What is the treatment for measles?

Treatment for Measles

The treatment for measles is primarily supportive care, with vitamin A supplementation recommended for all children with clinical measles (200,000 IU orally for children ≥12 months, 100,000 IU for children <12 months), with a second dose on day 2 for complicated cases. 1

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis through:

• Clinical presentation: Fever ≥38.3°C (≥101°F), generalized rash lasting ≥3 days, and at least one of: cough, coryza (runny nose), or conjunctivitis 1
• Laboratory confirmation: Measles IgM antibody testing, viral isolation, or PCR testing 2

Treatment Algorithm

Step 1: Supportive Care

• Antipyretics for fever control
• Adequate hydration and nutrition
• Rest and isolation to prevent transmission
• Oral rehydration therapy for patients with diarrhea and dehydration 1

Step 2: Vitamin A Supplementation

• All children with clinical measles should receive vitamin A 1:
  • Age <6 months: 50,000 IU
  • Age 6-11 months: 100,000 IU
  • Age ≥12 months: 200,000 IU
• Second dose should be given the next day for complicated cases
• Third dose 2-4 weeks later if clinical signs of vitamin A deficiency exist

Step 3: Management of Complications

• Secondary bacterial infections: Treat with appropriate antibiotics based on suspected site of infection 1
• Pneumonia: Empiric antibiotics covering common respiratory pathogens
• Encephalitis: Supportive care, anticonvulsants if seizures occur
• Severe dehydration: IV fluid replacement

Step 4: Special Population Considerations

• Immunocompromised patients: More aggressive supportive care; consider immune globulin (0.5 mL/kg IM, maximum 15 mL) 2
• Pregnant women: Close monitoring due to increased risk of complications 1
• Malnourished children: Additional nutritional support alongside vitamin A

Prevention in Exposed Individuals

For unvaccinated individuals exposed to measles:

• MMR vaccine within 72 hours of exposure may provide protection 1
• Immune globulin (0.25 mL/kg IM, maximum 15 mL) for those who cannot receive the vaccine, if given within 6 days of exposure 2, 1
• For immunocompromised patients: higher dose immune globulin (0.5 mL/kg IM, maximum 15 mL) 2

Public Health Measures

• Immediate case reporting to local health authorities 2, 1
• Isolation of infected individuals for 4 days after rash onset 1
• Exclusion of unvaccinated contacts from outbreak settings for 21 days after the last case 1

Common Pitfalls and Caveats

1. Delayed vitamin A administration: Vitamin A should be given promptly as it reduces mortality and morbidity, especially in children 1

2. Failure to recognize complications: Monitor closely for pneumonia, encephalitis, and secondary bacterial infections which require specific interventions 3

3. Inadequate isolation: Measles is highly contagious from 4 days before to 4 days after rash onset; proper airborne precautions are essential 1, 4

4. Overlooking vulnerable populations: Pregnant women, immunocompromised patients, and young children require more aggressive management and monitoring 1

5. Antibiotic overuse: Antibiotics should only be used for confirmed or strongly suspected bacterial superinfections, not routinely for all measles cases 1

The treatment approach focuses on supportive care while preventing complications that could lead to increased morbidity and mortality. Vitamin A supplementation is a cornerstone of treatment, particularly in children, as it has been shown to reduce mortality and complication rates.