What is the recommended treatment for measles?

Treatment of Measles

The recommended treatment for measles includes vitamin A supplementation (200,000 IU orally on days 1 and 2 for children over 12 months and 100,000 IU for children under 12 months), supportive care, and management of complications. 1

Vitamin A Supplementation

Vitamin A supplementation is a cornerstone of measles treatment:

• Children under 12 months: 100,000 IU orally on days 1 and 2
• Children over 12 months: 200,000 IU orally on days 1 and 2 1, 2
• For children with eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), follow this schedule:
  • 200,000 IU oral vitamin A on day 1
  • 200,000 IU oral vitamin A on day 2
  • 200,000 IU oral vitamin A 1-4 weeks later (half doses for children less than 12 months) 2

Evidence shows that two doses of vitamin A are associated with a 64% reduction in mortality risk compared to placebo, with even greater benefit (82% reduction) in children under 2 years 3.

Supportive Care

• Fever management: Administer antipyretics as needed
• Hydration: Provide oral rehydration therapy for diarrhea with dehydration 1
• Nutrition: Monitor nutritional status and enroll in feeding programs if indicated 2

Management of Complications

• Respiratory infections: Administer antibiotics for secondary bacterial infections such as pneumonia and acute lower respiratory infections 2, 1
• Diarrhea: Provide oral rehydration therapy for moderate to severe dehydration 2, 1
• Otitis media: Treat with appropriate antibiotics if bacterial infection is suspected 1

Post-Exposure Prophylaxis

For exposed individuals:

1. Vaccine prophylaxis:

   • MMR vaccine administered within 72 hours of initial measles exposure may provide some protection 2, 1
   • Appropriate for most persons ≥12 months and susceptible persons ≥6 months who are household contacts 1

2. Immune Globulin (IG):

   • If administered within 6 days of exposure, IG can prevent or modify measles in non-immune persons 2
   • Standard dose: 0.25 mL/kg of body weight (maximum 15 mL)
   • For immunocompromised persons: 0.5 mL/kg of body weight (maximum 15 mL) 2, 1
   • Indicated for susceptible household contacts, particularly those at increased risk for complications (infants ≤12 months, pregnant women, immunocompromised persons) 2

Special Considerations for High-Risk Populations

• Immunocompromised patients: Require more aggressive supportive care and monitoring as illness may be prolonged and severe 1
• Undernourished children: Prioritize for vaccination; undernutrition is not a contraindication but rather a strong indication for vaccination 2
• HIV-infected patients: Should receive IG prophylaxis regardless of vaccination status if exposed to measles 2

Infection Control Measures

• Isolate patients for at least 4 days after rash onset
• Use airborne-infection isolation rooms when available
• Healthcare workers should use N95 respirators or equivalent when entering the room 1

Common Pitfalls to Avoid

1. Delaying vitamin A administration: Vitamin A should be given promptly as it significantly reduces mortality, especially with two doses.

2. Overlooking secondary bacterial infections: These are common complications and require prompt antibiotic treatment.

3. Inadequate isolation: Measles is highly contagious; failure to implement proper isolation measures can lead to outbreaks.

4. Neglecting nutritional support: Nutritional monitoring and support are essential components of measles management, especially in undernourished children.

5. Forgetting post-exposure prophylaxis: Timely administration of vaccine (within 72 hours) or IG (within 6 days) can prevent or modify disease in exposed individuals.