What is the primary treatment approach for a patient with measles?

Measles Treatment

The primary treatment for measles is supportive care with mandatory vitamin A supplementation for all children, as there is no specific antiviral therapy available. 1, 2, 3

Vitamin A Supplementation (Essential Treatment)

All children with clinical measles must receive vitamin A supplementation, which is the only evidence-based intervention proven to reduce measles mortality and morbidity. 1, 2, 3

Standard Dosing Protocol

• Children ≥12 months and adults: 200,000 IU orally on day 1 1, 2, 3
• Children <12 months: 100,000 IU orally on day 1 1, 2, 3
• Day 2 dosing for complicated measles: Repeat the same dose on day 2 for patients with complications including pneumonia, otitis media, croup, diarrhea with dehydration, or neurological problems 1, 2, 3

Extended Dosing for Eye Symptoms

• If any eye symptoms of vitamin A deficiency are present: 200,000 IU on day 1,200,000 IU on day 2, and 200,000 IU at 1-4 weeks later 1, 3

Supportive Care and Complication Management

Treatment focuses on managing complications with standard therapies, as measles itself has no specific antiviral treatment. 2, 3, 4

Specific Interventions by Complication

• Diarrhea (most frequent complication): Oral rehydration therapy 2, 3
• Pneumonia and acute lower respiratory infections: Standard antibiotic treatment for secondary bacterial infections 2, 3
• Otitis media: Appropriate antibiotic therapy 3
• Nutritional support: Monitor nutritional status and enroll in feeding programs if indicated 1, 2, 3

Isolation and Infection Control

Immediate isolation is mandatory for at least 4 days after rash onset, as patients remain contagious from 4 days before through 4 days after rash appearance. 1, 3

• Healthcare worker protection: All staff entering the room must wear N95 respirators (not surgical masks), regardless of immunity status 1, 3
• Airborne precautions: Use airborne-infection isolation rooms 3
• Staff restrictions: Only personnel with presumptive evidence of immunity should provide care 1

Post-Exposure Prophylaxis (For Exposed Contacts)

Immunocompetent Persons

• Measles vaccine: May provide protection if administered within 72 hours of exposure 2, 3
• Immune globulin (IG): 0.25 mL/kg body weight (maximum 15 mL) as soon as possible after exposure for those with contraindications to vaccination 2, 3

Special Populations

• Immunocompromised patients: 0.5 mL/kg IG (maximum 15 mL) regardless of vaccination status 1, 2, 3
• Pregnant women: 0.25 mL/kg IG (maximum 15 mL) within 6 days of exposure 1

Diagnostic Confirmation

Laboratory confirmation should be obtained during the first clinical encounter to guide public health response. 2, 3

• Primary test: Serum measles IgM antibody testing during first visit 2, 3
• If negative within 72 hours of rash onset: Obtain another specimen at least 72 hours after rash onset 2, 3
• Viral isolation: Collect urine or nasopharyngeal specimens for molecular characterization as close to rash onset as possible 5, 2

Common Pitfalls to Avoid

• Do not use surgical masks instead of N95 respirators for healthcare workers, as measles is airborne 1, 3
• Do not forget vitamin A supplementation – this is critical and often overlooked, yet it is the only intervention proven to reduce mortality 1
• Do not end isolation early – maintain full 4 days after rash onset 1, 3
• Do not assume vitamin A supplementation in the previous month – confirm before withholding the dose 1
• Do not delay antibiotic treatment for secondary bacterial infections – these are common and can be severe 3, 4