The Importance of Measles Vaccination Amidst Vitamin A Discussions

The measles outbreak that originated in the South Plains region of Texas continues to spread, with nearly 320 cases and 2 unvaccinated deaths from measles-related causes as of March 18, 2025.^1,2 As the outbreak continues, concerns are growing among health care experts and agency leaders regarding the impact of misinformation, specifically around the use of vitamin A for measles prevention.³

Measles virus or virus - Image credit: Design Cells | stock.abobe.com

The US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has appeared to demonstrate his support for vitamin A supplementation along with vaccination in a recent opinion piece for Fox News. Although Kennedy expressed support for measles vaccination, acknowledging its role in protecting vulnerable individuals, he also emphasized that the decision to vaccinate should ultimately be a personal choice.^3,4

However, as cases rise, experts warn that vitamin A supplementation should not be used as a replacement for vaccination and that it is primarily used as a supplementary treatment for measles within a hospital setting for patients with moderate to severe infection. Notably, vitamin A deficiency is also uncommon in the United States and predominantly affects those with dietary insufficiencies or specific liver absorption disorders. However, it is a significant public health issue in developing nations, particularly among infants, children, and pregnant or breastfeeding women.⁵

“The context for conversations about vitamin A nutritional deficiencies is people in countries and regions where they are malnourished—not largely in the United States. The fear here is that we are going back to fishing people out of the stream once they have already fallen in and are drowning, versus preventing them from falling into the stream in the first place with vaccinations,” Jerome Adams, MD, MPH, FASA, executive director of health equity at Purdue University and the 20th surgeon general of the United States, said in an interview with Pharmacy Times.

Kennedy’s message has raised concerns, particularly regarding the availability of vitamin A treatment and how it might lead people to believe that vaccination against measles is unnecessary. However, experts emphasize that vitamin A is not a substitute or equivalent for measles, mumps, and rubella (MMR) vaccination.³

“We are either going to see measles cases continue to proliferate and we are going to lose our measles eradication status as a country, and more people are going to be harmed, or [Kennedy] is going to have to come out as HHS Secretary, as a strong advocate and get more people comfortable with vaccines,” Adams said.

According to the World Health Organization (WHO) and the American Academy of Pediatrics (AAP), once infected, measles complications are more likely to occur in children who are malnourished, especially those with limited intake of vitamin A or with a weakened immune system. Complications can include blindness; encephalitis; severe diarrhea and related dehydration; ear infections; and severe breathing difficulties.^6,7

Amidst the related complications surrounding lack of vitamin A, both WHO and AAP recommend the use of vitamin A for all individuals with measles—not only severe cases—due to its association with decreased morbidity and mortality, particularly in resource-limited settings.^6,7

Vitamin A treatment involves daily doses for 2 days, with amounts varying by age: 200,000 IU for children 12 months and older, 100,000 IU for infants 6 to 11 months, and 50,000 IU for infants younger than 6 months. A third dose is advised for children showing vitamin A deficiency signs weeks later. Individuals with mild, moderate, and severe infections are required to receive supplementation; however, this is only under the supervision of a physician or within a hospital setting to ensure proper dosing. Improper supplementation with vitamin A can lead to toxicities.^6,7

“Kennedy is either going to be known as the health secretary who was at the helm when America made measles great again," concluded Adams. "Or he's going to be known as the health secretary who went from skeptic to vaccine advocate, because those are the only 2 choices we have here."

REFERENCES

1. Measles cases rise to about 320 total in Texas and New Mexico. Here’s what you should know. AP News. News release. Updated March 18, 2025. Accessed March 20, 2025. https://apnews.com/article/measles-outbreak-texas-new-mexico-vaccine-rfk-d5444b3397ac7c4034e63becc219aa33

2. Measles Cases and Outbreaks. CDC. News release. Updated March 14, 2025. Accessed March 20, 2025. https://www.cdc.gov/measles/data-research/index.html

3. Vitamin A, While Helpful for Measles, Is Not a Replacement for Vaccination. MedPage Today. News release. March 6, 2025. Accessed March 20, 2025. https://www.medpagetoday.com/special-reports/features/114533?xid=nl_mpt_investigative2025-03-12&mh=6d2b5f4f91352444bdf817a9c17750bc&zdee=gAAAAABm4uL9FCoIf1N83nrcwYYqnQUvN6Iw4dbaY-dGva4sOp57nSM2Ew3wD87ohRuoseQBDbCp1MG30J6ETpHXK1wNpp0NgnGTMFXrtFaNfWUoL5ekf-Y%3D&utm_source=Sailthru&utm_medium=email&utm_campaign=InvestivativeMD_03122025&utm_term=NL_Gen_Int_InvestigateMD_Active

4. ROBERT F. KENNEDY JR.: Measles outbreak is call to action for all of us. Fox News. March 2, 2024. Accessed March 20, 2025. https://www.foxnews.com/opinion/robert-f-kennedy-jr-measles-outbreak-call-action-all-us

5. Vitamin A Deficiency. Cleveland Clinic. Updated May 23, 2022. Accessed March 20, 2025. https://my.clevelandclinic.org/health/diseases/23107-vitamin-a-deficiency

6. World Health Organization. Measles. November 14, 2024. Accessed March 20, 2025. https://www.who.int/news-room/fact-sheets/detail/measles

7. American Academy of Pediatrics. Measles. 2024. Accessed March 20, 2025. https://publications.aap.org/redbook/book/755/chapter/14079321/Measles?autologincheck=redirected