More than one month into a major measles outbreak in western Texas that has sickened 146 people and killed one school-age child, the Centers for Disease Control and Prevention released its first public statement and it highlighted a therapy that has raised some eyebrows among infectious disease experts.
“Measles does not have a specific antiviral treatment,” read the statement, which was posted only on X on Thursday night. “Supportive care, including vitamin A administration under the direction of a physician, may be appropriate.”
Dr. Lara Johnson, a pediatrician and the chief medical officer at Covenant Children’s Hospital in Lubbock, Texas, where measles patients from the current outbreak are being treated, didn’t comment on whether the hospital is using vitamin A.
“We can’t comment specifically about the care of our patients; however, our physicians have followed recommended treatment protocols for patients with measles,” Johnson said.
Vitamin A is involved in many functions in the body including vision, growth and immunity. For years, it’s been used for severe measles cases in children in developing countries, where vitamin deficiencies are common. In those cases, studies have found it can reduce complications and the risk of death, though it’s not seen as a cure for the disease. It’s also been recommended by the American Academy of Pediatrics and the World Health Organization in children hospitalized with measles.
“Virtually, all the studies have been done in resource-limited countries where it does seem to show a significant beneficial effect, and also in those countries, it’s been shown that children with lower levels of vitamin A tend to have more severe measles,” said Dr. Camille Sabella, director of pediatric infectious diseases at Cleveland Clinic Children’s, who added that he welcomed the CDC’s support of vitamin A.
Vitamin A is less commonly used for measles cases in the U.S., according to the National Foundation for Infectious Diseases. Doctors say one reason may be that most Americans have enough vitamin A in their diet.
“I think the big caveat of all of this is that there’s a significantly higher rate of vitamin A deficiency in developing countries,” said Dr. Alexandra Yonts, infectious disease specialist at Children’s National Hospital in Washington, D.C. “So it is less clear whether there is any benefit in populations like in the U.S. and other developed countries.”
Dr. Bernard Camins, medical director for infection prevention at the Mount Sinai Health System in New York, agrees that it’s unclear if vitamin A would have the same benefits in the U.S. but says there’s little harm in giving it at appropriate doses.
“I don’t think that it’s necessarily dangerous to give it, especially if you give it the right dose and if used in the right setting,” Camins said. “It’s just something doctors will prescribe if someone comes down with measles to help survive.”
But, he added, vitamin A isn’t effective for preventing measles.
“What I’m really worried about is what happened with Covid,” he said, when some people “were just taking anti-parasitic agents or whatever, instead of the vaccine.”
Getting that message wrong is a major concern of doctors. Anti-vaccine influencers and organizations, including new Health Secretary Robert F. Kennedy Jr., have for years rallied around vitamin A as protection against and treatment for measles. During outbreaks, anti-vaccine groups have organized drives to fundraise and send vitamin A to affected communities.
“There are examples of other outbreaks where that falsehood has spread through communities, the idea that vitamin A can be used as an alternative to MMR vaccination, and that is not the case,” said Dr. David Higgins, a pediatrician and preventive medicine specialist at the University of Colorado Anschutz Medical Campus.
“What I would have loved to see added in the CDC’s statement is that vitamin A is never an alternative to MMR vaccination for measles prevention,” Higgins said. “I think that clarity is really, really important.”
Adding to the concern is that vitamin A is toxic at high levels. It’s a fat-soluble vitamin, so it’s stored in the body instead of released through urine. The more you take, the more it accumulates in organs like the liver.
“You actually can overdose and have toxicity for vitamin A,” Yonts said, adding that she would only use it in rare cases if she knows a patient is deficient or is severely ill and hospitalized. Pregnant women with measles who aren’t taking a multivitamin may also benefit from the vitamin.
The WHO, CDC and AAP all provide specific dosing recommendations for measles cases based on age and say it should only be given for two days.
“So that’s why only using it in these extreme circumstances for a dose or two, and not doing what I’m afraid is going to happen in these communities, which is, ‘Oh, well, we’ll just go out there and start taking high doses of vitamin A every day to keep the measles away,’” Yonts said. “This can actually result in negative outcomes and illness for those kids, because you do accumulate the vitamin in your body.”