What is the supportive treatment for children with measles?

Supportive Treatment for Children with Measles

Vitamin A Supplementation: The Critical Intervention

All children with clinical measles must receive vitamin A supplementation immediately, as this is the only evidence-based intervention proven to reduce measles mortality and complications. 1

Dosing Protocol

• Children ≥12 months: 200,000 IU orally on day 1 1, 2
• Children <12 months: 100,000 IU orally on day 1 1, 2

Second Dose for Complicated Measles

Children with complicated measles (pneumonia, otitis media, croup, diarrhea with moderate or severe dehydration, or neurological problems) must receive a second identical dose of vitamin A on day 2. 3, 1, 2

The evidence strongly supports this two-dose regimen: studies demonstrate a 64% reduction in overall mortality (RR 0.36) and 67% reduction in pneumonia-specific mortality (RR 0.33) with two doses of 200,000 IU, compared to no significant mortality reduction with a single dose. 4, 5 The effect is particularly pronounced in children under 2 years of age, showing an 82% mortality reduction (RR 0.18). 4, 5

Additional Vitamin A for Eye Symptoms

If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer:

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

Management of Complications

Bacterial Superinfections

Treat secondary bacterial infections aggressively with appropriate antibiotics, as these are major contributors to measles mortality. 1, 2

• Pneumonia/acute lower respiratory infection: Standard antibiotic treatment 3, 2
• Otitis media: Appropriate antibiotic therapy 1
• Diarrhea: Oral rehydration therapy (ORT) 3, 2

Vitamin A supplementation reduces croup incidence by 47% (RR 0.53) and decreases diarrhea duration by approximately 2 days. 4

Nutritional Support

Monitor nutritional status of all children with measles and enroll in feeding programs if indicated. 3, 2 This is particularly critical as mortality is several times higher in malnourished children regardless of other interventions. 6

Common Pitfalls to Avoid

• Do NOT withhold vitamin A from undernourished children: Undernutrition is not a contraindication but rather a strong indication for vitamin A supplementation. 3, 2
• Do NOT delay vitamin A administration: Give vitamin A on the first clinical encounter, even before laboratory confirmation. 7
• Do NOT use only a single dose: Single-dose regimens (200,000 IU once) have not shown significant mortality reduction (RR 0.77), unlike the two-dose protocol. 4, 5
• Do NOT assume all children need only one dose: Complicated measles always requires the second dose on day 2. 3, 1

Post-Exposure Prophylaxis for Contacts

For exposed children with contraindications to vaccination:

• Standard dose: Immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1, 2
• Immunocompromised children: IG 0.5 mL/kg body weight (maximum 15 mL) 1, 2, 7
• Measles vaccine: May provide protection if administered within 72 hours of exposure 1, 2

Isolation Requirements

Isolate the child for at least 4 days after rash onset, as the infectious period extends from 4 days before through 4 days after rash appearance. 7 Isolation is not indicated in emergency camp settings but is essential in healthcare facilities with airborne precautions. 3, 1