Clinical Scenario:
A 10-month-old infant is admitted with laboratory-confirmed measles. He receives 100,000 IU of oral vitamin A on admission. He is clinically improving and is ready for discharge 48 hours later. Examination reveals severe acute malnutrition with bilateral corneal xerosis.
What is the most appropriate recommendation regarding vitamin A therapy?
A. No further vitamin A is required.
B. Repeat the second dose after one month.
C. Administer a second dose after 24 hours and a third dose 2–4 weeks later.
D. Continue daily vitamin A for 6 weeks.
E. Start intramuscular vitamin A.
Correct answer & Explanation:
Correct Answer: C. Administer a second dose after 24 hours and a third dose 2–4 weeks later.
Explanation: Vitamin A in measles
The second dose after 24 hours is recommended for all children with measles receiving vitamin A.
The third dose 2–4 weeks later is not given to every child. It is recommended for children who have clinical evidence of vitamin A deficiency (e.g., xerophthalmia) because they are likely to remain deficient.
According to Nelson Textbook of Pediatrics and WHO:
Vitamin A dosage
| Age | Day 1 | Day 2 (24 hours later) |
|---|---|---|
| <6 months | 50,000 IU | 50,000 IU |
| 6–11 months | 100,000 IU | 100,000 IU |
| ≥12 months | 200,000 IU | 200,000 IU |
Third dose
A third age-appropriate dose after 2–4 weeks is recommended for children with:
- Clinical vitamin A deficiency (xerophthalmia, Bitot spots, corneal lesions)
- Some references also include severe malnutrition because these children are at high risk of persistent vitamin A deficiency.
