Vitamin A, While Helpful for Measles, Is Not a Replacement for Vaccination

Both the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend vitamin A for all patients with measles — not just severe cases — but experts warn that this shouldn’t be seen as a replacement for vaccination.

In a recent opinion piece for Fox News, HHS Secretary Robert F. Kennedy Jr. wrote that studies support the administration of vitamin A “under the supervision of a physician for those with mild, moderate, and severe infection” and that it can reduce mortality from the disease.

He also indicated that the CDC had recently broadened its recommendation to use vitamin A in all measles cases, not just severe disease.

While Kennedy appeared to support measles vaccination in that opinion piece — he wrote that vaccines “contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons” — he also noted that the choice to vaccinate is a personal one.

Taken together, experts have raised concerns about a possible misinterpretation of Kennedy’s message: that because vitamin A is available, they don’t need to be vaccinated.

“Vitamin A is absolutely not a substitute nor an equivalent for MMR vaccination, which is the best way to prevent a child from getting measles,” Ericka Hayes, MD, of Children’s Hospital of Philadelphia, told MedPage Today.

Indeed, the measles, mumps, and rubella (MMR) vaccine is “one of the most effective and durable vaccines that we have,” she said, with the full two-dose series being 97% effective against measles.

“I think some people are thinking, ‘Oh, well, then, if I, for example, take vitamin A, I won’t get measles, or I’m less likely to get measles,'” Hayes said. “And that is absolutely not the case.”

Much of the literature about vitamin A and measles comes from lower- and middle-income countries, where deficiency may pose more of a problem. However, given that vitamin A deficiency can put kids at risk of worse outcomes with measles — and most kids aren’t assessed for vitamin A levels — U.S. expert consensus has settled on administering the vitamin in all cases.

Tina Tan, MD, of Northwestern University, who is president of the Infectious Diseases Society of America, said vitamin A “really plays an important role in maintaining a healthy immune system and supports the function of immune cells so the body can fight off infections like measles.”

However, taking vitamin A won’t prevent a child from getting measles in the first place, Hayes said, and it can have “significant toxicities,” especially when taken in high doses. “And just because you’re taking vitamin A or have a good vitamin A level doesn’t guarantee that you will not have a … severe case of measles,” she added.

The AAP Red Book — an encyclopedia of pediatric infectious diseases — noted that U.S. experts concur with WHO recommendations on giving vitamin A to all children with measles, and recommends giving it once a day for 2 days at the following doses:

• 200,000 IU for children 12 months or older
• 100,000 IU for infants 6 through 11 months of age
• 50,000 IU for infants younger than 6 months

“Again, if a child has measles, that vitamin A should be prescribed under the supervision of the physician to make sure that it is dosed appropriately,” Hayes said.

Still, both Hayes and Tan emphasized that vaccination is the only way to stop more measles outbreaks like the current one in west Texas, where 159 cases have been identified since late January, with 22 hospitalizations and one death — the first measles death in the U.S. since 2015.

Tan said that the “number of unvaccinated individuals is growing, and that basically increases the risk for spread of measles, because measles is one of the most contagious viruses.”

“If we cannot get our vaccination rates up to where they were, we’re going to continue to see these outbreaks,” she added, and that could mean more deaths, as it’s estimated that one to three children in 1,000 with measles will die.

Measles can also cause complications after the initial illness has passed, including subacute sclerosing panencephalitis — a rare, though fatal, neurologic disease — and immunodeficiency, Hayes said.

“I always find measles extremely concerning because it is so contagious,” Hayes said. There are “so many individuals in this country who are not immune,” such as infants under 1 year of age, who cannot be vaccinated yet, and individuals who are immunocompromised, she added. And there is a “risk for very severe disease as well as complications — both acute complications as well as long-term complications — with this virus.”

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