What is the treatment for measles in adults?

Treatment of Measles in Adults

Measles treatment in adults is primarily supportive care, with vitamin A supplementation (200,000 IU orally for two consecutive days) being the only specific therapy proven to reduce mortality and complications. 1

Supportive Care (Primary Treatment)

All adults with measles require supportive management as the cornerstone of treatment, which includes:

• Hydration and nutritional support to correct deficiencies that commonly develop during acute illness 2
• Antipyretics and analgesics for fever and discomfort management 3
• Rest and monitoring for development of complications, particularly pneumonia which is the most lethal complication 2
• Treatment of secondary bacterial infections with appropriate antibiotics when they occur (pneumonia, otitis media, or other superinfections) 2, 4

Vitamin A Supplementation (Evidence-Based Specific Therapy)

Administer vitamin A 200,000 IU orally for two consecutive days to all adults with measles, as this regimen demonstrates:

• 64% reduction in overall mortality risk (RR=0.36; 95% CI 0.14 to 0.82) 1
• 67% reduction in pneumonia-specific mortality (RR=0.33; 95% CI 0.08 to 0.92) 1
• 47% reduction in croup incidence (RR=0.53; 95% CI 0.29 to 0.89) 1
• Reduction in diarrhea duration by approximately 2 days 1

The two-dose regimen is superior to single-dose administration, which showed no significant mortality benefit 1. Water-based formulations appear more effective than oil-based preparations (81% vs 48% mortality reduction), though both are beneficial 1.

High-Risk Populations Requiring Enhanced Management

Pregnant Women

• Require hospitalization more frequently than non-pregnant adults (25% of adults with measles require ≥1 day hospitalization) 5, 6
• Face increased risks of spontaneous abortion, premature labor, and low birth weight infants 5
• Cannot receive measles vaccine as pregnancy is an absolute contraindication 5
• Should receive immune globulin (IG) 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure for post-exposure prophylaxis if susceptible 5

Immunocompromised Patients

• Face higher risk of severe complications and prolonged viral shedding 6
• May require higher dose immune globulin (0.5 mL/kg) for post-exposure prophylaxis 6
• Consider intravenous immunoglobulin for treatment in severely immunocompromised patients 3

Unvaccinated Adults

• May require more aggressive management including consideration of ribavirin in severe cases 3

Post-Exposure Prophylaxis (For Exposed Susceptible Adults)

Administer MMR vaccine within 72 hours of exposure to susceptible adults, as this is most likely to provide protection during that window 7. If vaccination is contraindicated or the 72-hour window has passed:

• Give immune globulin 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure to prevent or modify infection 7, 5
• Note that IG administration delays subsequent MMR vaccination by 3 months due to passive antibody interference 7

Infection Control Requirements

Implement airborne precautions immediately for all suspected or confirmed measles cases:

• Isolate in airborne infection isolation room with negative pressure 3, 6
• All healthcare personnel must use N95 respirators regardless of immunity status 6
• Maintain isolation from 4 days before rash onset through 4 days after rash onset (the infectious period) 6
• Exclude exposed healthcare workers without immunity from work days 5-21 post-exposure 6

Monitoring for Complications

Adults face the highest risk of severe complications, with encephalitis or death occurring in approximately 1 per 1,000 cases 7, 6. Monitor closely for:

• Pneumonia (most lethal complication requiring aggressive supportive care and treatment of bacterial superinfection) 2
• Encephalitis (neurological symptoms warrant immediate evaluation) 7
• Secondary bacterial infections (otitis media, sinusitis, pneumonia) 2, 4

Critical Pitfalls to Avoid

• Do not withhold vitamin A supplementation - this is the only evidence-based specific therapy that reduces mortality 1
• Do not give single-dose vitamin A and assume adequacy - two consecutive daily doses are required for mortality benefit 1
• Do not delay IG administration beyond 6 days post-exposure when indicated, as efficacy is time-dependent 5
• Do not assume adults born before 1957 are immune - up to 9.3% may be susceptible, particularly healthcare workers 5, 7
• Do not use standard droplet precautions - measles requires airborne precautions with N95 respirators 6, 3