What care should be provided to a child suspected of having measles?

Management of a Child with Suspected Measles

Immediately isolate the child and notify your local or state health department—this is an urgent public health situation requiring rapid action. 1

Immediate Actions: Isolation and Reporting

• Isolate the patient immediately for at least 4 days after rash onset, as the child remains contagious from 4 days before through 4 days after rash appearance 2
• Contact local or state health department immediately—one confirmed case of measles constitutes an urgent public health situation requiring prompt investigation 1, 3
• Use airborne precautions: All healthcare workers must wear N95 respirators (not surgical masks) when entering the room, regardless of immunity status 2, 4
• Only staff with documented immunity should provide direct care 2

Diagnostic Confirmation

Collect blood for measles-specific IgM antibody testing during the first clinical encounter, even before laboratory results return, as control activities should not be delayed 1, 3

Key diagnostic points:

• If IgM is negative within the first 72 hours of rash onset, obtain a second specimen at least 72 hours after rash onset, as IgM may not be detectable early 5, 3
• IgM peaks approximately 10 days after rash onset and remains detectable for at least 1 month 1
• Collect urine or nasopharyngeal specimens for viral isolation as close to rash onset as possible for molecular characterization (delay reduces isolation success) 1
• Be aware of false positives: In areas with low measles incidence, confirmatory testing using direct-capture IgM EIA method should be considered when there is no identified source or epidemiologic linkage 1

Essential Treatment: Vitamin A Supplementation

Administer vitamin A supplementation to all children with clinical measles—this is the only evidence-based intervention proven to reduce measles mortality. 2, 5

Dosing protocol:

• Children ≥12 months: 200,000 IU orally on day 1 2, 5, 3
• Children <12 months: 100,000 IU orally on day 1 2, 5, 3
• For complicated measles: Give a second dose on day 2 at the same dosage 2, 5
• If eye symptoms of vitamin A deficiency are present: Give 200,000 IU on day 1, day 2, and again 1-4 weeks later 2

Supportive Care and Complication Management

Monitor for and treat complications with standard therapies:

• Bacterial superinfections (pneumonia, purulent otitis media): Treat with appropriate antibiotics 5, 3, 6
• Diarrhea: Oral rehydration therapy 5, 3
• Acute lower respiratory infections: Standard antibiotic treatment 2, 5
• Monitor nutritional status and enroll in feeding programs if indicated 2, 5

The evidence suggests prophylactic antibiotics may prevent complications: pooled data shows reduced incidence of pneumonia (OR 0.17), purulent otitis media (OR 0.34), and tonsillitis (OR 0.08) when antibiotics are given, though definitive guidelines on type and timing are not established 6

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 2, 5

Pregnant women:

• Should have received IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure 2

Infants <12 months:

• Disease is often more severe in this age group 1
• In outbreak settings, measles vaccination may be given as early as 6 months of age 1

Outbreak Control Measures

Identify and manage contacts immediately:

• Persons without acceptable evidence of immunity should be vaccinated or excluded from the outbreak setting (school, daycare, hospital) 1
• Persons exempted from vaccination for medical or religious reasons must be excluded until 21 days after rash onset in the last case 1, 3
• Measles vaccine may provide protection if given within 3 days of exposure 5

Critical Pitfalls to Avoid

• Do not use surgical masks instead of N95 respirators—measles is airborne and requires proper respiratory protection 2, 4
• Do not forget vitamin A supplementation—this is critical for reducing mortality and is often overlooked 2
• Do not delay control activities while waiting for laboratory confirmation—act on clinical suspicion 1
• Do not assume negative IgM in first 72 hours rules out measles—repeat testing is essential 5, 3
• Do not withhold vaccination from malnourished children—undernutrition is a strong indication for vaccination, not a contraindication 5