What is the pathogenesis and treatment of measles (rubeola) syndrome?

From the Guidelines

Measles is a highly contagious viral disease that requires immediate medical attention, and the most effective strategy for prevention is vaccination with the MMR (measles, mumps, rubella) vaccine, with the first dose given at 12-15 months and the second at 4-6 years, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. The pathogenesis of measles begins when the virus enters the respiratory tract and infects epithelial cells, spreading to local lymphatic tissues and causing viremia. After an incubation period of 10-14 days, the virus disseminates throughout the body, infecting various organs and causing systemic inflammation. Some key points to consider in the treatment of measles include:

• Treatment is primarily supportive, including rest, adequate hydration, antipyretics like acetaminophen (10-15 mg/kg every 4-6 hours) for fever, and vitamin A supplementation (50,000-200,000 IU based on age) to reduce severity and mortality, especially in malnourished children 2.
• Antibiotics are not effective against the virus but may be prescribed for secondary bacterial infections like pneumonia or otitis media, as recommended for children with measles complications 3.
• Severe cases may require hospitalization for IV fluids, respiratory support, or management of complications.
• Post-exposure prophylaxis with immunoglobulin (0.5 mL/kg IM) can be administered within 6 days of exposure for high-risk individuals.
• Patients should be isolated for 4 days after rash onset to prevent transmission, as the virus spreads through respiratory droplets and has an attack rate of up to 90% among susceptible individuals. The ACIP has recommended a second MMR vaccine, PRIORIX, as an option to prevent measles, mumps, and rubella, which is considered safe, immunogenic, and noninferior to M-M-R II 1.

From the Research

Pathogenesis of Measles

• Measles is a highly contagious disease caused by the measles virus, which is transmitted by the respiratory route 4.
• The illness begins with fever, cough, coryza, and conjunctivitis, followed by a characteristic rash 5, 4, 6.
• Measles infection leads to immune suppression for weeks to months, making patients more susceptible to complications 7.
• Complications of measles can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhea 5, 4, 6.

Symptoms of Measles

• Symptoms of measles include fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis 5.
• Vaccinated individuals can have milder or even no symptoms 5.
• Laboratory diagnosis relies largely on the detection of specific IgM antibodies in serum, dried blood spots, or oral fluid, or the detection of viral RNA in throat or nasopharyngeal swabs, urine, or oral fluid 5, 6.

Treatment of Measles

• There is no specific antiviral therapy for the treatment of measles 5, 7, 4, 6.
• Treatment with vitamin A is recommended for younger children to decrease mortality from measles 8, 5, 7, 4.
• Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhea 5.
• Bacterial superinfections, if present, should be properly treated with antibiotics 6.

Prevention of Measles

• Measles can be prevented through vaccination, which is effective, cost-effective, and safe 8, 7, 4.
• The major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication 4.
• Urgent efforts are needed to increase stagnating global coverage with two doses of measles vaccine through advocacy, education, and the strengthening of routine immunization systems 4.
• Use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome 4.