Integrated case management reduces disease severity

Measles remains a leading cause of childhood morbidity and mortality in developing countries, with fatality rates in hospitalised children often exceeding 10%.1 Most deaths follow complications such as pneumonia, croup, and diarrhoea and are often associated with malnutrition. Reducing the severity of disease through appropriate management should thus be a priority. What is surprising and rather disturbing, however, is the lack of published scientific information on issues that are central to developing a sound basis for managing measles. A recent review of clinical problems associated with measles has highlighted the paucity of data on risk factors, aetiology, natural course, and management (except vitamin A) of the common complications of measles.2 The problems with prophylactic antibiotic trials are discussed by Shann in this week's BMJ.3

Nevertheless, on the basis of the available data, the World Health Organisation's Expanded Programme on Immunisation has developed a policy document on integrated management of measles to help health workers in developing countries to reduce the severity of measles.4 The basic principles are outlined in the box.