What is the treatment approach for measles?

Treatment Approach for Measles

Measles treatment is primarily supportive care, with vitamin A supplementation being essential for all cases, especially in children with complicated measles who should receive 200,000 IU on day 1 and day 2 (100,000 IU for children under 12 months). 1

Supportive Care

• Monitor and correct dehydration and nutritional deficiencies 2
• Provide antipyretics for fever management 3
• Ensure adequate rest and hydration 4

Vitamin A Supplementation

• For all children with clinical measles:
  • Children ≥12 months: 200,000 IU vitamin A orally on day 1 1
  • Children <12 months: 100,000 IU vitamin A orally on day 1 1, 5
• For children with complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems):
  • Add a second dose of vitamin A on day 2 (same dosage as day 1) 1
• For children with eye symptoms of vitamin A deficiency:
  • 200,000 IU oral vitamin A on day 1 1, 5
  • 200,000 IU oral vitamin A on day 2 1, 5
  • 200,000 IU oral vitamin A 1-4 weeks later 1, 5
  • Children <12 months receive half doses (100,000 IU) 1, 5

Management of Complications

• Treat secondary bacterial infections with appropriate antibiotics 1, 2
• For diarrhea: oral rehydration therapy 1
• For acute lower respiratory infections: standard antibiotic treatment 1
• Monitor nutritional status and enroll in feeding program if indicated 1

Special Populations

Immunocompromised Patients

• Immunocompromised patients (HIV, leukemia, lymphoma) may have more severe disease with higher mortality rates 6
• Absence of rash is common in immunocompromised patients (approximately 30%) 6
• Consider hospitalization for close monitoring 6
• Some evidence suggests ribavirin may be beneficial, though further study is needed 6

Post-Exposure Prophylaxis

• For persons with contraindications to measles vaccination requiring immediate protection:
  • Administer immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1
  • For immunocompromised persons: 0.5 mL/kg body weight (maximum 15 mL) 1
• Measles vaccine may provide protection if administered within 3 days of exposure 1

Infection Control Measures

• Immediate notification of local health department for suspected measles cases 7
• Laboratory confirmation through serum measles IgM antibody testing 7
• Special precautions for healthcare workers include N-95 masks and patient isolation in airborne infection isolation rooms 3
• Isolation of patients with measles is not indicated in emergency camp settings 1

Diagnostic Confirmation

• Collect serum for measles IgM antibody testing during first clinical encounter 1
• If IgM testing is negative within first 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1
• Consider molecular characterization of measles virus from urine or nasopharyngeal specimens 1

Common Pitfalls and Caveats

• Measles can be mistaken for other viral exanthems; laboratory confirmation is essential 7
• Absence of rash in immunocompromised patients may lead to missed diagnosis 6
• Vitamin A deficiency increases severity and mortality of measles; supplementation is critical 1, 5
• Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination 1