What is the recommended treatment and prevention for measles?

Measles: Treatment and Prevention

Measles treatment is primarily supportive care with vitamin A supplementation for all children, while prevention relies on two-dose MMR vaccination and strict airborne isolation precautions. 1

Treatment of Active Measles

Vitamin A Supplementation (Critical for All Children)

• Administer vitamin A to all children with clinical measles on day 1: 200,000 IU orally for children ≥12 months and 100,000 IU orally for children <12 months 1
• For complicated measles, give a second dose on day 2 at the same dosage 1
• Vitamin A deficiency increases measles severity and mortality, making supplementation critical even in well-nourished populations 1

Supportive Care Measures

• Treat secondary bacterial infections with appropriate antibiotics when they occur (common complications include otitis media, pneumonia, and laryngotracheobronchitis) 1, 2
• Provide oral rehydration therapy for diarrhea 1
• Monitor nutritional status and enroll in feeding programs if indicated 1
• No specific antiviral therapy is currently recommended for routine measles treatment 2

Diagnostic Confirmation

• Collect serum for measles IgM antibody testing during the first clinical encounter 1
• If IgM is negative within 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1
• Consider collecting urine or nasopharyngeal specimens for viral isolation and molecular characterization 3, 1

Post-Exposure Prophylaxis

MMR Vaccine (First-Line for Susceptible Contacts)

• Administer MMR vaccine within 72 hours of exposure to prevent or modify disease in susceptible contacts 3
• Even if administered too late for effective prophylaxis, vaccination provides future protection 3
• Contacts without evidence of immunity should be vaccinated immediately during outbreak investigations 3

Immune Globulin (For High-Risk Individuals)

• For persons with contraindications to vaccination requiring immediate protection: administer IG 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1
• For immunocompromised persons: increase dose to 0.5 mL/kg body weight (maximum 15 mL) 1
• Standard dosage for nonimmunocompromised contacts: 0.25 mL/kg (40 mg IgG/kg) intramuscular 3
• If IG is administered, observe for symptoms for 28 days (rather than 21 days) as IG may prolong the incubation period 3

Prevention Through Vaccination

Routine Immunization Schedule

• All healthcare personnel and the general population should have presumptive evidence of immunity: two documented doses of MMR vaccine administered at least 28 days apart, laboratory evidence of immunity, laboratory confirmation of disease, or birth before 1957 3
• The first dose should be administered on or after the first birthday; the second dose no earlier than 28 days after the first 3

Important Vaccination Principles

• Do not perform serologic testing before vaccination unless the facility considers it cost-effective 3
• During outbreaks, do not delay vaccination for serologic screening as rapid vaccination is necessary to halt transmission 3
• If a person with two documented MMR doses tests negative or equivocal for measles antibodies, do not administer additional vaccine doses—documented vaccination supersedes subsequent serologic results 3

Isolation and Infection Control

Patient Isolation Requirements

• Isolate patients until at least 4 days after rash onset as infected individuals are contagious from 4 days before through 4 days after rash onset 3, 4
• Immediately place suspected measles patients in an airborne-infection isolation room (negative air-pressure room) 3, 4
• If no isolation room is available, place in a private room with the door closed and have the patient wear a medical mask 3, 4

Healthcare Worker Precautions

• All staff entering the room must use N95 respirators or equivalent respiratory protection regardless of immunity status 3, 4
• Only staff with presumptive evidence of immunity should enter the room when possible 3, 4
• Healthcare workers who develop measles must be excluded from work until ≥4 days following rash onset 3, 4

Management of Exposed Healthcare Workers

• Healthcare workers without evidence of immunity should be offered MMR vaccine and excluded from work from day 5-21 following exposure 3, 4
• Those with one documented vaccine dose may remain at work but should receive the second dose 3
• Unvaccinated workers without immunity who refuse vaccination should be excluded from day 5 after first exposure through day 21 after last exposure, even if they received immune globulin 3

Outbreak Control Measures

Community and Institutional Settings

• Contact the local or state health department immediately when suspected measles cases occur—one confirmed case is an urgent public health situation 3
• Persons without acceptable evidence of immunity should be vaccinated or excluded from the outbreak setting (school, daycare, hospital) 3
• Persons exempt from vaccination for medical or religious reasons should be excluded until 21 days after rash onset in the last case 3, 4

Special Populations During Outbreaks

• For infants aged 6-11 months during outbreaks: consider measles vaccination (monovalent preferred, but MMR acceptable if monovalent unavailable), then revaccinate at 12-15 months and again before school entry 3
• Passive immunization with IG may be preferred for infant household contacts, especially if exposure occurred >72 hours before diagnosis 3

Critical Pitfalls to Avoid

• Do not underestimate the contagious period: patients are infectious 4 days before rash onset when diagnosis is not yet apparent 3, 4
• Do not use regular surgical masks—N95 respirators are required for airborne precautions 4, 5
• Do not allow healthcare workers without proper immunity to care for measles patients, as even vaccinated individuals have ~1% vaccine failure risk 3
• Do not withhold vitamin A supplementation in children—it is critical for reducing morbidity and mortality 1
• Do not delay isolation measures while awaiting laboratory confirmation—implement airborne precautions immediately upon clinical suspicion 3, 4