From the Guidelines
Measles treatment primarily focuses on supportive care, including rest, adequate fluid intake, and acetaminophen or ibuprofen to reduce fever and discomfort, as there is no specific antiviral therapy for the virus itself. The treatment approach is centered around managing symptoms and preventing complications, rather than directly targeting the virus.
Key Components of Treatment
- Vitamin A supplementation is recommended for all children with measles, with doses of 200,000 IU for children over 12 months (100,000 IU for 6-12 months, 50,000 IU for under 6 months), given once daily for two days, as it reduces mortality and complication risks by supporting the immune system and maintaining epithelial tissue integrity 1.
- Antibiotics are not effective against the measles virus but may be prescribed if bacterial complications like pneumonia or ear infections develop.
- Patients should be isolated for four days after the rash appears to prevent transmission.
- Severe cases may require hospitalization for intravenous fluids, respiratory support, or treatment of complications.
Prevention and Postexposure Prophylaxis
Prevention through vaccination remains the most effective approach to managing measles, as the disease is highly contagious but preventable. For postexposure prophylaxis, the administration of MMR or measles vaccine within 72 hours of initial exposure may provide some protection, especially for individuals aged greater than or equal to 12 months 1. However, for susceptible household contacts who are not vaccinated within 72 hours of initial exposure, administration of immune globulin (IG) is recommended, particularly for those with contraindications to measles vaccination or who are immunocompromised 1.
From the Research
Measles Treatment
- Measles is a highly contagious disease that can be fatal, but it is vaccine-preventable 2, 3.
- The World Health Organization (WHO) recommends administration of an oral dose of 200,000 IU of vitamin A per day for two days to children with measles in areas where vitamin A deficiency may be present 4.
- Studies have shown that vitamin A supplementation can reduce mortality in children with measles, particularly when given in two doses of 200,000 IU 5, 4, 6.
- A systematic review of randomized controlled trials found that two doses of 200,000 IU of vitamin A were associated with a 64% reduction in the risk of mortality in children with measles 4.
- Another study found that two doses of vitamin A reduced measles mortality by 62% (95% CI 19-82) 6.
- Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhea 2.
- There is no specific antiviral therapy for the treatment of measles, and disease control largely depends on prevention through vaccination 2, 3.
Vitamin A Dosage
- Two doses of 200,000 IU of vitamin A are recommended for the treatment of measles in children 5, 4, 6.
- A single dose of 200,000 IU of vitamin A is not associated with reduced mortality among children with measles 4, 6.
- The effect of vitamin A supplementation is greater in children under the age of 2 years 4.
Prevention
- Measles is best prevented through vaccination, and the major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication 2, 3.
- The use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome 3.