19 yrs
123 deaths ( 49% under 5yrs)
11,000 hospitalizations
Reason: Low vaccine coverage
Global Strategies
WHO and UNICEF: Global Measles Strategic
Plan.
By 2005, reduce global measles deaths by 50%
Achieve and maintain interruption of indigenous
measles transmission with elimination goals:
America(2000); Europe(2007); Eastern
Mediterranean(2010)
Global review and assessment of plan in 2005
Plan Strategies
1st dose by 9 months
2nd opportunity for vaccine
Monitor coverage and conduct surveillance
Improve measles case management
Additional campaigns:
Provide vitamin A supplements
Include Mumps and Rubella:MMR
Progress
Global vaccine coverage at 70%
40% global decline in cases from 1990 to
1999
South America - measles mortality reduced
by 99%
7 countries in south Africa – Measles
mortality reduced by 99% just from 1996 to
1998
Conclusion
Measles still accounts for 46% of the 1.7 million
deaths due to vaccine-preventable diseases
30 to 40 million cases and 777,000 measles deaths
still occur every year
It costs less than $1 to immunize a child with the
measles vaccine
Children DON’T HAVE to die from measles!!
Questions ?