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
BACKGROUND. Studies 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.