What are the recommendations for measles management?

Measles Management

All children with clinical measles should receive vitamin A supplementation (200,000 IU orally for children ≥12 months, 100,000 IU for children <12 months), with a second dose on day 2 for complicated cases, alongside supportive care and treatment of secondary bacterial infections with antibiotics. 1, 2

Immediate Supportive Care

Vitamin A Supplementation (Critical for Reducing Mortality)

• Administer 200,000 IU vitamin A orally on day 1 for all children ≥12 months with clinical measles 1, 2
• Give 100,000 IU vitamin A orally on day 1 for children <12 months 1, 2
• Provide a second dose of vitamin A on day 2 for children with complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems) 1, 2
• Repeat vitamin A every 3 months as part of routine supplementation schedule 1

Special Vitamin A Protocol for Eye Symptoms

If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration): 1

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

Management of Complications

Respiratory Complications

• Treat acute lower respiratory infections with standard antibiotic therapy 1, 2
• Pneumonia is the most common cause of measles-related death and requires aggressive antibiotic treatment 1, 3
• Monitor closely for bronchopneumonia, which is a frequent complication 1, 4

Gastrointestinal Complications

• Administer oral rehydration therapy (ORT) for diarrhea 1, 2
• Diarrhea is the most common complication of measles 1, 4

Other Complications

• Treat middle ear infections with appropriate antibiotics 1, 2
• Monitor for encephalitis (occurs in approximately 1 per 1,000 cases), which can cause permanent brain damage 1, 3, 4

Nutritional Support

• Monitor nutritional status of all children with measles and enroll in feeding programs if indicated 1, 2
• Undernutrition significantly increases mortality risk and should be considered a strong indication for intervention 1, 3

Post-Exposure Prophylaxis

For Unvaccinated Exposed Persons

• Administer measles vaccine within 3 days of exposure for potential protection or disease modification 1
• This is the preferred approach for immunocompetent individuals without contraindications 1

For Persons with Contraindications to Vaccination

• Give immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) intramuscularly as soon as possible after exposure 2, 5
• For immunocompromised persons: administer 0.5 mL/kg body weight (maximum 15 mL) of IG 2, 5
• For severely immunocompromised persons and pregnant women without evidence of immunity: use immune globulin intravenously (IGIV) 5
• For infants aged birth to 6 months exposed to measles: administer IGIM 5

Diagnostic Confirmation

• Collect serum for measles IgM antibody testing during the first clinical encounter 2, 4
• If IgM testing is negative within the first 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 2
• Collect urine or nasopharyngeal specimens for measles virus isolation and genetic characterization as close to rash onset as possible 1, 2

Infection Control Measures

• Isolate patients with measles in airborne infection isolation rooms 6
• Healthcare workers must use N-95 masks when caring for measles patients 6
• Patients are contagious from 4 days before to 4 days after rash onset 4
• Contact local or state health department immediately when suspected cases occur 1

High-Risk Populations Requiring Aggressive Management

Immunocompromised Patients

• Measles can be severe and prolonged in patients with leukemias, lymphomas, or HIV infection 1, 3
• These patients may present without typical rash and can shed virus for several weeks 1
• Higher doses of immune globulin are required for post-exposure prophylaxis 2, 5

Pregnant Women

• Measles increases risk of premature labor, spontaneous abortion, and low birth weight 1, 3, 4
• Use IGIV for post-exposure prophylaxis in pregnant women without evidence of immunity 5

Infants and Young Children

• Infants and young children have greater risk for death from measles complications 1, 3
• Death occurs in 1-2 per 1,000 reported cases in the United States, primarily from pneumonia and acute encephalitis 1, 3, 4

Critical Pitfalls to Avoid

• Never withhold vitamin A supplementation—it is critical for reducing mortality and should be given to all children with clinical measles 1, 2
• Do not delay treatment of secondary bacterial infections—pneumonia is the leading cause of measles death 1, 3
• Do not assume fever, respiratory infection, or diarrhea are contraindications to measles vaccination in outbreak settings—these are NOT contraindications 1
• Do not delay outbreak control measures pending laboratory confirmation—control activities should begin immediately 1
• Do not use isolation as an outbreak control measure in emergency settings—accelerate vaccination efforts instead 1