What is the treatment for an adult suspected of having measles?

Treatment of Suspected Measles in Adults

For an adult with suspected measles, treatment is primarily supportive care, as there is no specific antiviral therapy for uncomplicated measles. 1, 2

Immediate Management Steps

Isolation and Infection Control

• Immediately isolate the patient with airborne precautions using an airborne infection isolation room (negative pressure room) 2, 3
• Healthcare workers must wear N-95 respirators when caring for suspected measles patients 2
• The patient should remain in isolation until 4 days after rash onset 3
• Notify local public health department and hospital infection control immediately upon suspicion of measles 2, 3

Diagnostic Confirmation

• Obtain serum for measles-specific IgM antibody testing (most common confirmatory test) 2, 4
• Consider measles virus RNA detection by RT-PCR from nasopharyngeal or urine specimens 5, 6
• A four-fold rise in measles-specific IgG between acute and convalescent sera can also confirm diagnosis 4
• Do not delay isolation or outbreak control measures while awaiting laboratory confirmation 5

Supportive Treatment

General Supportive Care

• Manage fever with antipyretics 1
• Ensure adequate hydration and correct any dehydration 1
• Address nutritional deficiencies 1
• Monitor for and treat complications (pneumonia occurs in up to 40% of cases) 4

Vitamin A Supplementation

• Administer vitamin A to all patients with measles, particularly those who are malnourished, immunocompromised, or have evidence of vitamin A deficiency 1
• This intervention reduces morbidity and mortality 1

Treatment of Complications

• Bacterial superinfections (pneumonia, otitis media) should be treated with appropriate antibiotics 6, 1, 4
• Secondary bacterial pneumonia was observed in 18% of adult cases in one outbreak series 6
• Monitor for hepatitis, diarrhea, and other complications that occurred in 29% of hospitalized adults 6

Special Populations Requiring Aggressive Management

High-Risk Patients

The following groups require more intensive monitoring and may need additional interventions 2:

• Pregnant women (increased risk of spontaneous abortion, premature labor, low birth weight) 5
• Immunocompromised patients
• Unvaccinated individuals

Post-Exposure Prophylaxis Considerations

For exposed susceptible contacts (not the index case):

• MMR vaccine within 72 hours of exposure can provide protection 5
• Intravenous immunoglobulin (IVIG) within 6 days of exposure for those with contraindications to live vaccine (pregnant women, immunocompromised, infants) 2

Clinical Pearls and Pitfalls

Recognition

• Adults with measles often present with high fever (100%), malaise (89%), sore throat (89%), and rash (100%) 6
• Koplik spots (pathognomonic enanthem on buccal mucosa) appear before rash but were only present in 18% of adult cases in one series 6, 4
• The risk of encephalitis is greatest among adult patients (approximately 1 per 1,000 cases) 5

Laboratory Findings

Common abnormalities in adults include 6:

• Elevated C-reactive protein (54%)
• Leukopenia (43%)
• Elevated aminotransferases (43%)
• Thrombocytopenia (18%)

Nosocomial Transmission Risk

• Healthcare workers without documented immunity must be vaccinated immediately during outbreaks 6
• Nosocomial transmission occurred even in hospital settings with high vaccination rates among unvaccinated staff 6
• Adults born before 1957 are generally considered immune, but healthcare workers born before 1957 should still be offered vaccine if immunity is uncertain 5

Hospitalization

• 25% of adults with measles required ≥1 day of hospitalization 5
• Median hospitalization duration was 5 days in one adult outbreak series 6
• Complications are relatively common (10-40% of patients) and drive the need for admission 4