What is the treatment approach for measles?

Measles Treatment

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 Intervention)

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

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

Vitamin A deficiency increases measles severity and mortality, making supplementation critical for reducing morbidity and mortality. 1 This intervention is evidence-based and recommended by both the CDC and WHO. 2

Supportive Care Measures

Manage complications aggressively as they arise:

• Secondary bacterial infections: Treat with appropriate antibiotics 1, 2
• Pneumonia: Standard antibiotic treatment 1, 2
• Otitis media: Appropriate antibiotic therapy 2
• Diarrhea: Oral rehydration therapy 1, 2
• Nutritional status: Monitor and enroll in feeding programs if indicated 1, 2

Diarrhea is the most frequent complication, followed by otitis media and bronchopneumonia. 2 Encephalitis occurs in approximately 1 per 1,000 cases and carries significant morbidity. 2

Post-Exposure Prophylaxis

For exposed individuals requiring immediate protection:

• Persons with contraindications to vaccination: Immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1, 2
• Immunocompromised persons: IG 0.5 mL/kg body weight (maximum 15 mL) 1, 2
• Measles vaccine: May provide protection if administered within 72 hours (3 days) of exposure 1, 2

The timing of post-exposure prophylaxis is critical—earlier administration is more effective. 1

Diagnostic Confirmation

Obtain laboratory confirmation during the first clinical encounter:

• Serum measles IgM antibody testing during the first visit 1, 2
• If IgM negative within 72 hours of rash onset: Obtain another specimen at least 72 hours after rash onset 1, 2
• Consider molecular characterization: Measles virus RNA from urine or nasopharyngeal specimens 1

Infection Control in Healthcare Settings

Implement strict airborne precautions immediately:

• Airborne-infection isolation rooms are mandatory 2
• N95 respirators required for all healthcare personnel regardless of immunity status 2
• Infectious period: 4 days before rash onset through 4 days after rash onset 2
• Exposed workers without immunity: Must be excluded from work days 5-21 following exposure 2

Critical Pitfalls to Avoid

• Do not skip vitamin A supplementation—it is mandatory for all children with measles, as deficiency increases severity and mortality 1
• Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination 1
• Do not rely on standard droplet precautions—measles requires airborne precautions with N95 respirators even in negative pressure rooms 2, 3
• Do not perform elective surgery during the infectious period (4 days before through 4 days after rash onset), as transmission risk to healthcare workers and other patients is unacceptable 3