What is the treatment for measles (rubeola)?

From the Guidelines

Measles treatment should focus on supportive care, including rest, hydration, and management of symptoms, as well as vitamin A supplementation to reduce mortality and complication risks, as there is no specific antiviral therapy for the disease. The primary goal of treatment is to alleviate symptoms and prevent complications, such as pneumonia or encephalitis, which may require antibiotics or hospitalization. According to the study 1, children with measles complications should be administered standard treatment, e.g., ORT for diarrhea and antibiotics for acute lower respiratory infection (ALRI). However, the most recent and highest quality study 1 emphasizes the importance of prevention through vaccination, which is the main means for preventing measles, mumps, and rubella virus infections and their related complications.

Key Treatment Considerations

• Rest and hydration to manage symptoms
• Vitamin A supplementation to reduce mortality and complication risks, with dosing of 200,000 IU for children over 12 months, 100,000 IU for 6-12 months, and 50,000 IU for under 6 months, given once daily for two consecutive days
• Management of complications, such as pneumonia or encephalitis, with antibiotics or hospitalization as needed
• Isolation for four days after rash onset to prevent transmission

Prevention

• Vaccination is the most effective means of preventing measles, mumps, and rubella, with two doses of the MMR vaccine recommended for all individuals aged ≥12 months 1
• The use of PRIORIX, a newly approved MMR vaccine, is recommended as an option to prevent measles, mumps, and rubella, according to the existing recommended schedules and for off-label uses 1

From the Research

Treatment of Measles

• The World Health Organization (WHO) recommends administration of an oral dose of vitamin A (200,000 international units (IU), or 100,000 IU in infants) each day for two days to children with measles in areas where vitamin A deficiency may be present 2, 3, 4.
• Vitamin A therapy, commenced after measles has been diagnosed, is beneficial in preventing mortality, pneumonia and other secondary complications in children 2, 3, 4.
• Two doses of vitamin A (200,000 IU) on consecutive days were associated with a reduction in the risk of mortality in children under the age of two years (RR 0.18; 95% CI 0.03 to 0.61) and a reduction in the risk of pneumonia-specific mortality (RR 0.33; 95% CI 0.08 to 0.92) 2, 4.
• There was no evidence that vitamin A in a single dose was associated with a reduced risk of mortality among children with measles 2, 3, 4.
• Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhoea 5, 6.
• Treatment may consist of the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin, especially for patients who are pregnant, immunocompromised, or unvaccinated 6.

Complications of Measles

• Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea 5.
• Neurological complications are uncommon but serious, and can occur during or soon after the acute disease (eg, acute disseminated encephalomyelitis) or months or even years later (eg, measles inclusion body encephalitis and subacute sclerosing panencephalitis) 5.
• Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M 6.

Prevention of Measles

• Disease control largely depends on prevention, and the measles vaccine is a safe and effective way to prevent the disease 5, 6.
• Disrupted vaccination activities during the pandemic increase the potential for another resurgence of measles in the near future, and effective, timely catch-up vaccination campaigns, strong commitment and leadership, and sufficient resources will be required to mitigate this threat 5.