Vitamins that may be helpful
Preliminary research shows that supplemental
vitamin A improves the likelihood that the measles vaccine will provide
protection.6 Vitamin A has, since the 1920s, been the subject of much research into
the prevention and treatment of childhood exanthems, particularly measles.7 This
nutrient has a critical role in proper immune
function, and there is evidence that supplementation with vitamin A reduces the incidence
and severity of, and deaths from, childhood measles.8 9 The World Health
Organization (WHO) has therefore recommended that children with signs of deficiency receive
supplementation with vitamin A. The recommended amounts are 100,000 IU for children younger
than one year and 200,000 IU for children older than one year, immediately upon diagnosis, and
repeated once the next day and once in one to four weeks.10 A controlled trial of
African children given vitamin A supplementation according to the WHO’s recommendations
found that severity of measles and its long-term consequences were reduced by 82% on day
eight, 61% in week six, and 85% six months after the onset.11
Another controlled trial found that giving approximately 200,000 IU of vitamin A once
during measles illness was not adequate to provide any benefit in African children whose
vitamin A status was unknown.12 In a controlled prevention study, Indian children
treated with 2,500 mcg (8,333 IU) of vitamin A weekly had fewer measles complications and less
than half of the rate of death as compared with children receiving placebo;13 but
in another study, Indian children receiving 200,000 IU of vitamin A every six months did not
have a different rate of total infectious illness nor rate of death as compared with children
receiving placebo.14
An analysis of 20 controlled trials concluded that vitamin A supplementation reduced deaths
from measles respiratory infection by 70%.15 While vitamin A deficiency is
widespread in developing countries, it has also been reported in the United States and has
been linked with more severe cases of measles.16 The American Academy of Pediatrics
has recommended supplementation with vitamin A for children between the ages of six months and
two years who are hospitalized with measles and its complications. The recommended amount is a
single administration of 100,000 IU for children aged 6 to 12 months and 200,000 IU for
children older than 1 year, followed by a second administration 24 hours later and a third
after four weeks in children who are likely to have vitamin A deficiency.17
One trial showed that low levels of vitamin A are more prevalent in children with measles
than in similar children without measles, with levels rising back to normal several days after
the onset of the infection. This observation led the authors of the study to conclude that
vitamin A deficiency is a consequence of infection with the measles virus and to recommend
supplementation with vitamin A during measles infection even when prior deficiency is not
suspected.18 Vitamin A stores have also been shown to be depleted during chicken
pox infection,19 and some preliminary data supports its use in treatment of chicken
pox. In a controlled trial, in which children without vitamin A deficiency were given either
200,000 IU of vitamin A or placebo one time during chicken pox, the children given vitamin A
had shorter duration of illness and fewer severe complications. The researchers then treated
the patients’ siblings with vitamin A before chicken pox became evident, and they had an
even shorter length of illness.20
Selenium is a mineral known to have
antioxidant properties and to be involved in healthy immune system activity. Recent animal and
human research suggests that selenium deficiency increases the risk of viral infection and
that supplementation prevents viral infection.21 22 23
24 25 In a controlled trial, children with a specific viral infection
(respiratory syncytial virus) who received a single supplement of 1 mg (1,000 mcg) of sodium
selenite (a form of selenium) recovered more quickly than children who did not receive
selenium.26 While it is possible that childhood exanthemous viral infections might
similarly be more severe in selenium-deficient children and helped through supplementation,
none of the current research involves these specific viruses.
Zinc is another mineral antioxidant
nutrient that the immune system requires. Zinc deficiency results in lowered immune defenses,
and zinc supplementation increases immune activity in people with certain
illnesses.27 As with vitamin A, zinc levels have been observed to fall during the
early stages of measles infection and to return to normal several days later.28
There is evidence that zinc supplements are helpful in specific viral infections,29
30 31 but there are no data on the effect of zinc on childhood
exanthemous infections.
Vitamin C has been demonstrated in test
tube, animal, and human studies to have immune-enhancing and direct antiviral
properties.32 Preliminary observations made on the effect of vitamin C on viral
infections have involved both measles and chicken pox.33 An active immune system
uses vitamin C rapidly, and blood levels fall in children with bacterial or viral
infections.34 Reduced immune cell activity has been observed in people with
measles, but in one preliminary study, supplementation with 250 mg daily of vitamin C in
children 18 months to 3 years old had no impact on the course of the illness.35 The
authors of this study admit that this amount of vitamin C may have been too low to bring about
an observable increase in immune cell activity and thus an increase in speed of recovery.
