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

Vitamin A Supplementation (Critical Intervention)

Administer 200,000 IU of vitamin A orally on day 1 for all children ≥12 months of age—this is the only evidence-based intervention proven to reduce measles mortality. 1, 2, 3

• Children <12 months of age should receive 100,000 IU orally on day 1. 4, 2, 3
• For complicated measles (pneumonia, otitis media, croup, diarrhea with moderate or severe dehydration, or neurological problems), administer a second dose of the same amount on day 2. 4, 1, 2
• If any eye symptoms of vitamin A deficiency are observed (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer 200,000 IU on day 1, day 2, and again 1-4 weeks later (half doses for children <12 months). 4, 3
• Vitamin A deficiency increases severity and mortality; supplementation is critical even in well-nourished children. 1, 2

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

• For acute lower respiratory infections (pneumonia, bronchopneumonia): use standard antibiotic treatment protocols. 4, 2, 3
• For otitis media: provide appropriate antibiotic therapy. 3
• For diarrhea: administer oral rehydration therapy (ORT). 4, 2, 3
• Monitor nutritional status continuously and enroll in feeding programs if indicated. 4, 2, 3

Post-Exposure Prophylaxis for Contacts

Measles vaccine may provide protection or modify disease severity if administered within 3 days of exposure. 4, 1, 2

• For persons with contraindications to vaccination requiring immediate protection: administer immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure. 1, 2, 3
• For immunocompromised persons: administer IG 0.5 mL/kg body weight (maximum 15 mL) regardless of vaccination status. 1, 2, 3
• For pregnant women: administer IG 0.25 mL/kg (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 and morbidity. 1, 2

• Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination. 4, 2
• Fever, respiratory tract infection, and diarrhea are NOT contraindications for measles vaccination. 4
• Do not underestimate transmission risk—measles is highly contagious through aerosols, requiring strict airborne precautions. 1, 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, 5

• SSPE risk is particularly elevated in children who acquire measles before age 5 years. 1
• Encephalitis occurs in approximately 1 per 1,000 cases and can result in permanent neurological sequelae. 3

Special Populations

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

• Measles illness during pregnancy leads to increased rates of premature labor, spontaneous abortion, and low birth weight. 4
• Unimmunized persons infected with HIV should receive the vaccine. 4