Management of Measles in a Recently Diagnosed Patient
Supportive care is the primary treatment for measles, focusing on symptom management, preventing complications, and limiting disease spread through isolation.
Clinical Management of Measles
Supportive Care
- Ensure adequate rest and hydration
- Antipyretics for fever management (acetaminophen or ibuprofen)
- Humidified air for cough and respiratory symptoms
- Adequate nutrition support
- Vitamin A supplementation for all children with measles 1:
- 200,000 IU orally for children over 12 months
- 100,000 IU orally for children under 12 months
- Second dose on day 2 for complicated measles cases
- Additional dose 1-4 weeks later for children with vitamin A deficiency symptoms
Complication Management
- Monitor for and promptly treat complications 1, 2:
- Pneumonia: appropriate antibiotics for bacterial superinfection
- Otitis media: antibiotics if bacterial
- Diarrhea: oral rehydration therapy
- Neurological complications: supportive care and close monitoring
Isolation Precautions
- Implement airborne isolation until 4 days after rash onset
- Advise patient to avoid contact with:
- Pregnant women
- Infants under 12 months
- Immunocompromised individuals
- Unvaccinated individuals
Special Considerations
Immunocompromised Patients
- Immunocompromised patients require more intensive monitoring 1
- Consider immune globulin for severely immunosuppressed patients exposed to measles 1
- Dose: 0.5 mL/kg body weight intramuscularly (maximum 15 mL) for immunocompromised patients 1
Nutritional Support
- All children with measles should have nutritional status monitored 1
- Enroll in feeding program if indicated
- Undernutrition is not a contraindication for vaccination but rather a strong indication 1
Prevention of Spread
Household Contacts
- Vaccinate susceptible household contacts if within 72 hours of exposure 1
- For those who cannot receive vaccine (immunocompromised, pregnant):
- Consider immune globulin within 6 days of exposure
- Dose: 0.25 mL/kg body weight (maximum 15 mL) 1
Public Health Notification
- Report all suspected measles cases immediately to local health department 1
- Assist with contact tracing efforts
Patient Education
- Explain the typical course of illness (7-10 days)
- Emphasize importance of isolation during contagious period
- Discuss warning signs requiring immediate medical attention:
- Difficulty breathing
- Persistent high fever
- Severe headache
- Altered mental status
- Severe dehydration
Important Considerations
- Measles can cause immune amnesia, eliminating 11-73% of preexisting antibody repertoire, increasing vulnerability to other infections 3
- Complications occur in 10-40% of patients 2
- Recent resurgence in measles cases highlights importance of vaccination 4, 5
- Measles remains a significant cause of mortality worldwide, with over 100,000 deaths annually 3
Remember that prompt management and appropriate isolation are essential to prevent complications and limit disease spread.