What is the treatment for measles?

Treatment for Measles

Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all children, management of complications with antibiotics for secondary bacterial infections, and post-exposure prophylaxis with immune globulin or vaccine for susceptible exposed individuals. 1

Vitamin A Supplementation (Critical Component)

All children with clinical measles must receive vitamin A supplementation, as vitamin A deficiency significantly increases measles severity and mortality 1:

• Children ≥12 months: 200,000 IU orally on day 1 1
• Children <12 months: 100,000 IU orally on day 1 1
• Complicated measles: Administer a second dose on day 2 at the same dosage 1

This recommendation applies regardless of nutritional status, as vitamin A deficiency is a major contributor to measles-related morbidity and mortality 1.

Supportive Care

The mainstay of measles management involves symptomatic treatment 2:

• Hydration: Maintain adequate fluid intake; use oral rehydration therapy for diarrhea 1
• Fever management: Acetaminophen or NSAIDs for fever control 3
• Nutritional monitoring: Assess nutritional status and enroll in feeding programs if indicated 1
• Respiratory support: Monitor for acute respiratory complications and provide supportive care as needed 2

Management of Complications

Complications occur in 10-40% of measles cases and require specific interventions 4:

• Secondary bacterial infections: Treat with appropriate antibiotics (common complications include otitis media, pneumonia, and laryngotracheobronchitis) 1, 2
• Acute lower respiratory infections: Use standard antibiotic treatment protocols 1
• Diarrhea: Implement oral rehydration therapy 1
• Pneumonia: This is the most common cause of measles-related death and requires aggressive antibiotic therapy 5, 2

Important caveat: There is no specific antiviral therapy approved for measles treatment, though ribavirin has been used in severe cases in immunocompromised patients 6, 2.

Post-Exposure Prophylaxis

For susceptible individuals exposed to measles, intervention depends on timing and patient characteristics 1:

Measles Vaccine (Preferred if eligible)

• Administer within 3 days of exposure for potential protection 1
• Can be given to susceptible individuals without contraindications 6

Immune Globulin (IG)

For persons with contraindications to vaccination requiring immediate protection 1:

• Standard dose: 0.25 mL/kg body weight (maximum 15 mL) intramuscularly as soon as possible after exposure 1
• Immunocompromised patients: 0.5 mL/kg body weight (maximum 15 mL) 1
• Infants <12 months exposed to household cases: IG may be preferred due to higher complication risk 7

Diagnostic Confirmation

Proper laboratory confirmation is essential for case management and public health reporting 1:

• Collect serum for measles IgM antibody testing during the first clinical encounter 1
• Timing is critical: IgM may not be detectable in the first 72 hours after rash onset 7
• If initial IgM is negative within 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1
• Consider molecular characterization: Collect urine or nasopharyngeal specimens for viral isolation and genetic characterization, ideally as close to rash onset as possible 1

Infection Control Measures

Healthcare settings require strict precautions to prevent nosocomial transmission 6:

• Airborne precautions: Use N-95 respirators and place patients in airborne infection isolation rooms 6
• Isolation duration: Maintain precautions until 4 days after rash onset 7
• Healthcare worker management: Susceptible exposed workers should be excluded from patient contact from day 5 to day 21 after exposure 7

Special Populations Requiring Aggressive Management

Certain patient groups warrant heightened vigilance and more intensive treatment 6:

• Pregnant women: Higher risk of complications including pneumonia and preterm labor 6
• Immunocompromised patients: Increased risk of severe disease and prolonged viral shedding; consider higher-dose IG for post-exposure prophylaxis 1, 6
• Infants <12 months: Higher complication rates, particularly acute respiratory failure (20% in one case series) 5

Critical Pitfalls to Avoid

• Do not delay vitamin A supplementation: This is a critical, evidence-based intervention that reduces mortality 1
• Do not assume vaccination status equals immunity: Even vaccinated individuals can develop modified measles, though typically milder 2
• Do not wait for laboratory confirmation to implement infection control: Initiate airborne precautions immediately upon clinical suspicion 6
• Undernutrition is NOT a contraindication to vaccination: It should be considered a strong indication for vaccination in outbreak settings 1