What is the treatment for measles in adults?

Treatment of Measles in Adults

Measles treatment in adults is primarily supportive care, with immediate implementation of airborne isolation precautions and close monitoring for severe complications, particularly encephalitis which occurs in approximately 1 per 1,000 adult cases. 1

Immediate Infection Control Measures

• Implement airborne precautions immediately upon suspicion or confirmation of measles, requiring isolation in a negative-pressure airborne infection isolation room with all healthcare personnel using N95 respirators regardless of immunity status. 1
• Maintain strict isolation from 4 days before rash onset through 4 days after rash appearance. 1
• Exclude exposed healthcare workers without documented immunity from work during days 5-21 post-exposure. 1

Supportive Care Management

• Provide best supportive care including correction of dehydration and nutritional deficiencies. 2
• Treat secondary bacterial infections with appropriate antibiotics as they develop. 2
• Monitor closely for pneumonia, which represents one of the most lethal complications in adults. 2
• Evaluate immediately for encephalitis if neurological symptoms develop, as this occurs in approximately 1 per 1,000 adult cases and requires urgent intervention. 1

Vitamin A Supplementation

Vitamin A supplementation is NOT recommended for adults in high-income countries, as the evidence supporting its use comes exclusively from pediatric studies in areas with high case fatality rates and vitamin A deficiency. 3, 4 The WHO recommendation of 200,000 IU for two consecutive days applies specifically to children in resource-limited settings where vitamin A deficiency is prevalent. 3, 4

Post-Exposure Prophylaxis for Susceptible Adults

For Non-Pregnant Adults Without Contraindications:

• Administer MMR vaccine within 72 hours of exposure to susceptible adults, as this window provides the highest likelihood of protection. 1
• If the 72-hour window has passed or vaccination is contraindicated, give immune globulin (IG) 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure to prevent or modify infection. 1

For Pregnant Women:

• Pregnant women require enhanced monitoring as 25% require hospitalization and face increased risks of spontaneous abortion, premature labor, and low birth weight infants. 1
• Pregnancy is an absolute contraindication to MMR vaccine; therefore, administer immune globulin 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure for post-exposure prophylaxis. 1

Critical Pitfalls to Avoid

• Do not delay immune globulin administration beyond 6 days post-exposure, as efficacy is strictly time-dependent. 1
• Do not assume adults born before 1957 are immune, as up to 9.3% may be susceptible, particularly healthcare workers who should be considered for vaccination regardless of birth year. 1
• Do not use standard droplet precautions instead of airborne precautions—measles requires N95 respirators and negative-pressure isolation. 1
• Do not discharge patients without ensuring adequate follow-up for monitoring complications, as adults face the highest risk of severe outcomes including death in approximately 1 per 1,000 cases. 1

Monitoring for Complications

• Assess for respiratory complications including pneumonia, which is among the most lethal complications. 2
• Monitor for encephalitis development, requiring immediate neurological evaluation if symptoms emerge. 1
• In pregnant women, monitor for signs of premature labor, spontaneous abortion, or fetal distress. 1