What is the treatment for measles?

Treatment of Measles

The treatment for measles is primarily supportive care, with vitamin A supplementation recommended for children with severe measles to reduce morbidity and mortality. 1, 2

Clinical Presentation and Diagnosis

Measles presents with characteristic symptoms that should be recognized promptly:

• Prodromal phase with fever (≥38.3°C/101°F), cough, coryza (runny nose), and conjunctivitis 3
• Pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash 4
• Rash typically begins on the face and spreads cephalocaudally, becoming more confluent 4

Diagnosis is confirmed by:

• Positive serologic test for measles IgM antibody 3
• Significant rise in measles antibody levels between acute and convalescent sera 3
• Isolation of measles virus from a clinical specimen 3
• Detection of measles virus RNA by RT-PCR 4

Treatment Approach

Supportive Care

• Maintain adequate hydration and nutrition 1
• Antipyretics for fever management 1
• Rest and isolation to prevent transmission 1

Specific Interventions

1. Vitamin A Supplementation:

   • Recommended for children with severe measles 2
   • Reduces morbidity and mortality, particularly in malnourished children 2

2. Management of Complications:

   • Bacterial superinfections should be treated with appropriate antibiotics 4
   • Respiratory support for pneumonia if needed 1

3. Special Populations:

   • Immunocompromised Patients:

     • Require more aggressive management 1
     • May benefit from immune globulin (IG) administration 3
     • Recommended dose for immunocompromised persons: 0.5 mL/kg body weight IM (maximum 15 mL) 3

   • Unvaccinated Exposed Individuals:

     • MMR vaccine within 72 hours of exposure may provide protection 1
     • IG (0.25 mL/kg, maximum 15 mL) for those with contraindications to vaccination 3

Infection Control Measures

• Immediate isolation of suspected cases 3
• Airborne precautions with N-95 masks for healthcare workers 1
• Exclusion from school/daycare until 4 days after rash onset 3
• Prompt notification of local health department for any suspected case 3

Prevention

• Two doses of MMR vaccine provide the most effective prevention 2
• First dose at 12-15 months and second dose at 4-6 years in developed countries 4
• In countries with high transmission rates, WHO recommends first dose at 9 months and second dose at 15-18 months 4
• 95% vaccination coverage is required for herd immunity 2

Common Pitfalls to Avoid

• Delaying diagnosis and isolation, which can lead to outbreaks 3
• Failing to recognize atypical presentations in immunocompromised patients 1
• Underestimating the importance of vitamin A supplementation in severe cases 2
• Not reporting cases to public health authorities, which is mandatory 3

Special Considerations

• Measles can cause immune amnesia, leading to increased susceptibility to other infections for months after recovery 5
• Complications occur in 10-40% of patients and can include pneumonia, encephalitis, and secondary bacterial infections 4
• Recent outbreaks have primarily affected unvaccinated individuals (96% of cases in recent U.S. outbreaks) 6