Treatment for Measles
The primary treatment for measles consists of vitamin A supplementation (200,000 IU orally on days 1 and 2 for children over 12 months, 100,000 IU for children under 12 months), supportive care including oral rehydration therapy, and antibiotics for secondary bacterial infections. 1
Diagnosis and Identification
Before initiating treatment, confirm measles diagnosis through:
- Clinical presentation: Fever ≥38.3°C, generalized rash lasting ≥3 days, and at least one of: cough, coryza (runny nose), or conjunctivitis 1
- Laboratory confirmation: Positive measles IgM antibody test, significant rise in measles antibody level, isolation of measles virus, or detection of measles virus RNA by PCR 1
- Specimen collection: Blood (for IgM testing), urine or nasopharyngeal specimens (for virus isolation) 1
Important: Report suspected cases to local health authorities immediately. IgM may not be detectable until 72 hours after rash onset, so repeat testing may be necessary if initial results are negative 1
Treatment Protocol
1. Vitamin A Supplementation
Administer vitamin A immediately according to the following dosage:
- Children >12 months: 200,000 IU orally on days 1 and 2
- Children <12 months: 100,000 IU orally on days 1 and 2 1
2. Supportive Care
- Hydration: Provide oral rehydration therapy for moderate to severe dehydration due to diarrhea 1
- Fever management: Use antipyretics as needed
- Nutritional support: Essential component of measles management, particularly important for undernourished children 1
3. Management of Complications
- Respiratory infections: Administer antibiotics for secondary bacterial infections such as pneumonia and acute lower respiratory infections 1
- Otitis media: Treat with appropriate antibiotics
- Neurological complications: Monitor for signs of encephalitis and provide supportive care
- Supplemental oxygen: Provide as needed for respiratory distress 1
Special Populations Requiring Enhanced Management
High-Risk Individuals
- Infants and young children: More aggressive monitoring and supportive care
- Pregnant women: Require close monitoring due to increased risk of complications
- Immunocompromised patients: Need more intensive supportive care as illness may be prolonged and severe 1
- Undernourished children: Require additional nutritional support 1
Post-Exposure Prophylaxis
For exposed, susceptible individuals:
- MMR vaccine: Administer within 72 hours of exposure to provide some protection (appropriate for most persons ≥12 months and susceptible persons ≥6 months who are household contacts) 1
- Immune Globulin (IG): Can prevent or modify measles if administered within 6 days of exposure
- Standard dose: 0.25 mL/kg body weight (maximum 15 mL)
- Immunocompromised persons: 0.5 mL/kg (maximum 15 mL) 1
Infection Control Measures
- Isolation: Isolate infected individuals for at least 4 days after rash onset 1
- Healthcare setting: Place patients in an airborne-infection isolation room or private room with door closed 1
- Personal protective equipment: Healthcare workers should use N95 respirators or equivalent when entering the room 1, 2
- Contact management: Unvaccinated contacts should be excluded from outbreak settings for 21 days after the last case 1
Common Pitfalls to Avoid
- Delayed vitamin A administration: Vitamin A should be given immediately upon diagnosis, not delayed
- Underestimating contagiousness: Patients are contagious from approximately 4 days before rash onset until 4 days after rash appearance 1
- Failure to report: Not reporting cases to public health authorities delays containment efforts
- Inadequate isolation: Proper airborne precautions are essential to prevent spread
- Missing complications: Regular monitoring for common complications (pneumonia, otitis media, diarrhea, encephalitis) is crucial 1, 3
While there is no specific antiviral therapy for measles 3, prompt implementation of the above treatment protocol can significantly reduce morbidity and mortality, particularly in high-risk populations.