Healthy immune function also requires adequate amounts of vitamin E. Vitamin E deficiency is associated with
increased severity of viral infections in mice.36 37 38
Supplementation with vitamin E during viral infections has been shown to increase immune cell
activity39 and reduce virus activity40 in mice. Research into the
effects of vitamin E supplementation on childhood exanthems has not been done.
Flavonoids are a group of compounds found
in some plant foods and medicinal herbs. An antiviral action of some flavonoids has been
observed in a number of test tube experiments.41 42 43
44 45 Quercetin, one of the
flavonoids, has shown particularly strong antiviral properties in the test tube;46
47 48 however, one study did not find quercetin to be of benefit to mice
with a viral infection.49 It is not known whether flavonoids can be absorbed in
amounts sufficient to exert an antiviral effect in humans, and therefore their possible role
in the treatment of childhood exanthems remains unknown.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
1. Bohler E, Wathne KO. Malnutrition and infections in children--a
destructive interplay with global dimensions. Tidsskr Nor Laegeforen
2000;120:1740–5 [in Norwegian].
2. Bhaskaram P. Measles & malnutrition. Indian J Med Res
1995;102:195–9.
3. Tomkins A. Malnutrition, morbidity and mortality in children and their
mothers. Proc Nutr Soc 2000;59:135–46.
4. Adeiga AA, Akinosho RO, Onyewuche J. Evaluation of immune response in
infants with different nutritional status: vaccinated against tuberculosis, measles and
poliomyelitis. J Trop Pediatr 1994;40:345–50.
5. Greenwood BM, Bradley-Moore AM, Bradley AK, et al. The immune response
to vaccination in undernourished and well-nourished Nigerian children. Ann Trop Med
Parasitol 1986;80:537–44.
6. Benn CS, Aaby P, Bale C, et al. Randomised trial of effect of vitamin
A supplementation on antibody response to measles vaccine in Guinea-Bissau, west Africa.
Lancet 1997;350:101–5.
7. Semba RD. Vitamin A as “anti-infective” therapy,
1920–1940. J Nutr 1999;129:783–91 [review].
8. Molina EL, Patel JA. A to Z: vitamin A and zinc, the miracle duo.
Indian J Pediatr 1996;63:427–31 [review].
9. Malvy D. Micronutrients and tropical viral infections: one aspect of
pathogenic complexity in tropical medicine. Med Trop (Mars) 1999;59:442–8
[review; in French].
10. World Health Organization. Expanded programme on immunization:
programme for the prevention of blindness nutrition. Joint WHO/UNICEF statement. Vitamin A for
measles. Wkly Epidemiol Rec 1987;62:133–4.
11. Coutsoudis A, Broughton M, Coovadia HM. Vitamin A supplementation
reduces measles morbidity in young African children: a randomized, placebo-controlled,
double-blind trial. Am J Clin Nutr 1991;54:890–5.
12. Rosales FJ, Kjolhede C. A single 210-mumol oral dose of retinol does
not enhance the immune response in children with measles. J Nutr
1994;124:1604–14.
13. Rahmathullah L. Effect of receiving a weekly dose of vitamin A
equivalent to the recommended dietary allowances among pre school children on mortality in
south India. Indian J Pediatr 1991;58:837–47.
14. Vijayaraghavan K, Rashmiah G, Suryaprakasam B, et al. Effect of
massive dose of vitamin A on morbidity and mortality in Indian children. Lancet
1990;336:1342–53.
15. Glasziou PP, Mackerras DE. Vitamin A supplementation in infectious
diseases: a meta-analysis. BMJ 1993;306:366–70 [review].
16. Frieden TR, Sowell AL, Henning JK, et al. Vitamin A levels and
severity of measles: New York City. Am J Dis Child 1992;146:182–6.
17. Committee on Infectious Diseases, American Academy of Pediatrics.
Vitamin A treatment of Measles. Pediatrics 1993;91:1014–5.
18. Coutsoudis A, Coovadia HM, Broughton M, et al. Micronutrient
utilisation during measles treated with vitamin A or placebo. Int J Vitam Nutr Res
1991;61:199–204.
19. Campos FA, Flores H, Underwood BA. Effect of an infection on vitamin
A status of children as measured by the relative dose response. Am J Clin Nutr
1987;46:91–4.
20. Ozsoylu S, Cemeroglu AP, Gunay M. Vitamin A for varicella. J
Pediatr 1994;125:1017–8 [letter].
21. Levander OA, Beck MA. Selenium and viral virulence. Br Med
Bull 1999;55:528–33.
22. Beck MA, Levander OA. Host nutritional status and its effect on a
viral pathogen. J Infect Dis 2000;182:S93–S96 [review].
23. Beck MA. Nutritionally induced oxidative stress: effect on viral
disease. Am J Clin Nutr 2000;71:1676S–81S [review].
