What is the recommended treatment for a patient with symptomatic measles?

Management of Symptomatic Measles Following Exposure

For a patient who has developed symptomatic measles after exposure, treatment is primarily supportive with vitamin A supplementation being the critical therapeutic intervention, while implementing strict airborne isolation for 4 days after rash onset to prevent transmission. 1

Immediate Isolation and Infection Control

• Isolate the patient immediately for at least 4 days after rash onset, as infected individuals remain contagious from 4 days before through 4 days after rash appearance 1
• Place the patient in an airborne-infection isolation room with negative air-pressure when available 1
• If no isolation room exists, use a private room with the door closed 1
• All healthcare workers entering the room must wear N95 respirators or equivalent respiratory protection, regardless of immunity status 1, 2
• Only staff with presumptive evidence of immunity should provide care 1

Essential Treatment: Vitamin A Supplementation

All children with clinical measles should receive vitamin A supplementation, which reduces morbidity and mortality:

• Standard dosing: 200,000 IU orally for children ≥12 months; 100,000 IU for children <12 months 3
• Do not administer if vitamin A was given within the previous month 3
• Repeat every 3 months as part of routine supplementation schedule 3

For complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems):

• Give a second dose of vitamin A on day 2 3

For eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, corneal ulceration):

• 200,000 IU oral vitamin A on day 1 3
• 200,000 IU oral vitamin A on day 2 3
• 200,000 IU oral vitamin A 1-4 weeks later 3
• Children <12 months receive half doses 3

Supportive Care and Complication Management

• Monitor nutritional status and enroll in feeding programs if indicated 3
• Treat complications with standard therapies:
  • Oral rehydration therapy (ORT) for diarrhea 3
  • Antibiotics for acute lower respiratory infection (ALRI) and other bacterial superinfections 3, 4
  • Correct dehydration and nutritional deficiencies 5, 4
• Provide symptomatic relief for fever, cough, and other symptoms 6, 4

Special Populations Requiring Enhanced Management

Immunocompromised patients:

• Should have received immune globulin (IG) 0.5 mL/kg (maximum 15 mL) if exposed, regardless of vaccination status 3
• May require higher doses of IGIV (100-400 mg/kg) if already receiving regular infusions 3
• Monitor closely for severe complications 3

Pregnant women:

• Should have received IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure 3
• Monitor closely for complications as they are at increased risk 7

Healthcare workers:

• Must be excluded from work until ≥4 days following rash onset 1
• Those without immunity who were exposed should be excluded from day 5-21 following exposure 1

Common Pitfalls to Avoid

• Failing to isolate during the 4 days before rash onset when patients are already contagious but not yet diagnosed 1
• Not maintaining isolation for the full 4 days after rash onset 1
• Using regular surgical masks instead of N95 respirators, as airborne precautions are mandatory 1, 7
• Forgetting vitamin A supplementation, which is the only evidence-based intervention to reduce measles mortality 3
• Withholding vitamin A in well-nourished populations - all symptomatic measles patients benefit regardless of nutritional status 3

No Specific Antiviral Therapy

• There is no specific antiviral therapy proven effective for measles treatment 4
• Ribavirin has been used in severe cases but lacks robust evidence 7
• Management remains primarily supportive with vitamin A as the only intervention shown to reduce mortality 4

Post-Illness Considerations

• Patients develop lifelong immunity following natural infection 5, 6
• Continue monitoring for late complications, particularly neurological sequelae which can occur months to years later 4