What is the treatment approach for measles?

Measles Treatment

Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all patients, aggressive management of secondary bacterial infections, and strict isolation protocols—there is no specific antiviral therapy available. 1, 2, 3

Immediate Actions Upon Diagnosis

Isolate the patient immediately for at least 4 days after rash onset, as measles remains contagious from 4 days before through 4 days after rash appearance. 1

• Implement airborne precautions with N95 respirators for all healthcare personnel, regardless of immunity status. 1, 3
• Contact local or state health department immediately—one confirmed measles case constitutes an urgent public health situation requiring prompt investigation. 1
• Place patient in an airborne-infection isolation room. 3

Vitamin A Supplementation (Critical Intervention)

Administer vitamin A supplementation on day 1 of clinical encounter—this is the only evidence-based intervention proven to reduce measles mortality. 1, 2, 3

Dosing Protocol:

• Children ≥12 months: 200,000 IU orally on day 1. 1, 2, 3
• Children <12 months: 100,000 IU orally on day 1. 4, 1, 2
• Complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems): Administer a second identical dose on day 2. 4, 1, 2, 3

For Vitamin A Deficiency with Eye Symptoms:

If any eye symptoms are observed (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), follow this schedule: 4

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

Management of Complications

Treat secondary bacterial infections aggressively with appropriate antibiotics, as bacterial superinfections are common and contribute significantly to morbidity and mortality. 2, 3, 5

• Pneumonia: Standard antibiotic treatment for acute lower respiratory infections. 4, 1, 2
• Otitis media: Appropriate antibiotic therapy. 3
• Diarrhea: Oral rehydration therapy (ORT). 4, 1, 2, 3
• Monitor nutritional status and enroll in feeding programs if indicated. 4, 1, 2, 3

Diagnostic Confirmation

Collect serum for measles-specific IgM antibody testing during the first clinical encounter, even before laboratory results return. 1, 2, 3

• 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. 1, 2, 3
• Consider molecular characterization of measles virus from urine or nasopharyngeal specimens for public health tracking. 1, 2

Post-Exposure Prophylaxis for Contacts

Measles vaccine may provide protection if administered within 72 hours (3 days) of exposure. 4, 1, 3

Immune Globulin (IG) Administration:

For persons with contraindications to vaccination requiring immediate protection: 1, 2, 3

• Standard dose: 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure
• Immunocompromised persons: 0.5 mL/kg body weight (maximum 15 mL) regardless of vaccination status 1, 2, 3
• Pregnant women: 0.25 mL/kg body weight (maximum 15 mL) within 6 days of exposure 1

Critical Pitfalls to Avoid

Do not delay vitamin A supplementation—administer on day 1 of clinical encounter, as this directly impacts mortality. 1, 2

• Do not consider undernutrition a contraindication for measles vaccination; it should be considered a strong indication for vaccination. 4, 2
• Do not assume fever, respiratory tract infection, or diarrhea are contraindications for measles vaccination—they are not. 4
• Do not underestimate transmission risk—measles is highly contagious through aerosols, with exposed healthcare workers without immunity requiring exclusion from work days 5-21 following exposure. 3, 5
• Do not assume vaccination history provides complete protection—approximately 5% of children who receive only one dose of MMR vaccine fail to develop immunity. 1

Long-Term Neurological Complications

Measles can cause three separate encephalitic illnesses: acute encephalitis or acute disseminated encephalomyelitis, sub-acute encephalopathy, and subacute sclerosing panencephalitis (SSPE). 1

• SSPE risk is particularly elevated in children who acquire measles before age 5 years. 1
• Encephalitis occurs in approximately 1 per 1,000 cases. 3
• Permanent sequelae can include paralysis, seizures, cranial nerve palsies, aqueductal stenosis, hydrocephalus, and sensorineural deafness. 4

Special Populations

Immunocompromised persons may experience severe and prolonged measles without the typical rash and may shed measles virus for several weeks after acute illness. 4

Pregnant women with measles experience increased rates of premature labor, spontaneous abortion, and low birth weight among affected infants. 4