What is the treatment for measles?

Treatment of Measles

Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all children, as there is no specific antiviral therapy available. 1, 2

Vitamin A Supplementation (Critical Component)

All children with clinical measles must receive vitamin A supplementation on day 1: 1, 3

• Children ≥12 months: 200,000 IU orally 1, 3
• Children <12 months: 100,000 IU orally 1, 3
• Complicated measles: Administer a second identical dose on day 2 1, 3
• Vitamin A deficiency with eye symptoms: Additional dose 1-4 weeks later 3

The evidence strongly supports two-dose vitamin A regimens. A Cochrane review demonstrated that two doses of 200,000 IU reduced mortality risk by 64% (RR=0.36; 95% CI 0.14 to 0.82), with an 82% reduction in children under 2 years (RR=0.18; 95% CI 0.03 to 0.61) and a 67% reduction in pneumonia-specific mortality (RR=0.33; 95% CI 0.08 to 0.92). 4 Notably, single-dose regimens showed no significant mortality benefit (RR=0.77; 95% CI 0.34 to 1.78), making the two-dose approach superior. 4

Management of Complications

Treat secondary bacterial infections aggressively with appropriate antibiotics: 1, 3

• Pneumonia: Standard antibiotic treatment for acute lower respiratory infections 1
• Otitis media: Appropriate antibiotic therapy 3
• Diarrhea: Oral rehydration therapy 1, 3
• Monitor nutritional status: Enroll in feeding programs if indicated 1

Complications are common, occurring in 10-40% of patients. 5 Diarrhea is the most frequent complication, followed by otitis media and bronchopneumonia. 3 Encephalitis occurs in approximately 1 per 1,000 cases, with death occurring in 1-2 per 1,000 reported U.S. cases. 6, 3

Post-Exposure Prophylaxis

For persons with contraindications to measles vaccination requiring immediate protection: 1

• Standard dose: Immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1
• Immunocompromised persons: 0.5 mL/kg body weight (maximum 15 mL) of IG 1, 7
• Alternative: Measles vaccine may provide protection if administered within 72 hours of exposure 3

For symptomatic HIV-infected and other immunocompromised persons, administer IG regardless of previous vaccination status. 6 Intramuscular IG may not be needed if a patient receives at least 100-400 mg/kg IGIV at regular intervals and exposure occurs within 3 weeks after the last IGIV dose. 6

Supportive Care Measures

Provide comprehensive supportive therapy: 8, 2

• Hydration: Correct dehydration, especially with diarrhea 8, 2
• Nutritional support: Address nutritional deficiencies 8
• Fever management: Symptomatic treatment 2
• Monitoring: Watch for complications affecting multiple organ systems 2

Diagnostic Confirmation

Obtain laboratory confirmation during the first clinical encounter: 1

• Serum measles IgM antibody testing during first visit 1
• If negative within 72 hours of rash onset: Obtain another specimen at least 72 hours after rash onset 1
• Consider molecular characterization: Measles virus from urine or nasopharyngeal specimens 1

Infection Control in Healthcare Settings

Implement strict airborne precautions immediately: 7

• Airborne-infection isolation room required 7
• N95 respirators mandatory for all healthcare personnel regardless of immunity status 7
• Infectious period: 4 days before rash onset through 4 days after rash onset 7
• Healthcare worker exclusion: Exposed workers without immunity must be excluded from work days 5-21 following exposure 7

Critical Pitfalls to Avoid

Vitamin A deficiency increases measles severity and mortality—supplementation is not optional. 1 The two-dose regimen is essential for reducing mortality, particularly in children under 2 years. 4

Undernutrition is NOT a contraindication to measles vaccination—it should be considered a strong indication for vaccination. 1, 3 This is a common misconception that can lead to missed prevention opportunities.

There is no specific antiviral therapy for measles. 2 While ribavirin has been mentioned in some contexts for severe cases, it is not part of standard treatment recommendations. 9 Management remains supportive with vitamin A supplementation and treatment of complications.

Do not underestimate transmission risk. Measles is highly contagious, transmitted through aerosols, and poses substantial risk in healthcare settings. 7 Airborne precautions with N95 respirators are mandatory even in negative pressure rooms—isolation alone is insufficient. 7