The measles outbreak highlights why Vitamin A is essential

Despite having made major progress in childhood immunisation through the Expanded Programme on Immunization (EPI), Bangladesh is experiencing one of the most severe measles outbreaks in a decade. Between March 15 and May 19 this year, at least 475 confirmed and suspected measles deaths have been reported around the country. The scale of infection demonstrates how quickly immunity gaps can reverse decades of public health progress.

Measles is often misunderstood as a simple childhood rash illness. In reality, it is a highly aggressive viral infection caused by the measles virus, which spreads rapidly through coughing, sneezing, and respiratory droplets. This infection can lead to pneumonia, severe diarrhoea, blindness, encephalitis, and prolonged immune suppression. Young children, particularly those who are malnourished, face the highest risk of severe complications and even death.

Why does measles cause such widespread damage throughout the body?

One major reason is that the measles virus aggressively attacks epithelial tissues, which build the protective linings of our respiratory tract, intestines, and eyes. These tissues are heavily dependent on Vitamin A for their maintenance, repair, and immune protection.

Vitamin A is a fat-soluble micronutrient that can be obtained from eggs, liver, fish, milk, carrots, pumpkin, mango, papaya, sweet potato, spinach, and dark green leafy vegetables. During measles infection, the demand for this “anti-infective” vitamin rises sharply as the body attempts to repair damaged epithelial linings and maintain immune functions. As a result, Vitamin A deficiency usually occurs during measles infection.

For nearly a century, doctors and scientists have observed that children with measles often recover better and survive more frequently when their bodies have adequate Vitamin A. In 1932, British physician Joseph Ellison observed that children receiving vitamins A and D during measles infection had roughly half the death rate compared to the untreated children. More convincing evidence emerged in 1987, when researchers in Tanzania conducted a randomised clinical trial showing that Vitamin A doses reduced measles mortality, particularly among children under two years of age and among those suffering from severe respiratory complications. In another important study published in The New England Journal of Medicine in 1990, researchers showed that Vitamin A treatment significantly reduced overall illness severity, especially respiratory infections in hospitalised children in South Africa, while also improving recovery and weight gain.

Scientists subsequently began investigating the molecular and immunological reasons behind Vitamin A’s protective role during measles infection. Over time, researchers discovered that Vitamin A influences several interconnected components of our immune system.

In 2004, immunology research by Japanese researchers showed that retinoic acid, the active form of Vitamin A, binds to specialised receptors inside cells. This molecular signalling process helps direct important immune cells such as T cells towards vulnerable tissues during infection. Much like emergency radio signals which are used to direct rescue teams to the site of a crisis, these signals help immune cells reach inflamed mucosal surfaces and help control infection, regulate inflammation, and support tissue healing. A couple of years later, research published in Science further showed that Vitamin A also helps immune cells named B cells to produce IgA antibodies, which form a protective immune layer along the moist inner surfaces of the respiratory and digestive tracts, the very places where measles virus often first enters, attacks, and spreads.

The accumulation of evidence on Vitamin A’s role in tackling the effects of measles over decades eventually shaped global health policy. The World Health Organization (WHO) now recommends high-dose oral Vitamin A supplementation for two consecutive days in children with measles.

It is necessary to distinguish between the routine Vitamin A supplementation given to children as part of nutrition programmes and the high-dose Vitamin A treatment recommended to treat an active measles infection. Children who receive adequate Vitamin A through diet or routine supplementation programmes may be less vulnerable to severe measles complications. During measles illness, however, doctors often use additional high-dose Vitamin A therapy because the infection rapidly depletes the body’s Vitamin A reserve as it is being continuously used for the repair attempts. Therefore, maintaining adequate Vitamin A levels before infection and ensuring appropriate supplementation during measles infection in particular are both necessary.

However, an important distinction must be emphasised clearly: Vitamin A does not replace vaccination.

This distinction has become increasingly important as measles resurges globally, even in countries that previously eliminated the disease. The United States, where measles was declared eliminated in 2000, has reported a sharp rise in cases again in 2025 and in 2026. Japan, which achieved measles elimination status from WHO in 2015, has also experienced an outbreak in 2026. These events serve as a reminder that measles can quickly return wherever immunity gaps emerge. Because measles spreads extraordinarily fast, communities need very high vaccination coverage, often around 95 percent, to maintain herd immunity, which can protect vulnerable children who may be too young or too ill to be vaccinated.

For Bangladesh, the lesson is clear: measles control cannot rely on vaccination or supplementation alone. We need a combined strategy involving strong vaccination coverage, proper nutrition, Vitamin A campaigns, breastfeeding awareness, and deworming programmes. The last nationwide Vitamin A Plus campaign was held in March 2025, while the National Deworming Campaign has remained suspended since May 2024, despite both programmes traditionally being conducted twice a year. This prolonged interruption may have worsened the recent measles outbreak by increasing malnutrition and weakening children’s immunity.

Parents must ensure that children receive all measles vaccine doses on time. Universities and scientific organisations must also move beyond classrooms, laboratories, and journals. Their responsibility includes helping families understand why vaccination matters, why nutrition matters, and how preventable diseases such as measles continue to threaten children. Policymakers and healthcare workers must strengthen nutrition and immunisation programmes, particularly in vulnerable communities where malnutrition and missed vaccination often coexist.

Measles is preventable. Vaccines protect children from infection, while proper Vitamin A status prior to and during infection helps the body survive and recover when infection occurs. In an era increasingly shaped by misinformation, Bangladesh must continue to rely not on rumour or fear, but on science to protect its children.

Dr Nafsoon Rahman is assistant professor in the Department of Biochemistry and Molecular Biology at Jagannath University in Dhaka.

Views expressed in this article are the author's own. 

Follow The Daily Star Opinion on Facebook for the latest opinions, commentaries, and analyses by experts and professionals. To contribute your article or letter to The Daily Star Opinion, see our guidelines for submission.