PEDIATRICS Vol. 91 No. 6 June 1993, pp. 1176-1181
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Measles Severity and Serum Retinol (Vitamin A) Concentration Among Children in the United States

Jay C. Butler MD1, Peter L. Havens MD, MS2, Susan E. Day MD2, Michael J. Chusid MD2, Anne L. Sowell PhD3, Dan L. Huff MT3, Dan E. Peterson MD, MPH4, Robert A. Bennin 5, Richard Circo MS5, and Jeffrey P. Davis MD6

1 From the Section of Acute and Communicable Disease Epidemiology, Bureau of Community Health and Prevention, Wisconsin Division of Health, Madison; Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA
2 From the Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
3 From the National Center for Environmental Health and Injury Control, Centers for Disease Control and Prevention, Atlanta
4 From the Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA
5 From the Virus Section, State Laboratory of Hygiene, Madison, WI.
6 From the Section of Acute and Communicable Disease Epidemiology, Bureau of Community Health and Prevention, Wisconsin Division of Health, Madison

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 le5 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 µmol/L (median 0.58 µmol/L); 82 (72%) patients had low retinol concentration (le0.70 µmol/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.

Key Words: measles • retinol • vitamin A • illness severity • hospitalization

Submitted on December 17, 1992
Accepted on March 1, 1993




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