What is the management for measles?

Management of Measles

Measles management is primarily supportive care with mandatory vitamin A supplementation for all children, aggressive treatment of secondary bacterial infections, and appropriate isolation precautions to prevent transmission. 1, 2

Vitamin A Supplementation (Critical for Reducing Mortality)

All children with clinical measles must receive vitamin A supplementation on day 1:

• Children ≥12 months: 200,000 IU orally 1, 2
• Children <12 months: 100,000 IU orally 1, 2

For complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems):

• Administer a second identical dose of vitamin A on day 2 3, 1, 2

For vitamin A deficiency with eye symptoms (xerosis, Bitot's spots, keratomalacia, corneal ulceration):

• 200,000 IU on day 1 3
• 200,000 IU on day 2 3
• 200,000 IU at 1-4 weeks later 3, 1
• Children <12 months receive half doses 3

Vitamin A deficiency significantly increases measles severity and mortality; supplementation is not optional. 1

Management of Complications

Treat secondary bacterial infections aggressively with appropriate antibiotics: 1, 2

• Pneumonia: Standard antibiotic treatment 3, 2
• Otitis media: Appropriate antibiotic therapy 2
• Acute lower respiratory infections: Standard antibiotic treatment 3, 1

Diarrhea management:

• Oral rehydration therapy (ORT) 3, 1, 2

Nutritional support:

• Monitor nutritional status of all children with measles 3, 2
• Enroll in feeding programs if indicated 3, 2

Common pitfall: Undernutrition is NOT a contraindication for measles vaccination—it should be considered a strong indication for vaccination. 3, 1

Post-Exposure Prophylaxis

For persons with contraindications to measles vaccination requiring immediate protection:

• Immune globulin (IG) 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure 1, 2

For immunocompromised persons:

• IG 0.5 mL/kg body weight (maximum 15 mL) 1, 2

Measles vaccine for post-exposure prophylaxis:

• May provide protection or modify disease severity if administered within 72 hours (3 days) of exposure 3, 2

For infants <12 months who are household contacts:

• Passive immunization with IG is preferred over vaccination, as they are at highest risk for complications 3

Diagnostic Confirmation

Obtain laboratory confirmation during the first clinical encounter: 2

• Collect serum for measles IgM antibody testing during the first visit 1, 2
• If IgM testing is negative within the first 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1, 2

For epidemiologic tracking:

• Collect urine or nasopharyngeal specimens for measles virus isolation and molecular characterization as close to rash onset as possible 3, 1

Infection Control and Isolation

Implement strict airborne precautions immediately: 2

• Airborne-infection isolation rooms required 2
• N95 respirators mandatory for all healthcare personnel regardless of immunity status 2

Infectious period:

• 4 days before rash onset through 4 days after rash onset 2
• Exposed healthcare workers without immunity must be excluded from work days 5-21 following exposure 2

Important caveat: Isolation of patients with measles is not indicated in emergency refugee camp settings where resources are limited. 3

Special Populations at High Risk

Infants, young children, and adults have greater risk for death from measles complications than older children and adolescents: 3, 4

• Most common causes of death: pneumonia and acute encephalitis 3
• Death occurs in 1-2 per 1,000 reported measles cases in the United States 3

Immunocompromised persons (leukemias, lymphomas, HIV infection):

• Measles can be severe and prolonged 3, 4
• May occur without typical rash 3
• May shed virus for several weeks after acute illness 3

Pregnant women:

• Increased rates of premature labor, spontaneous abortion, and low birth weight 3, 4

No Specific Antiviral Therapy

There is no FDA-approved specific antiviral therapy for measles. 2, 5

Note: While one small study suggested potential benefit of ribavirin 6, this is not supported by major guidelines and ribavirin is not recommended in standard practice for measles treatment. 2, 5