Measles severity and serum retinol (vitamin A) concentration among children
in the United States.
Butler JC; Havens PL; Sowell AL; Huff DL; Peterson DE; Day SE; Chusid
MJ; Bennin RA; Circo R; Davis JP
Pediatrics 1993 Jun;91(6):1176-81
in developing countries have shown that children with measles have low
serum retinol concentrations and that lower retinol levels are associated
with measles-related mortality. Vitamin A therapy has been shown to reduce
mortality among African children with acute measles. OBJECTIVES.
To determine whether serum retinol concentration is low among children
with measles in the United States and to determine whether retinol concentration
is associated with illness severity. SETTING. Pediatric
referral hospital and clinic in Milwaukee, WI, during the measles outbreak
of 1989-1990. PATIENTS. One hundred fourteen patients
< or = 5 years of age evaluated for serologically confirmed measles
with serum obtained within 5 days following rash onset. METHODS.
Serum retinol concentration was determined by high-performance liquid
chromatography. Clinical data were collected by hospital record review.
A modified Pediatric Risk of Mortality (PRISM) score was used to assess
physiologic instability as a measure of illness severity. RESULTS.
Retinol concentrations ranged from 0.25 to 1.18 mumol/L (median 0.58 mumol/L);
82 (72%) patients had low retinol concentration (< or = 0.70 mumol/L).
Median retinol concentrations were lower among hospitalized patients (0.56
vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02)
but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher
modified PRISM scores, reflecting greater physiologic instability, were
associated with lower retinol concentration (beta coefficient -.0147,
P = .025). In multivariate analysis, higher modified PRISM scores were
associated with lower retinol concentration (beta coefficient -.0144,
P = .025) even after controlling for hospitalization, presence of complications,
race, age, receipt of Aid to Families With Dependent Children, gender,
and interval from rash onset until serum was collected. CONCLUSIONS.
Among these children with measles in an urban United States community,
retinol concentrations were depressed, and the degree of depression was
associated with illness severity. Vitamin A therapy should be considered
for children with measles in the United States who require hospitalization.