Measles Treatment Recommendations
The recommended treatment for measles includes vitamin A supplementation (100,000 IU orally for children under 12 months and 200,000 IU for children over 12 months on days 1 and 2), supportive care, and management of complications. 1
Primary Treatment Approach
Vitamin A Supplementation
- Dosing regimen:
- Children < 12 months: 100,000 IU orally on days 1 and 2
- Children ≥ 12 months: 200,000 IU orally on days 1 and 2
- Children with eye symptoms of vitamin A deficiency: 200,000 IU on days 1 and 2, and again 1-4 weeks later (half doses for children < 12 months) 1
Supportive Care
- Fever management with antipyretics
- Adequate hydration and nutrition
- Oral rehydration therapy for moderate to severe dehydration due to diarrhea 1
- Nutritional support and monitoring 1
Management of Complications
- Bacterial infections: Antibiotics for secondary bacterial infections such as pneumonia and acute lower respiratory infections 1
- Neurological complications: Monitor for and manage acute disseminated encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis 2
Evidence for Vitamin A Treatment
The recommendation for vitamin A supplementation is strongly supported by evidence showing significant reduction in mortality risk. Two doses of 200,000 IU of vitamin A are associated with a 64% reduction in mortality risk compared to placebo (RR=0.36; 95% CI 0.14 to 0.82) 3. The effect is even more pronounced in children under two years of age, with an 82% reduction in mortality risk (RR=0.18; 95% CI 0.03 to 0.61) 3.
Infection Control Measures
- Isolate infected individuals for at least 4 days after rash onset 1
- In healthcare settings:
- Place patients in airborne-infection isolation rooms or private rooms with doors closed
- Healthcare workers should use N95 respirators when entering the room 1
Post-Exposure Prophylaxis
For exposed susceptible individuals:
- MMR vaccine: Administer within 72 hours of exposure to provide some protection 1
- Immune Globulin (IG): Can prevent or modify measles if administered within 6 days of exposure
- Standard dose: 0.25 mL/kg (maximum 15 mL)
- Immunocompromised persons: 0.5 mL/kg (maximum 15 mL) 1
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: Should be prioritized for treatment and vaccination 1
- Pregnant women: Require close monitoring due to increased risk of complications 1
Common Pitfalls and Caveats
- There is no specific antiviral therapy for measles treatment 2
- A single dose of vitamin A appears less effective than the two-dose regimen 3
- Delaying vitamin A administration may reduce its effectiveness in preventing complications
- Failure to report cases to public health authorities can hamper outbreak control efforts 1
- Inadequate isolation of infected individuals can lead to further transmission, especially in healthcare settings
The treatment of measles focuses primarily on supportive care and prevention of complications, with vitamin A supplementation being the most evidence-based specific intervention to reduce mortality and morbidity, particularly in children under two years of age.