MEASLES SEVERITY AND SERUM RETINOL (VITAMIN-A) CONCENTRATION AMONG CHILDREN IN THE UNITED-STATES

Background. Studies in developing countries have shown that children w ith measles have low serum retinol concentrations and that lower retin ol levels are associated with measles-related mortality. Vitamin A the rapy has been shown to reduce mortality among African children with ac ute measles. Objectives. To determine whether serum retinol concentrat ion is low among children with measles in the United States and to det ermine whether retinol concentration is associated with illness severi ty. Setting. Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990. Patients. One hundred fourte en patients less-than-or-equal-to 5 years of age evaluated for serolog ically confirmed measles with serum obtained within 5 days following r ash onset. Methods. Serum retinol concentration was determined by high -performance liquid chromatography. Clinical data were collected by ho spital record review. A modified Pediatric Risk of Mortality (PRISM) s core was used to assess physiologic instability as a measure of illnes s severity. Results. Retinol concentrations ranged from 0.25 to 1.18 m umol/L (median 0.58 mumol/L); 82 (72%) patients had low retinol concen tration (less-than-or-equal-to 0.70 mumol/L). Median retinol concentra tions 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 c hildren with otitis media (0.63 vs 0.54, P = .01). Higher modified PRI SM scores, reflecting greater physiologic instability, were associated with lower retinol concentration (beta coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associate d 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, gende r, and interval from rash onset until serum was collected. Conclusions . Among these children with measles in an urban United States communit y, retinol concentrations were depressed, and the degree of depression was associated with illness severity. Vitamin A therapy should be con sidered for children with measles in the United States who require hos pitalization.