Treatment of Measles
Measles treatment is primarily supportive care with vitamin A supplementation for all children, as there is no specific antiviral therapy available. 1, 2
Vitamin A Supplementation (Critical Intervention)
All children with clinical measles should receive vitamin A supplementation on day 1 of diagnosis: 1
- Children ≥12 months: 200,000 IU orally on day 1 1
- Children <12 months: 100,000 IU orally on day 1 1
- Complicated measles: Administer a second dose on day 2 at the same dosage 1
Vitamin A deficiency significantly increases measles severity and mortality, making supplementation critical even in well-nourished populations. 1, 3
Supportive Care Measures
Management focuses on treating symptoms and preventing complications: 1, 2
- Hydration: Oral rehydration therapy for diarrhea to prevent dehydration 1
- Fever management: Antipyretics as needed 2
- Nutritional support: Monitor nutritional status and enroll in feeding programs if indicated 1
- Monitoring: Close observation for development of complications, particularly pneumonia and encephalitis 3, 2
Management of Complications
Secondary bacterial infections require prompt antibiotic treatment: 1, 2
- Pneumonia: Standard antibiotic therapy (pneumonia is the most common cause of measles-related death) 1, 3
- Acute lower respiratory infections: Appropriate antibiotic coverage 1
- Otitis media: Treat with standard antibiotic protocols 4
Neurological complications (encephalitis occurs in approximately 1 per 1,000 cases) require hospitalization and intensive supportive care. 3, 4
Post-Exposure Prophylaxis
For exposed individuals who cannot receive vaccination: 1
- 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
- Vaccination option: MMR vaccine may provide protection if administered within 3 days of exposure 1
Infection Control and Isolation
Patients are contagious from 4 days before to 4 days after rash onset: 4
- Implement airborne precautions immediately upon suspicion 5
- Use N-95 masks for healthcare workers 5
- Isolate in airborne infection isolation room 5
- Contact local or state health department immediately for outbreak control measures 6
Common Pitfalls
Do not delay treatment while awaiting laboratory confirmation - begin supportive care and vitamin A supplementation based on clinical presentation. 1, 2
Do not withhold vaccination from malnourished children - undernutrition is a strong indication for vaccination, not a contraindication. 1
Do not assume immunity in healthcare workers born before 1957 - up to 9.3% may still be susceptible and require vaccination. 3
Remember that ribavirin has been used in severe cases (particularly immunocompromised patients), though evidence is limited and it is not routinely recommended. 5