What is the recommended treatment for measles?

Treatment of Measles

Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all children, monitoring for complications, and treatment of secondary bacterial infections with antibiotics. 1

Vitamin A Supplementation (Critical Component)

Vitamin A supplementation is essential for all children with clinical measles, as deficiency increases severity and mortality 1:

Standard dosing for uncomplicated measles:

• Children ≥12 months: 200,000 IU orally on day 1 2, 1
• Children <12 months: 100,000 IU orally on day 1 2, 1

For complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems):

• Administer a second dose on day 2 at the same dosage 2, 1

For children with eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, corneal ulceration):

• 200,000 IU oral vitamin A on day 1 2, 3
• 200,000 IU oral vitamin A on day 2 2, 3
• 200,000 IU oral vitamin A 1-4 weeks later 2, 3
• Children <12 months receive half doses (100,000 IU) 2, 3

Supportive Care Measures

Management of specific complications:

• Diarrhea: Oral rehydration therapy (ORT) 2, 1
• Acute lower respiratory infections: Standard antibiotic treatment 2, 1
• Secondary bacterial infections: Appropriate antibiotics 1, 4
• Nutritional monitoring: Assess nutritional status and enroll in feeding programs if indicated 2, 1

General supportive care:

• Fever management 4
• Hydration maintenance 4
• Monitoring for complications affecting multiple organ systems 4

Post-Exposure Prophylaxis

For persons with contraindications to measles vaccination requiring immediate protection:

• Immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1
• Immunocompromised persons: 0.5 mL/kg body weight (maximum 15 mL) 1

For susceptible persons without contraindications:

• Measles vaccine may provide protection if administered within 3 days of exposure 2, 1

Infection Control and Isolation

Airborne precautions are mandatory:

• Patients are infectious 4 days before rash onset through 4 days after rash onset 2
• Place patient in airborne-infection isolation room (negative air-pressure room) immediately 2
• If unavailable, use private room with closed door and patient should wear medical mask 2
• All staff entering room should use N95 respirator regardless of immunity status 2
• Healthcare workers with measles should be excluded from work until ≥4 days following rash onset 2

Diagnostic Confirmation

Laboratory testing should not delay treatment or control measures:

• Collect serum for measles IgM antibody testing during first clinical encounter 1, 4
• If IgM negative within first 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 2, 1
• IgM peaks approximately 10 days after rash onset and is usually undetectable 30-60 days after 2
• Consider molecular characterization from urine or nasopharyngeal specimens 1

Critical Pitfalls to Avoid

Common contraindication misconceptions:

• Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination 2, 1
• Fever, respiratory tract infection, and diarrhea are NOT contraindications for measles vaccination 2
• Unimmunized HIV-infected persons should receive the vaccine 2

Vitamin A is critical:

• Vitamin A deficiency significantly increases measles severity and mortality 1
• Do not omit vitamin A supplementation even if child received it within the previous month for uncomplicated measles 2

No specific antiviral therapy:

• There is no specific antiviral therapy for measles treatment 4
• Ribavirin has been mentioned in some contexts but is not standard of care 5

Immediate Reporting Requirements

All suspected measles cases must be reported immediately:

• Contact local or state health department immediately upon suspicion 2
• One confirmed case is considered an urgent public health situation requiring rapid response 2
• Do not delay reporting, investigation, or control activities pending laboratory results 2