What is the effect of zinc supplementation in the treatment of children with measles?
Measles infection has reduced globally over the last decade, but large outbreaks still occur, especially in low-income countries. Zinc is one of the essential micronutrients necessary for the optimal functioning of the immune system. Zinc deficiency is particularly common in children in low- and middle-income countries. It was therefore important to examine the potential role of zinc supplementation in controlling the symptoms of measles infection in children.
We aimed to critically assess the current evidence from published studies on the effect of zinc supplementation for the treatment of measles in children.
We searched for evidence up to 03 February 2017. This is an update of a review first published in 2015. We did not include any new studies for this update.
We found one small randomised trial (involving 85 children) that compared zinc supplements versus placebo administered to children with measles and pneumonia. All 85 children received supportive care and vitamin A. The study was conducted in India and funded by the Child Health Foundation USA and the Nestlé Foundation.
The included study was small and did not provide enough data to determine whether zinc had an effect on mortality when compared with placebo. Although no adverse effects were reported, there was insufficient evidence to draw any conclusions about the use of zinc supplements to improve measles symptoms in children. More research is needed to clarify any benefits or harms.
Quality of the evidence
We assessed the quality of the evidence as very low.
We could not draw any definitive conclusions from this review about the effects of zinc supplementation on clinical outcomes of children with measles due to the very low quality of the evidence available. There is insufficient evidence to confirm or refute the effect of zinc supplementation in children with measles.
Measles is an important cause of childhood morbidity and mortality globally, despite increasing vaccine coverage. Zinc plays a significant role in the maintenance of normal immunological functions, therefore supplements given to zinc-deficient children will increase the availability of zinc and could reduce measles-related morbidity and mortality. This is an update of a review first published in 2015.
To assess the effects of zinc supplementation in reducing morbidity and mortality in children with measles.
We searched CENTRAL (03 February 2017, Issue 2), MEDLINE (1946 to 03 February 2017), Embase (1974 to 03 February 2017), CINAHL (1981 to 03 February 2017), LILACS (1982 to 03 February 2017), Web of Science (1985 to 03 February 2017), and BIOSIS Previews (1985 to 27 June 2014). We also searched ClinicalTrials.gov, the Australian New Zealand Clinical Trials Registry and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 03 February 2017 to identify unpublished and ongoing studies.
Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of zinc in reducing morbidity and mortality in children with measles.
Two review authors independently assessed the studies for inclusion and extracted data on outcomes, details of the interventions, and other study characteristics using a standardised data extraction form. We used risk ratio (RR) and hazard ratio (HR) as measures of effect with 95% confidence intervals (CI). We included only one study, and did not conduct meta-analysis.
We did not identify any new studies for inclusion in this update. One RCT met our inclusion criteria. The study was conducted in India and included 85 children diagnosed with measles and pneumonia. The trial showed no significant difference in mortality between children with measles and pneumonia who received zinc supplements and those who received placebo (RR 0.34, 95% CI 0.01 to 8.14). There was no significant difference in time to absence of fever between children who received zinc supplements and those who did not (HR 1.08, 95% CI 0.67 to 1.74). No treatment-related side effects were reported in either group. We assessed the overall quality of the evidence as very low.