This guideline replaces previous recommendations on vitamin A supplementation for the prevention of vitamin A deficiency, xerophthalmia and nutritional blindness in infants and children 6–59 months of age (8).

The above recommendation can also be applied in populations where infants and children may be infected with HIV.

The magnitude of the effect may differ across settings and populations, possibly due to the extent of vitamin A deficiency or the availability of other nutrients (e.g. dietary intake of vitamin A will differ across locations and the effects of supplementation may be smaller in places with greater access to vitamin A-rich foods or with regular consumption of vitamin A-fortified foods).

This intervention should be used along with other strategies to improve vitamin A intakes, such as dietary diversification (21) and food fortification (22).

Adverse effects within 48 hours of receiving supplements containing 100 000–200 000 IU vitamin A are usually mild and transient, with no long-term consequences. Adverse effects may include bulging of open fontanelles in younger infants, and nausea and/or vomiting and headache in older children with closed fontanelles.

Vitamin A supplements should be delivered to children 6–59 months of age twice yearly, during health system contacts. This should be marked on the child health card, or integrated into other public health programmes aimed at improving child survival, such as polio or measles national immunization days, or biannual child health days delivering a package of interventions such as deworming, distribution of insecticide-treated mosquito nets and immunizations.

A quality assurance process should be established to guarantee that supplements are manufactured, packaged and stored in a controlled and uncontaminated environment (23).

When determining the vitamin A status of a population, guidelines on indicators for assessing vitamin A deficiency should be referred to (24, 25).

Recommendations for the treatment of xerophthalmia and the use of vitamin A supplements during episodes of measles are not covered in this guideline. Existing guidelines on the treatment of xerophthalmia and measles in infants and children 6–59 months of age should be referred to in these cases (8, 26).