What are the treatment and prevention options for a patient suspected of having measles?

Management of Suspected Measles

Immediately isolate the patient in an airborne-infection isolation room (negative pressure) and implement strict airborne precautions with N95 respirators for all staff, regardless of immunity status, as the patient is contagious from 4 days before through 4 days after rash onset. 1, 2

Immediate Infection Control Measures

• Place the patient in a medical mask immediately upon arrival and transfer to an airborne-infection isolation room (negative air-pressure room) as soon as possible 1
• If no isolation room is available, use a private room with the door closed and maintain mask use 1
• All healthcare personnel entering the room must use N95 respirators or equivalent respiratory protection, even if they have documented immunity, due to the ~1% possibility of vaccine failure 1, 3
• Only staff with presumptive evidence of immunity (2 documented MMR doses, laboratory evidence of immunity, laboratory-confirmed disease, or birth before 1957) should provide care when possible 1
• Maintain isolation for at least 4 days after rash onset 1, 2, 4

Treatment Protocol

Vitamin A Supplementation (Critical for Reducing Mortality)

All patients with clinical measles should receive vitamin A supplementation immediately:

• Adults and children ≥12 months: 200,000 IU orally on day 1 4
• Children <12 months: 100,000 IU orally on day 1 4
• Administer a second dose of the same amount on day 2 for complicated cases (pneumonia, otitis media, croup, diarrhea with dehydration, or neurological complications) 4
• For patients with eye symptoms of vitamin A deficiency: give 200,000 IU on day 1, day 2, and again 1-4 weeks later 4

This is the only evidence-based intervention proven to reduce measles morbidity and mortality 4

Supportive Care

• Monitor and treat complications with standard therapies: oral rehydration for diarrhea, antibiotics for bacterial superinfections (pneumonia, otitis media) 4
• Assess nutritional status and provide feeding support as indicated 4
• Management is primarily supportive; no specific antiviral therapy is routinely recommended 5

Diagnostic Confirmation

• Collect serum for measles IgM antibody testing (most common confirmatory test) as soon as possible after rash onset 1, 5
• Collect urine or nasopharyngeal specimens for viral isolation and genetic characterization as close to rash onset as possible (delay reduces isolation success) 1
• Contact local or state health department immediately when measles is suspected—this is an urgent public health situation requiring prompt investigation 1
• Do not delay control activities while awaiting laboratory confirmation 1

Post-Exposure Prophylaxis for Contacts

For Susceptible Contacts (No Evidence of Immunity)

Evaluate all contacts immediately for presumptive evidence of measles immunity:

• MMR vaccine within 72 hours of exposure can prevent or modify disease 1, 3, 4
• Immune globulin (IG) 0.25 mL/kg intramuscularly (maximum 15 mL) within 6 days of exposure for those who cannot receive MMR 1, 4
• Pregnant women: IG 0.25 mL/kg (maximum 15 mL) within 6 days 4
• Immunocompromised patients: IG 0.5 mL/kg (maximum 15 mL) regardless of vaccination status 4

Healthcare Personnel Management

• HCP without evidence of immunity should receive MMR vaccine and be excluded from work from day 5-21 following exposure 1
• HCP who refuse vaccination after exposure must be excluded from day 5 after first exposure through day 21 after last exposure, even if they received IG 1
• HCP with 1 documented dose may remain at work but should receive the second dose 1
• HCP who develop measles must be excluded from work until ≥4 days following rash onset 1, 2

Observation Periods

• Standard observation: 21 days after exposure 1, 3, 4
• If IG was administered: extend observation to 28 days (IG prolongs incubation period) 1, 3, 4

Outbreak Control Measures

• Vaccinate or exclude from the outbreak setting (school, daycare, hospital) all persons who cannot provide acceptable evidence of immunity 1
• Persons exempt from vaccination for medical or religious reasons must be excluded until 21 days after rash onset in the last case 1, 2
• In daycare/school outbreaks: revaccinate all attendees and siblings who lack 2 documented doses of measles-containing vaccine 1
• For infants 6-11 months in outbreak settings: may vaccinate early (requires revaccination at 12-15 months and before school entry) 1
• Mass community revaccination is generally not necessary 1

Critical Pitfalls to Avoid

• Do not use regular surgical masks—N95 respirators are required for airborne precautions 2, 4
• Do not forget that patients are contagious 4 days before rash onset, making early transmission likely before diagnosis 2, 4
• Do not omit vitamin A supplementation—this is the only intervention proven to reduce mortality 4
• Do not allow HCP without proper immunity to provide care, even in emergencies 2, 4
• Do not terminate isolation before the full 4 days after rash onset 2, 4
• Do not delay public health notification—one confirmed case constitutes an urgent public health emergency requiring immediate action 1