As a measles outbreak in West Texas continues to grow, the response from US Health and Human Services Secretary Robert F. Kennedy Jr. has leaned heavily on treatment with vitamin A, as well as “good results” from the use of the steroid budesonide, the antibiotic clarithromycin and cod liver oil.
Doctors say that this messaging might take away from efforts to increase vaccination, and some misinformation about these therapies is already circulating online.
Many US doctors have never seen measles, given that the virus was declared eliminated in the country in 2000. There are no antiviral medications specifically to treat measles infection.
“Vitamin A is not a substitute for vaccination,” said Dr. Megan Ranney, dean of the Yale School of Public Health.
Vitamin A is important for vision and immunity. The World Health Organization recommends two doses for all children and adults who are diagnosed with measles. Guidance from the US Centers for Disease Control and Prevention also says vitamin A should be given to children with severe measles, such as those who are hospitalized, and specifies doses based on age.
In an opinion piece published Sunday on Fox News, Kennedy referenced studies that show that vitamin A can “dramatically reduce measles mortality.” Speaking to Fox News on Tuesday, Kennedy described how CDC has been on the ground in West Texas and discussed the use of cod liver oil, which has high amounts of vitamins A and D.
However, vitamin A is most useful for measles support in patients who have a specific deficiency. The studies mainly draw on evidence from low-income countries where that deficiency is common.
“It’s actually valid information,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, but it is “out of context.”
“Vitamin A supplementation can be lifesaving for measles cases when vitamin A deficiency is present,” he said. In these cases, it strengthens the immune system in providing a response against the virus.
But in the American context, the data for vitamin A use in measles is “weak,” said Dr. Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine.
Vitamin A “really doesn’t have much of a role in the current discussion on the West Texas measles epidemic because it becomes a distraction about what we really need to focus on, which is vaccinating our kids,” he said.
Beyond the updated CDC guidelines on vitamin A, there’s no set treatment regimen for measles because cases in the US have been generally rare. One of the medications that Kennedy mentioned, the antibiotic clarithromycin, could be an attempt to prevent secondary bacterial infections like pneumonia, but evidence for that is limited. Budesonide is a steroid with a variety of uses, but it’s not clear how it might help someone with measles.
“It’s really important not to conflate what … [is] supportive or adjunctive care for measles versus curative treatment for measles,” said Dr. Christina Johns, a pediatric emergency physician at PM Pediatrics in Annapolis, Maryland. “There is no treatment for measles.”
“I believe that it is incredibly important to speak very clearly and directly with regard to therapy,” she said.
The American Academy of Pediatrics released comments last week seeking to combat misinformation that says vitamin A can prevent measles.
“Vitamin A is only recommended in hospitalized patients, and it’s only recommended at specific doses,” said Dr. Leslie Motheral, a pediatrician in Lubbock, Texas, where the measles outbreak is growing. “I want to be very clear with that, because I do think there are patients who are not vaccinating and are just giving their kids high doses of vitamin A.”
Motheral said she has started seeing misinformation about vitamin A on social media and wants to inform people that it cannot be used as measles prevention. Excess amounts of vitamin A can even be dangerous.
“As pediatricians … we learn about vitamin A toxicity, but now we’ve got to really make sure we’re watching for those things in these patients,” she said.
Vitamin A toxicity can cause vomiting, nausea, blurry vision, muscle weakness, liver damage and potential brain damage.
The measles outbreak in West Texas stands at 159 cases as of Tuesday, according to the Texas Department of Health Services. Many are in Gaines County, home to a high number of unvaccinated people, including a Mennonite community. One unvaccinated school-age child has died. Experts say the case count is probably far greater than what has been reported.
Some Texas residents have decided to get vaccinated, which experts attribute to access to good information.
Those who are choosing vaccination are getting “vaccine questions answered by medical and public health professionals rather than purveyors of disinformation on social media,” Dr. Katherine Wells, director of Lubbock Public Health, and Dr. Phil Huang, director of health and human services in Dallas County, wrote in an opinion piece in a USA Today.
Kennedy, who has a history of anti-vaccine activism, has said little about vaccination. He did not explicitly recommend the vaccine in his opinion piece on Fox News, calling the decision to vaccinate “a personal one,” and acknowledging it can contribute to “community immunity.”
In Kennedy’s interview on Tuesday, he said measles vaccination, “in highly unvaccinated communities like the Mennonites, it’s something we recommend, but we also understand there is a lot of mistrust of the vaccines.”