What are the safety measures and treatment options for individuals with active measles?

Safety Measures and Treatment for Active Measles

Individuals with active measles must be isolated for at least 4 days after rash onset, receive vitamin A supplementation (200,000 IU for adults and children ≥12 months), and be managed with supportive care while implementing strict airborne precautions with N95 respirators for all healthcare personnel. 1, 2

Isolation Requirements

The infectious period extends from 4 days before rash onset through 4 days after rash onset, making immediate isolation critical. 1, 2

Healthcare Setting Isolation Protocol

• Place patients immediately in an airborne-infection isolation room (negative air-pressure room) upon suspected measles 3, 1
• If no isolation room is available, use a private room with the door closed 3, 1
• Patients must wear a medical mask immediately upon arrival 1, 2
• Maintain isolation for the full 4 days after rash onset—not a day less 1, 2

Healthcare Worker Management

• Healthcare workers who develop measles must be excluded from work until ≥4 days following rash onset 3, 1
• Only staff with presumptive evidence of immunity should enter the patient's room when possible 3, 1
• All staff entering the room must use N95 respirators or equivalent respiratory protection, regardless of immunity status, due to ~1% vaccine failure rate 3, 1, 4
• Exposed healthcare workers without immunity must be offered MMR vaccine and excluded from work from day 5-21 following exposure 3, 1

Essential Treatment: Vitamin A Supplementation

Vitamin A is the only evidence-based intervention proven to reduce measles morbidity and mortality and must not be omitted. 2

Dosing Protocol

• Adults and children ≥12 months: 200,000 IU orally on day 1 2
• Children <12 months: 100,000 IU orally on day 1 2
• Give a second dose on day 2 for complicated measles 2
• For patients with eye symptoms of vitamin A deficiency, give a third dose 1-4 weeks later 2

Supportive Care and Complication Management

Treatment is primarily supportive, as no specific antiviral therapy exists for measles 5, 6.

Core Supportive Measures

• Monitor nutritional status and enroll in feeding programs if indicated 2
• Provide oral rehydration therapy for diarrhea 2
• Treat bacterial superinfections (otitis media, pneumonia, laryngotracheobronchitis) with appropriate antibiotics 2, 5
• Monitor for neurological complications including acute disseminated encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis 5

Common Complications Requiring Treatment

• Pneumonia occurs frequently and is one of the most lethal complications 7
• Otitis media, stomatitis, and diarrhea are common and require standard therapies 2, 5
• Encephalitis or death occurs in approximately 1 per 1,000 cases, with highest risk in adults and infants 4

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
• Face higher risk of severe complications and prolonged viral shedding 4
• May require consideration of ribavirin in severe cases 6

Pregnant Women

• Should have received IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure 2
• Face increased rates of spontaneous abortion, premature labor, and low birth weight 4
• Require hospitalization more frequently than non-pregnant adults 4

Unvaccinated Patients

• Require more aggressive management and monitoring 6
• Should receive post-exposure prophylaxis with MMR vaccine within 72 hours of exposure if not yet symptomatic 3

Post-Exposure Prophylaxis for Contacts

Rapid intervention for exposed contacts is essential to prevent further transmission. 3, 1

Vaccination Approach

• MMR vaccine is effective if administered within 72 hours of measles exposure 3
• Contacts without evidence of immunity should be offered the first dose of MMR vaccine immediately 3, 1
• Those with documentation of 1 vaccine dose should receive the second dose 3

Immune Globulin Approach

• For contacts who cannot receive vaccine, offer intramuscular immune globulin 0.25 mL/kg (40 mg IgG/kg) for non-immunocompromised persons 3
• Must be administered within 6 days of exposure 2
• If immune globulin is given, observation should continue for 28 days after exposure as it may prolong the incubation period 3, 1

Quarantine Requirements

• Contacts without presumptive evidence of immunity who are not vaccinated or given immune globulin should be quarantined until 21 days after exposure 3, 1
• In outbreak settings, susceptible individuals exempt from vaccination should be excluded until 21 days after rash onset in the last case 1

Critical Pitfalls to Avoid

Isolation Failures

• Do not end isolation before the full 4 days after rash onset 1, 2
• Remember patients are contagious 4 days before rash onset when diagnosis is not yet apparent—this is when most transmission occurs 1, 2
• Do not use regular surgical masks instead of N95 respirators—they are insufficient for airborne precautions 1, 2

Treatment Omissions

• Never forget vitamin A supplementation—it is the only intervention proven to reduce mortality 2
• Do not delay treatment of bacterial superinfections with appropriate antibiotics 2
• Do not neglect nutritional assessment and rehydration needs 2

Healthcare Worker Safety

• Do not allow healthcare workers without proper immunity to care for measles patients 1
• Do not assume two doses of MMR vaccine provides absolute protection—all staff must use N95 respirators due to ~1% vaccine failure rate 3, 4
• Do not allow exposed healthcare workers without immunity to continue working during days 5-21 post-exposure 3, 1

Post-Exposure Management

• Do not delay post-exposure prophylaxis—MMR vaccine must be given within 72 hours and immune globulin within 6 days to be effective 3, 2
• Do not assume immune globulin recipients are immediately safe—continue observation for 28 days as it may prolong incubation 3, 1