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 and significantly reduces mortality:

• Children ≥12 months: 200,000 IU orally on day 1 1
• Children <12 months: 100,000 IU orally on day 1 1
• Complicated measles (pneumonia, otitis, croup, diarrhea with dehydration, or neurological problems): Administer a second dose of vitamin A on day 2 at the same dosage 1

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

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

Critical caveat: Undernutrition is NOT a contraindication for measles vaccination—it should be considered a strong indication for vaccination. 2, 1 Similarly, fever, respiratory tract infection, and diarrhea are not contraindications. 2

Management of Complications

Secondary bacterial infections require prompt antibiotic therapy:

• Acute lower respiratory infections: Standard antibiotic treatment 1
• Otitis media: Appropriate antibiotics 1
• Other bacterial superinfections: Treat according to standard protocols 3

Diarrhea management:

• Oral rehydration therapy (ORT) for dehydration 1
• Monitor hydration status closely 4

Nutritional support:

• Monitor nutritional status of all children with measles 1
• Enroll in feeding programs if indicated 1

Post-Exposure Prophylaxis

For exposed persons with contraindications to vaccination:

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

For susceptible persons without contraindications:

• MMR vaccine may provide protection or modify disease severity if administered within 3 days of exposure 2, 1

Infection Control Measures

Isolation requirements:

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

Diagnostic Confirmation

Laboratory testing should not delay treatment or control measures:

• Collect serum for measles IgM antibody testing during first clinical encounter 1
• If IgM negative within first 72 hours of rash onset, obtain another specimen ≥72 hours after rash onset 2, 1
• Consider molecular characterization from urine or nasopharyngeal specimens 1

Clinical case definition:

• Generalized rash lasting ≥3 days 2
• Temperature ≥38.3°C (≥101°F) 2
• Cough, coryza, or conjunctivitis 2

Important Clinical Pitfalls

Do not delay treatment: Vitamin A deficiency increases measles severity and mortality; supplementation is critical even in well-nourished populations. 1

No specific antiviral therapy exists: Despite investigation of agents like ribavirin, there is no proven specific antiviral treatment for measles. 5, 4 Treatment remains supportive.

Report immediately: All suspected measles cases must be reported to local or state health departments immediately for outbreak control. 2

Vaccination during outbreaks: Measles immunization programs should be accelerated, not stopped, during outbreaks. 2