Treatment for Measles
The treatment for measles primarily consists of supportive care and vitamin A supplementation, with the Centers for Disease Control and Prevention recommending 200,000 IU of vitamin A orally on day 1 for children ≥12 months and 100,000 IU for children <12 months, with a second dose on day 2 for complicated cases. 1
Supportive Care Measures
- Provide adequate hydration, especially with oral rehydration therapy for patients experiencing diarrhea 1, 2
- Manage fever with appropriate antipyretics 2
- Ensure adequate nutrition and monitor nutritional status 1
- Treat secondary bacterial infections, particularly pneumonia, with appropriate antibiotics 1, 2
- Monitor for and manage complications affecting various organ systems 2
Vitamin A Supplementation
- For children <12 months: 100,000 IU orally on day 1 1, 3
- For children ≥12 months: 200,000 IU orally on day 1 1, 3
- For complicated measles: repeat the same dose on day 2 1, 3
- For patients with vitamin A deficiency eye symptoms: additional dose 1-4 weeks later 3
Management of Complications
- Pneumonia (most common cause of measles-related death): treat with appropriate antibiotics 4, 1
- Acute encephalitis (occurs in approximately 1 per 1,000 cases): provide supportive care 4, 3
- Diarrhea: administer oral rehydration therapy 1, 3
- Otitis media: treat with appropriate antibiotics if bacterial in origin 3
Special Considerations for High-Risk Populations
- Infants and young children: higher mortality risk, require close monitoring 4, 3
- Adults: experience higher complication rates 3
- Pregnant women: at risk for premature labor, spontaneous abortion, and low birth weight infants 4, 3
- Immunocompromised individuals: may develop severe, prolonged infection, sometimes without the typical rash 4, 3
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: administer 0.5 mL/kg body weight (maximum 15 mL) of IG 1
- Measles vaccine may provide protection if administered within 3 days of exposure 1, 3
Important Considerations and Pitfalls
- There is no specific antiviral therapy for measles that has been proven effective in routine clinical practice 2
- Vitamin A deficiency significantly increases the severity and mortality of measles; supplementation is critical even if deficiency is not confirmed 1, 5
- Undernutrition is not a contraindication for measles vaccination; it should be considered a strong indication for vaccination 1, 3
- Notify local or state health department immediately when suspected cases of measles occur to facilitate prompt outbreak control measures 6
- Implement appropriate isolation precautions, including airborne precautions with N-95 masks and patient isolation in an airborne infection isolation room 7
Diagnostic Confirmation
- Collect serum for measles IgM antibody testing during the first clinical encounter 1
- If IgM testing is negative within the first 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1, 6
- Consider molecular characterization of measles virus from urine or nasopharyngeal specimens 1, 6