What is the treatment and management for measles?

Treatment and Management of Measles

The treatment of measles is primarily supportive, with additional interventions including vitamin A supplementation for children with severe disease, and immune globulin for high-risk individuals exposed to measles. 1, 2

Clinical Presentation and Diagnosis

• Measles typically presents with fever, generalized maculopapular rash lasting ≥3 days, temperature ≥38.3°C (≥101°F), and at least one of: cough, coryza (runny nose), or conjunctivitis 3
• Koplik spots (pathognomonic enanthem) may appear during the prodromal phase before the characteristic rash 4
• Patients are contagious from 4 days before rash onset to 4 days after rash appearance 3
• Laboratory confirmation is essential and can be achieved through:
  • Positive serologic test for measles IgM antibody
  • Significant rise in measles antibody level between acute and convalescent sera
  • Isolation of measles virus from clinical specimens
  • Detection of measles virus RNA by RT-PCR 3

Supportive Management

• The mainstay of measles treatment is supportive care, focusing on:
  • Fever management
  • Maintaining hydration
  • Respiratory support as needed
  • Monitoring for and treating complications 2

Specific Interventions

Vitamin A Supplementation

• Vitamin A supplementation is recommended for children with severe measles 5
• This intervention has been shown to reduce morbidity and mortality, particularly in malnourished children 2

Management of Secondary Infections

• Monitor for and treat secondary bacterial infections with appropriate antibiotics 4, 2
• Common complications requiring treatment include:
  • Otitis media
  • Pneumonia
  • Laryngotracheobronchitis
  • Diarrhea 2

Post-Exposure Prophylaxis

• For exposed susceptible individuals, especially high-risk groups:
  • MMR vaccine within 72 hours of exposure may provide protection 3
  • Immune globulin (IG) may be administered to high-risk individuals if given within 6 days of exposure 3
  • Infants <12 months who are household contacts of measles patients should receive passive immunization with IG 3
  • The recommended IG dose is 0.25 mL/kg body weight (maximum 15 mL) 3
  • For immunocompromised persons, a higher dose of 0.5 mL/kg body weight is recommended (maximum 15 mL) 3

Special Populations

Immunocompromised Patients

• Immunocompromised patients exposed to measles should receive IG regardless of vaccination status 3
• Higher doses of IG (0.5 mL/kg, maximum 15 mL) are recommended for these patients 3
• Patients receiving regular IGIV may be protected if exposure occurs within 3 weeks after administration 3

Healthcare Workers

• Healthcare workers with suspected measles should be excluded from work until ≥4 days following rash onset 3
• Healthcare workers without evidence of immunity who are exposed to measles should be offered MMR vaccine and excluded from work from day 5-21 following exposure 3

Infection Control Measures

• Immediate implementation of airborne infection control precautions is essential 3
• Patients with suspected measles should:
  • Wear a medical mask
  • Be placed in an airborne-infection isolation room (negative pressure) 3
  • If isolation room is unavailable, place in a private room with door closed 3
• Healthcare personnel should use N95 respirators or equivalent when caring for measles patients, regardless of immunity status 3

Public Health Measures

• All suspected or confirmed measles cases must be reported immediately to local or state health departments 3
• Prompt investigation and contact tracing are essential to prevent further transmission 3
• During outbreaks:
  • Susceptible contacts should be vaccinated or excluded from high-risk settings 3
  • Persons exempted from vaccination should be excluded until 21 days after the onset of rash in the last case 3
  • Mass revaccination of entire communities is generally not necessary 3

Prevention

• Vaccination remains the cornerstone of measles prevention and outbreak control 3
• Two doses of MMR vaccine provide long-lasting immunity for most individuals 3
• During outbreaks, revaccination may be recommended for certain groups 3

Common Pitfalls and Caveats

• Delaying isolation of suspected cases can lead to healthcare-associated transmission 3
• Failure to recognize atypical presentations, especially in vaccinated individuals who may have milder symptoms 2
• Waiting for laboratory confirmation before implementing control measures can allow further spread 3
• Underestimating the high infectivity of measles (contagious 4 days before rash onset) 3