From the Guidelines
Measles presents with a characteristic progression of symptoms, including fever, cough, runny nose, and red, watery eyes, followed by a distinctive red, blotchy rash, and treatment is primarily supportive care with no specific antiviral therapy, emphasizing the importance of vaccination as the most effective prevention strategy. The clinical presentation of measles is marked by a prodrome of cough, coryza, and conjunctivitis with fever, followed by a maculopapular or morbilliform rash that begins on the face and spreads downward to the trunk and out to the extremities, as described in the study by 1. Koplik spots, which are considered pathognomonic, also appear during the prodrome. Patients are contagious 4 days before the rash to 4 days after the rash appears.
The treatment for measles includes rest, adequate fluid intake to prevent dehydration, and antipyretics like acetaminophen or ibuprofen to reduce fever. Vitamin A supplementation is recommended for all children with measles, with a second dose given the next day, as it has been shown to reduce the severity of the disease. Antibiotics are only indicated if bacterial complications like pneumonia or ear infections develop. Isolation is crucial to prevent transmission, with patients remaining isolated for four days after rash onset.
Measles is highly contagious due to the respiratory spread of the virus, and vaccination remains the most effective prevention strategy, as highlighted in the study by 1, which recommends the use of the measles, mumps, and rubella vaccine (PRIORIX) for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The study also notes that vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications.
Some key points to consider in the treatment and prevention of measles include:
- The importance of vaccination in preventing measles, as emphasized in the study by 1
- The use of supportive care, including rest, fluid intake, and antipyretics, in the treatment of measles
- The recommendation for vitamin A supplementation in children with measles, as noted in the example answer
- The need for isolation to prevent transmission, with patients remaining isolated for four days after rash onset
- The potential for measles vaccine to provide some protection or modify the clinical severity of the disease if administered within 3 days of exposure, as noted in the study by 1.
From the Research
Clinical Presentation of Measles
- Measles typically begins with fever, runny nose, cough, and pathognomonic enanthem (Koplik spots) followed by a characteristic erythematous, maculopapular rash 2
- The rash classically begins on the face and becomes more confluent as it spreads cephalocaudally 2
- Complications occur in 10% to 40% of patients, and can include pneumonia, which accounts for most measles-associated morbidity and mortality 2, 3
- Severe forms of measles are reported, mainly in young, unvaccinated adults, and in specific populations, with risk factors including no or incomplete vaccination and vitamin A deficiency 4
Treatment of Measles
- Treatment is mainly symptomatic, with bacterial superinfections, if present, being properly treated with antibiotics 2
- Vitamin A is recommended for the treatment of measles, particularly in areas where vitamin A deficiency may be present, with a reduction in mortality and pneumonia-specific mortality seen in children given two doses of 200,000 IU of vitamin A 5
- Ribavirin may also be a treatment option for severe cases of measles, with some studies showing significant improvements in morbidity and mortality with its use, particularly when combined with vitamin A 6, 4
- The World Health Organization recommends administration of an oral dose of 200,000 IU (or 100,000 IU in infants) of vitamin A per day for two days to children with measles in areas where vitamin A deficiency may be present 5