Treatment of Measles in Adults
Adults with measles should receive supportive care, and while vitamin A supplementation is not routinely recommended for adults in developed countries, older children, adolescents, and adults may need to be immunized during outbreaks if surveillance data show these groups are being affected. 1
Vitamin A Supplementation in Adults
The available guidelines focus primarily on pediatric populations for vitamin A supplementation in measles treatment. The CDC-based recommendations specify dosing for children but do not extend routine vitamin A supplementation recommendations to adults 2. The 1992 MMWR guidelines note that "older children, adolescents, and adults may also need to be immunized if surveillance data show that these groups are being affected during an outbreak," but vitamin A treatment protocols are specified only for children 1.
In resource-limited settings or refugee populations, vitamin A supplementation protocols are explicitly designed for children under 12 years of age, with no parallel recommendations for adults. 1
Supportive Care for Adults
Adults with measles require supportive management focused on preventing and treating complications:
- Secondary bacterial infections should be treated with appropriate antibiotics 2
- Pneumonia management follows standard protocols for acute lower respiratory infections 1, 2
- Oral rehydration therapy for diarrhea 1, 2
- Nutritional status monitoring, particularly in adults with underlying malnutrition 1
Post-Exposure Prophylaxis
For adults exposed to measles who have 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 adults, increase the dose to 0.5 mL/kg body weight (maximum 15 mL) 2
- Measles vaccine may provide protection if administered within 3 days of exposure 1, 2
Vaccination Considerations for Adults
Adults born in 1957 or later should have documentation of at least one dose of live measles vaccine unless they have physician-diagnosed disease or laboratory evidence of immunity. 1
High-risk adults require two doses of MMR:
- Health care workers 1
- International travelers to endemic areas 1
- College students and those in post-secondary educational institutions 1
- Persons in outbreak settings 1
Adults born before 1957 may be considered immune, though health care workers in this age group should be offered vaccine if there is reason to believe they may be susceptible, as 29% of health care workers with measles in 1985-1989 were born before 1957. 1
Important Clinical Caveats
Measles in adults carries significant morbidity: Encephalitis risk is greatest among adult patients (aside from infants), occurring in approximately 1 per 1,000 cases 1. In 1989-1990,28% of measles-associated deaths occurred in persons ≥20 years of age, and 25% of adults with measles required ≥1 day of hospitalization 1.
Pregnancy considerations: Measles during pregnancy increases rates of spontaneous abortion, premature labor, and low birth weight 1. Measles vaccine is contraindicated in pregnancy, and women should be counseled to avoid pregnancy for 4 weeks after vaccination 1.
Undernutrition is not a contraindication for measles vaccination; it should be considered a strong indication for vaccination. 1, 2