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LETTERS: Keith P West, Jr and Alfred Sommer Vitamin A programme in Assam probably caused hysteria BMJ 2002; 324: 791a [Full text]

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Can Mass Hysteria Kill?

Prabir K Chatterjee   (29 March 2002)

Data calls for more Vitamin A campaigns, not less

Pradeep K Goel, DrPH, MSc, MPH, MBBS   (1 April 2002)

Vitamin A - real or unnatural substitute?

John P Heptonstall   (2 April 2002)

Vitamin A campaign as cause of Hysteria amongst the general population

Umesh Kapil   (23 February 2005)

Can Mass Hysteria Kill? 29 March 2002
Prabir K Chatterjee, Surveillance Medical Officer Godda-814133 India Send response to journal: Re: Can Mass Hysteria Kill?	While one accepts that Vitamin A may not have caused even one death in Assam, it is obvious that the public no longer accept the programme. Even the doctor-professor who heads the Union Ministry was not willing to stand up for the huge mass Vitamin A administration campaign. There were deaths. Was any investigating team able to state what caused the deaths? No child death is "natural" surely. The question that goes begging an answer is: If there are so many deaths in a few days, shouldn't the donors and the government be addressing the current causes of death. public health programmes can be piggy backed on a good health service. But should a lot of money be spent in forcing Hospital Staff to leave their curative work?
Data calls for more Vitamin A campaigns, not less 1 April 2002
Pradeep K Goel, DrPH, MSc, MPH, MBBS, Regional Technical Advisor, Public Health CRS/India 5 Community Center, Zamrudpur New Delhi, 110048, India Send response to journal: Re: Data calls for more Vitamin A campaigns, not less	Dear Editor: The controversy surrounding special campaigns for administering Vitamin A is the most unfortunate for public health programs in India.[1]While the reported deaths of fourteen children among 2.5 million preschool children who benefited from one such campaign in Assam is unfortunate, statistics point to the need for more such campaigns, not less. Critics state that green leafy vegetables could be more effective.[2] However, only 10.7 to 55.6% of children between 10-35 months of age receive them. Malnutrition rates in children under three are high, 47% under age 3 overall and about 50% in rural areas where most of such children still live.[3] It is hard to imagine that this substantially large group of malnourished children receive adequate amounts of Vitamin A through their regular diets. While coverage of children with Vitamin A through routine immunization channels would be ideal, national statistics on routine immunization coverage itself leave much to be desired. Only half of the children aged 12-23 months received a dose of measles; in Assam, only one- quarter of such children received a dose of measles.[3] Should we then leave Vitamin A coverage at the mercy of routine immunization channels? I totally agree with the Union Health Ministry that Vitamin A should be treated as a drug because its administration does need medical supervision and health worker training. I also believe that parents of fourteen such unfortunate children and those entrusted with the health of the populations need answers as to what caused their demise. However, we should not withhold from millions of other children a relatively safe and effective public health intervention. 1. West Jr KP, Sommer A. Vitamin A programme in Assam probably caused hysteria. BMJ 2002; 324:791 (30 March). 2. Nutrition expert C. Gopalan cited in: Vitamin A norms violated, say officials. Times of India, November 19, 2001 3. International Institute for Population Sciences (IIPS) and ORC Macro. 2000. National Family Health Survey (NFHS-2), 1998-99: India. Mumbai: IPPS.
Vitamin A - real or unnatural substitute? 2 April 2002
John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG Send response to journal: Re: Vitamin A - real or unnatural substitute?	Sir It is not clear from the article whether the children were dosed with real or synthetic Vitamin A. Surely cod liver oil would have been relatively harmless, it contains a synergism that is not found in doses of synthetic Vitamin A - or do drug companies favour synthetic against natural where children are concerned? I believe natural is safer, especially in this case with such young children, and the UK has generations of experience of youngsters and cod liver oil. Regards John H.
Vitamin A campaign as cause of Hysteria amongst the general population 23 February 2005
Umesh Kapil, Professor, Human Nutrition Unit All India Institute of Medical Sciences, New delhi, India Send response to journal: Re: Vitamin A campaign as cause of Hysteria amongst the general population	Dear Sir If Vitamin A campaign can cause hysteria amongst general population in developing countries like India, as mentioned by the authors, then by all means we should avoid any such public health intervention as it would disrupt the implementation of the routine primary health care services which have been documented to be more beneficial than vertical supplementation of Vitamin A (like immunisation services). We must learn lessons from this episode and avoid VA campaigns. Competing interests: None declared