What is the management for a patient with measles exposure and symptoms?

Management of Symptomatic Measles Following Exposure

Immediately isolate the patient for at least 4 days after rash onset and initiate vitamin A supplementation, which is the only evidence-based intervention proven to reduce measles mortality. 1

Immediate Isolation and Infection Control

• Place the patient in airborne isolation immediately for at least 4 days after rash onset, as they remain contagious from 4 days before through 4 days after rash appearance. 1, 2

• All healthcare workers must wear N95 respirators (not surgical masks) when entering the room, regardless of their immunity status. 1, 2

• Only staff with documented immunity should provide direct care, though all must maintain N95 precautions due to the ~1% vaccine failure rate. 1, 3

• If an airborne-infection isolation room (negative pressure) is unavailable, use a private room with the door closed. 2

Essential Treatment: Vitamin A Supplementation

This is the cornerstone of measles treatment and must not be forgotten:

• For children ≥12 months: 200,000 IU orally on day 1. 1

• For children <12 months: 100,000 IU orally on day 1. 1

• For complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems): Give a second dose of vitamin A on day 2. 1, 4

• For eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, corneal ulceration): Give 200,000 IU on day 1, day 2, and again 1-4 weeks later (half doses for infants <12 months). 1, 4

Supportive Care and Complication Management

• Monitor nutritional status closely and enroll in feeding programs if indicated, as undernutrition increases measles mortality. 1, 4

• Treat complications with standard therapies:

  • Oral rehydration therapy for diarrhea 1, 4
  • Antibiotics for acute lower respiratory infection and other bacterial superinfections 1, 4
  • Antipyretics and hydration for fever 5, 6

• Watch for serious complications including pneumonia (most common cause of death), otitis media, laryngotracheobronchitis, stomatitis, and neurological complications (acute disseminated encephalomyelitis, measles inclusion body encephalitis, subacute sclerosing panencephalitis). 6, 7

Special Populations Requiring Enhanced Management

Immunocompromised patients:

• Should have received immune globulin (IG) 0.5 mL/kg (maximum 15 mL) within 6 days of exposure, regardless of vaccination status. 1, 4
• If not given prophylactically, these patients require aggressive supportive care and close monitoring for complications. 4

Pregnant women:

• Should have received IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure. 1
• Require close obstetric monitoring as measles increases risk of preterm labor, spontaneous abortion, and maternal mortality. 4

Healthcare workers:

• Must be excluded from work until ≥4 days following rash onset. 2, 3
• Exposed susceptible workers should be excluded from day 5-21 following exposure (or day 12-26 in outbreak settings). 2

Common Pitfalls to Avoid

• Do not use surgical masks instead of N95 respirators – measles is airborne and requires proper respiratory protection. 1, 2

• Do not forget vitamin A supplementation – this is the only intervention with proven mortality benefit and is often overlooked in developed countries. 1

• Do not end isolation early – maintain full 4 days after rash onset even if patient feels better. 2

• Do not assume immunity based on negative titers alone – patients are contagious 4 days before rash when diagnosis is not yet apparent, making early recognition critical. 2

• Do not withhold vitamin A due to fever, respiratory infection, or diarrhea – these are not contraindications and are actually strong indications for supplementation. 4