24. Beck MA. Selenium and host defence towards viruses. Proc Nutr
Soc 1999;58:707–11 [review].
25. Beck MA, Levander OA. Dietary oxidative stress and the potentiation
of viral infection. Annu Rev Nutr 1998;18:93–116 [review].
26. Liu X, Yin S, Li G. Effects of selenium supplement on acute lower
respiratory tract infection caused by respiratory syncytial virus. Chung Hua Yu Fang I
Hsueh Tsa Chih 1997;31:358–61 [in Chinese].
27. Fraker PJ, King LE, Laakko T, Vollmer TL. The dynamic link between
the integrity of the immune system and zinc status. J Nutr 2000;130:1399S-406S
[review].
28. Coutsoudis A, Coovadia HM, Broughton M, et al. Micronutrient
utilisation during measles treated with vitamin A or placebo. Int J Vitam Nutr Res
1991;61:199–204.
29. Mocchegiani E, Muzzioli M. Therapeutic application of zinc in human
immunodeficiency virus against opportunistic infections. J Nutr
2000;130:1424S–31S.
30. Novick SG, Godfrey JC, Pollack RL, Wilder HR. Zinc-induced
suppression of inflammation in the respiratory tract, caused by infection with human
rhinovirus and other irritants. Med Hypotheses 1997;49:347–57 [review].
31. Kumel G, Schrader S, Zentgraf H, Brendel M. Therapy of banal HSV
lesions: molecular mechanisms of the antiviral activity of zinc sulfate. Hautarzt
1991;42:439–45 [review; in German].
32. Jariwalla RJ, Harakeh S. Antiviral and immunomodulatory activities of
ascorbic acid. Subcell Biochem 1996;25:213–31 [review].
33. Stone I. The Healing Factor: Vitamin C Against Disease. New
York: Perigee Books, 1972, 75.
34. Tanzer F, Ozalp I. Leucocyte ascorbic acid concentration and plasma
ascorbic acid levels in children with various infections. Mater Med Pol
1993;25:5–8.
35. Joffe MI, Sukha NR, Rabson AR. Lymphocyte subsets in measles.
Depressed helper/inducer subpopulation reversed by in vitro treatment with levamisole and
ascorbic acid. J Clin Invest 1983;72:971–80.
36. Beck MA, Levander OA. Host nutritional status and its effect on a
viral pathogen. J Infect Dis 2000;182:S93–S96 [review].
37. Beck MA. Nutritionally induced oxidative stress: effect on viral
disease. Am J Clin Nutr 2000;71:1676S–81S [review].
38. Beck MA, Levander OA. Dietary oxidative stress and the potentiation
of viral infection. Annu Rev Nutr 1998;18:93–116.
39. Han SN, Wu D, Ha WK, et al. Vitamin E supplementation increases T
helper 1 cytokine production in old mice infected with influenza virus. Immunology
2000;100:487–93.
40. Hayek MG, Taylor SF, Bender BS, et al. Vitamin E supplementation
decreases lung virus titers in mice infected with influenza. J Infect Dis
1997;176:273–6.
41. Vrijsen R, Everaert L, Boeye A. Antiviral activity of flavones and
potentiation by ascorbate. J Gen Virol 1988;69:1749–51.
42. Debiaggi M, Tateo F, Pagani L, et al. Effects of propolis flavonoids
on virus infectivity and replication. Microbiologica 1990;13:207–13.
43. Fesen MR, Kohn KW, Leteurtre F, Pommier Y. Inhibitors of human
immunodeficiency virus integrase. Proc Natl Acad Sci 1993;90:2399–403.
44. Amoros M, Simoes CM, Girre L, et al. Synergistic effect of flavones
and flavonols against herpes simplex virus type 1 in cell culture. Comparison with the
antiviral activity of propolis. J Nat Prod 1992;55:1732–40.
45. Spedding G, Ratty A, Middleton E Jr. Inhibition of reverse
transcriptases by flavonoids. Antiviral Res 1989;12:99–110.
46. Kaul TN, Middleton E Jr, Ogra PL. Antiviral effect of flavonoids on
human viruses. J Med Virol 1985;15:71–9.
47. Mucsi I, Pragai BM. Inhibition of virus multiplication and alteration
of cyclic AMP level in cell cultures by flavonoids. Experientia
1985;41:930–1.
48. Ohnishi E, Bannai H. Quercetin potentiates TNF-induced antiviral
activity. Antiviral Res 1993;22:327–31.
49. Esanu V, Prahoveanu E, Crisan I, Cioca A. The effect of an aqueous
propolis extract, of rutin and of a rutin-quercetin mixture on experimental influenza virus
infection in mice. Virologie 1981;32:213–5.