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EDITORIALS: Neal A Halsey Measles in developing countries BMJ 2006; 333: 1234 [Full text]

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Measles in developing countries: Vitamin A and prophylactic antibiotics

May-Lill Garly, Carlitos Balé, Cesário L. Martins, Hilton C. Whittle, Jens Nielsen, Ida M. Lisse, Peter Aaby   (28 January 2007)

Measles in developing countries: Vitamin A and prophylactic antibiotics 28 January 2007
May-Lill Garly, Researcher Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, DENMARK, Carlitos Balé, Cesário L. Martins, Hilton C. Whittle, Jens Nielsen, Ida M. Lisse, Peter Aaby Send response to journal: Re: Measles in developing countries: Vitamin A and prophylactic antibiotics	EDITOR – In the editorial accompanying our paper on prophylactic antibiotics to prevent pneumonia in measles infection (1), Professor Halsey expressed that it was a limitation of the trial that we did not mention vitamin A therapy (2). Therefore, Halsey indicated that “further studies need to determine whether antibiotics provide additional benefits to children who do not have clinical pneumonia and who receive vitamin A at the time of measles diagnosis”. We agree that vitamin A therapy is an essential part of managing measles, and all subjects enrolled in the trial did receive vitamin A according to WHO recommendations. The protocol submitted to BMJ and the reviewers, states that “Vitamin A will be provided according to WHO recommendations”, and this was mentioned to trial participants in the consent form: “Your child will also receive tablets containing vitamin A”. We regret that this was not mentioned in the paper; in a paper discussing the management of measles a short mentioning of vitamin A would have been relevant. Hence, it should be clear that our study– as suggested by Professor Halsey - did assess whether antibiotics provide additional benefits to children who do not have clinical pneumonia and who receive vitamin A at the time of measles diagnosis. As stated in the paper we found that prophylactic antibiotics should be used in patients with measles, irrespective of vaccination status, in settings with a high risk of complications when the diagnosis of measles is quite certain, such as during epidemics (1). Whether additional trials are needed given our present knowledge will be for others to decide. References 1. Garly ML, Balé C, Martins CL, Whittle HC, Nielsen J; Lisse IM, Aaby P. Prophylactic antibiotics to prevent pneumonia and other complications after measles: community based randomised double blind placebo controlled trial in Guinea-Bissau. BMJ 2006;333:1245-7 2. Halsey NA. Measles in developing countries. Vitamin A and antibiotics to prevent complications, but vaccination remains the priority. BMJ 2006;333:1234 Competing interests: None declared