What are the treatment approaches for mild, moderate, and severe measles?

Treatment of Measles by Severity

All children with clinical measles should receive vitamin A supplementation immediately, with dosing based on age and severity, and treatment is primarily supportive with aggressive management of complications using antibiotics for secondary bacterial infections and oral rehydration therapy for diarrhea. 1, 2

Mild Measles (Uncomplicated Disease)

Vitamin A Supplementation - Essential for All Cases

• Administer 200,000 IU vitamin A orally on day 1 for children ≥12 months of age 1, 2
• Administer 100,000 IU vitamin A orally on day 1 for children <12 months of age 1, 2
• This single dose should be given even if the child received vitamin A within the previous month 1
• Repeat vitamin A every 3 months as part of routine supplementation schedule 1

Supportive Care

• Monitor nutritional status and enroll in feeding programs if indicated 1, 2
• Provide symptomatic treatment for fever, cough, and discomfort 3
• Ensure adequate hydration 3
• No specific antiviral therapy is available or recommended 3

Moderate Measles (With Complications)

Vitamin A - Intensified Dosing

• Give the same initial dose as mild disease (200,000 IU for ≥12 months; 100,000 IU for <12 months) on day 1 1, 2
• Administer a second identical dose of vitamin A on day 2 1, 2
• Complications warranting this approach include: pneumonia, otitis media, croup, or diarrhea with moderate dehydration 1

Complication-Specific Treatment

• For acute lower respiratory infection (pneumonia): administer standard antibiotic treatment 1, 2
• For diarrhea: provide oral rehydration therapy (ORT) 1, 2
• For otitis media: treat with appropriate antibiotics 1
• Monitor closely for progression to severe disease 3

Severe Measles (Life-Threatening Complications)

Vitamin A - Maximum Dosing Protocol

• Administer 200,000 IU vitamin A orally on day 1 (100,000 IU if <12 months) 1, 2
• Give second dose of 200,000 IU on day 2 (100,000 IU if <12 months) 1, 2
• Severe complications include: severe dehydration, neurological problems (encephalitis, acute disseminated encephalomyelitis), or signs of vitamin A deficiency 1, 3

Eye Complications from Vitamin A Deficiency

If xerosis, Bitot's spots, keratomalacia, or corneal ulceration are present:

• 200,000 IU oral vitamin A on day 1 1
• 200,000 IU oral vitamin A on day 2 1
• 200,000 IU oral vitamin A 1-4 weeks later 1
• Children <12 months receive half these doses 1

Aggressive Management of Complications

• Treat secondary bacterial infections (pneumonia, sepsis) with appropriate broad-spectrum antibiotics 1, 2
• For severe diarrhea with dehydration: aggressive rehydration with ORT or intravenous fluids 1, 2
• For encephalitis: provide intensive supportive care with monitoring for increased intracranial pressure 3
• Hospitalization is typically required for severe cases 3

Special Populations

Immunocompromised Patients

• Measles is particularly severe in immunocompromised hosts, with complications occurring in approximately 80% and high mortality rates (40-70%) 4
• Rash may be absent in approximately 30% of immunocompromised patients—do not rule out measles based on absence of rash 4
• Treatment remains supportive with vitamin A supplementation 2
• While ribavirin has been used in some cases with rapid defervescence, it requires further study and is not standard of care 4

Post-Exposure Prophylaxis (Prevention of Severe Disease)

• For unvaccinated persons exposed to measles: administer measles vaccine within 3 days of exposure for possible protection or disease modification 1, 2
• For persons with contraindications to vaccination: administer immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 2
• For immunocompromised persons: administer IG 0.5 mL/kg body weight (maximum 15 mL) 2

Critical Pitfalls to Avoid

• Never withhold vitamin A supplementation—it is critical for reducing severity and mortality, particularly in malnourished children 2, 5
• Undernutrition is NOT a contraindication to measles vaccination; it should be considered a strong indication 1, 2
• Fever, respiratory tract infection, and diarrhea are NOT contraindications to measles vaccination 1
• Do not rely on presence of rash to diagnose measles in immunocompromised patients—approximately 30% may have no rash 4
• Isolation of patients is not indicated in emergency settings, but standard infection control precautions should be maintained in healthcare facilities 1