CONCENTRATED VITAMIN A SOLUTION

Concentration of vitamin A in the solution
1,00,000 IU per mL

Which is the oil used
Arachis oil (peanut oil)

A total of how many doses are recommended.
Nine doses till 5 years of age.

The spoon supplied with the bottle has amarking inside. This indicates a volume of 1 mL.Completely filled spoon measures 2 mL.

Whether part of NIS?
Yes

Mention the dosage schedule under NIS.
1. First dose is 1 mL (1 lakh units) at 9 months of age. This is given along with the MR-1, PCV-Booster and JE-1(if applicable) which are also administered at the same age.
2. Second dose is 2 mL (2 lakh units) at 16-24 months of age. This is given along with DPT and OPV boosters, MR – 2 and JE – 2 (if applicable).
3. The 3rd, 4th, 5th, 6th, 7th, 8th, and 9th doses of 2 mL each at 6 monthly intervals beginning 6 months after the second dose

How many prophylactic doses of vitamin A should be given and till what age under the national program?
A total of nine prophylactic doses of vitamin A should be given till 5 years of age.

What should be the minimum gap between two doses of vitamin A and why?
The minimum gap between any two doses of vitamin A should be 6 months as the liver can store enough vitamin A for 6-9 months. Too frequent doses may lead to vitamin A toxicity.

How do we ensure that the health worker delivers the correct dose to the child?
Vitamin A syrup has to be administered using only the spoon which is provided with each bottle. The inner mark in the spoon indicates a volume of 1 mL which is equivalent to 1,00,000 IU and a level full spoon has a capacity of 2 mL which is equivalent to 2,00,000 IU of vitamin A.

Is the dose any different for those children who show clinical signs of vitamin A deficiency?
Administer 2,00,000 IU of vitamin A immediately after diagnosis, followed by another dose of 2,00,000 IU 1–4 weeks later.

Storage instructions
Vitamin A solution must be kept away from direct sunlight and should be used only till the expiry date printed on the bottle.

Mention natural sources of vitamin A.
• Eggs, liver, fish, and meat
• Dairy products such as milk, cheese, curd, and butter
• Fruit rich in vitamin A
- Papaya
- Mango
- Oranges
• Vegetables rich in vitamin A
- Green leafy vegetables such as spinach
- Carrots
- Pumpkin

Mention the richest natural source of vitamin A.
Fish liver oils

Mention the manifestations of vitamin A deficiency.
Ocular signs
• Night blindness (nyctalopia)
• Conjunctivalxerosis
• Bitot's spots
• Corneal xerosis
• Keratomalacia
Extraocular manifestations of vitamin A deficiency
• Follicular hyperkeratosis
• Anorexia
• Growth retardation
• Susceptibility to respiratory and intestinal infections

What is the aim of the oral vitamin A prophylaxis program?
The revised objective is to decrease the prevalence of vitamin A deficiency to below 0.5%.

What are the other strategies for achieving the reduction of vitamin A deficiency?
• Improving peoples' diet to ensure adequate intake of vitamin A rich food.
• Encourage early breastfeeding especially the colostrum which is rich in vitamin A.
• Controlling the frequency and severity of factors which contribute to vitamin A deficiency, such as measles, diarrhea, PEM, and respiratory tract infections.

References:
1. Park K. Nutrition and health. In: Park's Textbook of Preventive and Social Medicine, 24th ed. Jabalpur, India: M/S BanarasidasBhanot Publishers, 2017.

National Immunization Schedule in India; 2017: http://www.ihatepsm.com/blog/national-immunization-schedule-india-2017

Rotavirus vaccine: http://www.ihatepsm.com/blog/rotavirus-vaccine

Pentavalent vaccine: http://www.ihatepsm.com/blog/pentavalent-vaccine

BACILLE CALMETTE GUERIN (BCG) VACCINE: http://www.ihatepsm.com/blog/bacille-calmette-guerin-bcg-vaccine

IPV (INACTIVATED POLIOVIRUS VACCINE): http://www.ihatepsm.com/blog/ipv-inactivated-poliovirus-vaccine

DT & TT Vaccines: http://www.ihatepsm.com/blog/dpt-and-tt-vaccines

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Measles Containing Vaccines (MCV): http://www.ihatepsm.com/blog/measles-containing-vaccines-mcv

HEPATITIS B VACCINE: http://www.ihatepsm.com/blog/hepatitis-b-vaccine

JAPANESE ENCEPHALITIS (JE) VACCINE: http://www.ihatepsm.com/blog/japanese-encephalitis-je-vaccine

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