Treatment of Measles
Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all children—there is no specific antiviral therapy available. 1, 2
Vitamin A Supplementation (Critical for Reducing Mortality)
All children with clinical measles must receive vitamin A supplementation on day 1: 1, 2
For complicated measles (pneumonia, encephalitis, hospitalization, or immunocompromised status), administer a second identical dose on day 2. 1, 2
For vitamin A deficiency with eye symptoms, give an additional dose 1-4 weeks later. 2
The evidence strongly supports this approach: two doses of 200,000 IU vitamin A reduce mortality risk by 64%, with water-based formulations showing 81% mortality reduction compared to 48% with oil-based preparations. 3 The effect is most pronounced in children under 2 years, with 82% reduction in mortality risk and 67% reduction in pneumonia-specific mortality. 3 Vitamin A deficiency increases measles severity and mortality, making supplementation critical regardless of nutritional status. 1
Management of Complications
Treat secondary bacterial infections aggressively with appropriate antibiotics: 1, 2
- Pneumonia: Standard antibiotic treatment (pneumonia is the most common cause of measles-related death) 2, 4
- Otitis media: Appropriate antibiotic therapy 2
- Diarrhea: Oral rehydration therapy 1, 2
Monitor nutritional status and enroll in feeding programs if indicated. 1, 2
Common complications occur frequently: diarrhea is most frequent, followed by otitis media and bronchopneumonia, while encephalitis occurs in approximately 1 per 1,000 cases. 2 Vitamin A supplementation reduces croup incidence by 47% and shortens diarrhea duration by nearly 2 days. 3
Post-Exposure Prophylaxis
For unvaccinated persons exposed to measles: 1, 2
- Measles vaccine within 72 hours of exposure may provide protection 2
- Immune globulin (IG) for persons with contraindications to vaccination: 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1, 2
- Immunocompromised persons: 0.5 mL/kg body weight (maximum 15 mL) of IG 1, 2
Diagnostic Confirmation
Collect serum for measles IgM antibody testing during the first clinical encounter. 1, 2
If IgM testing is negative within 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset. 1, 2
Consider molecular characterization from urine or nasopharyngeal specimens. 1
Infection Control in Healthcare Settings
Implement strict airborne precautions immediately: 2
- Airborne-infection isolation rooms required 2
- N95 respirators mandatory for all healthcare personnel regardless of immunity status 2
- The infectious period is 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 withhold measles vaccination due to undernutrition—it should be considered a strong indication for vaccination, not a contraindication. 1
Do not assume healthcare workers born before 1957 are immune—up to 9.3% may be susceptible to measles. 4
Do not give only a single dose of vitamin A in complicated cases—two doses significantly improve outcomes. 1, 2, 3
High-Risk Populations Requiring Aggressive Management
Infants, young children, adults, immunocompromised individuals (especially those with leukemia, lymphoma, or HIV), and pregnant women face higher mortality risk. 4, 5 Pregnant women experience increased rates of premature labor, spontaneous abortion, and low birth weight infants. 4