What is the recommended treatment for measles in adults?

Treatment of Measles in Adults

For adults with measles, treatment is primarily supportive care, with vitamin A supplementation recommended for severe cases, particularly those with evidence of vitamin A deficiency, immunocompromised status, or severe symptoms. 1

Diagnosis and Confirmation

• Clinical presentation typically includes:

  • Fever
  • Maculopapular rash
  • At least one of: cough, coryza (runny nose), or conjunctivitis 2
  • Pathognomonic Koplik spots (enanthem) may be present 3

• Laboratory confirmation via:

  • Serum measles-specific IgM antibodies
  • Four-fold increase in measles-specific IgG between acute and convalescent sera
  • Isolation of measles virus in culture
  • Detection of measles virus RNA by RT-PCR 3

Treatment Protocol

Supportive Care (First-line)

• Adequate hydration and antipyretics for fever
• Monitoring for and treatment of secondary bacterial infections with appropriate antibiotics 2
• Rehydration therapy for patients with severe diarrhea 2

Vitamin A Supplementation

• Recommended for adults with severe measles, particularly those with:
  • Evidence of vitamin A deficiency
  • Immunocompromised status
  • Severe symptoms or complications 1
• Dosing: 200,000 IU per day for two days (based on WHO recommendations for children) 4
• Benefits: Two doses of vitamin A have been shown to reduce mortality risk and pneumonia-specific mortality in children 4

Special Populations

Immunocompromised Patients

• Higher risk of severe disease and complications
• Consider IVIG (intravenous immunoglobulin) administration 1

Pregnant Women

• Higher risk of complications including premature labor and low birth weight
• Require close monitoring 1

Post-Exposure Prophylaxis

• For unvaccinated exposed individuals:
  • MMR vaccine within 72 hours of exposure may provide protection
  • IVIG may be considered for high-risk exposed individuals who cannot receive the vaccine 1

Infection Control Measures

• Airborne precautions:
  • N-95 respirator masks for healthcare workers
  • Patient isolation in airborne infection isolation room
  • Maintain isolation until 4 days after rash onset in normal hosts 1, 5

Monitoring for Complications

• Common complications (10-40% of patients) 3:

  • Respiratory: pneumonia, laryngotracheobronchitis (croup)
  • Otitis media
  • Diarrhea
  • Stomatitis

• Serious neurological complications (uncommon):

  • Acute disseminated encephalomyelitis
  • Measles inclusion body encephalitis
  • Subacute sclerosing panencephalitis 2

Prevention

• Primary prevention through vaccination:
  • Adults born in 1957 or later who lack evidence of immunity should receive at least one dose of MMR vaccine
  • Second dose recommended for high-risk adults including healthcare workers, international travelers, students in postsecondary educational institutions, and those in outbreak settings 1