What are the post-discharge care recommendations for a patient who has been hospitalized for measles?

Post-Discharge Care for Hospitalized Measles Patients

Patients hospitalized with measles should remain isolated at home until at least 4 days after rash onset, with close monitoring for complications including pneumonia, encephalitis, and secondary bacterial infections, while ensuring household contacts without immunity receive immediate MMR vaccination or immune globulin prophylaxis. 1

Isolation and Infectivity Period

• The patient must remain in home isolation until at least 4 days following rash onset, as measles infectivity extends from 4 days before rash through 4 days after rash appearance 1, 2
• During home isolation, the patient should remain in a separate room with the door closed when other household members are present, particularly if any contacts lack immunity 1
• All household members and close contacts should be immediately evaluated for presumptive evidence of measles immunity 1

Contact Management and Prophylaxis

Immediate assessment of all household and close contacts is critical to prevent secondary transmission:

• Contacts without evidence of immunity should receive MMR vaccine within 72 hours of exposure, as this can prevent or modify disease 1
• For contacts who cannot receive MMR (immunocompromised, pregnant, infants <12 months), administer intramuscular immune globulin 0.25 mL/kg (40 mg IgG/kg) as soon as possible 1
• Unvaccinated contacts who do not receive prophylaxis must be quarantined from day 5 through day 21 after exposure 1
• If immune globulin is administered, monitor for measles symptoms for 28 days (rather than 21 days) as immune globulin may prolong the incubation period 1

Monitoring for Complications

Given that 23% of measles cases require hospitalization and complications are common, vigilant post-discharge monitoring is essential: 1, 3

Respiratory Complications

• Monitor for signs of pneumonia (most common serious complication): fever recurrence, increased cough, dyspnea, chest pain 3, 4, 5
• Watch for respiratory insufficiency and other respiratory disorders, which were among the most frequent complications in hospitalized children 5
• Secondary bacterial pneumonia requires prompt antibiotic treatment 3, 4

Neurological Complications

• Assess for acute disseminated encephalomyelitis: altered mental status, seizures, focal neurological deficits (can occur during or shortly after acute illness) 3
• Educate families about rare but serious delayed complications including measles inclusion body encephalitis (months later, particularly in immunocompromised) and subacute sclerosing panencephalitis (years later) 3, 5

Other Complications

• Monitor for otitis media, laryngotracheobronchitis, stomatitis, and feeding problems 3, 5
• Assess for severe diarrhea requiring rehydration 3

Nutritional Support and Vitamin A

• All children with measles should receive vitamin A supplementation regardless of country of residence: 200,000 IU for children ≥12 months, 100,000 IU for children <12 months 6
• This reduces risk of blindness and other complications, even in developed countries 6
• Address any nutritional deficiencies identified during hospitalization 3

Follow-Up Care Structure

• Schedule follow-up within 3-5 days post-discharge to assess for complications and ensure adequate recovery 3
• Provide clear written instructions on warning signs requiring immediate medical attention: difficulty breathing, altered mental status, persistent high fever, inability to maintain hydration 7, 3
• Ensure the patient has a designated healthcare contact for questions during the isolation period 7

Special Populations Requiring Enhanced Monitoring

Certain patients require more intensive post-discharge surveillance:

• Immunocompromised patients: higher risk for measles inclusion body encephalitis and prolonged viral shedding 3
• Pregnant women: increased risk of severe complications and adverse pregnancy outcomes 7
• Infants and young children: higher mortality and complication rates 6
• Patients who required ICU admission during hospitalization: closer follow-up for residual complications 1

Public Health Reporting

• Ensure the case has been reported to local public health authorities for contact tracing 7
• Cooperate with public health investigation to identify all potential exposures during the infectious period 1

Common Pitfalls to Avoid

• Do not allow the patient to return to work, school, or public spaces before completing the full 4-day post-rash isolation period, even if symptoms improve 1
• Do not assume household contacts born before 1957 are immune—during outbreaks, facilities should recommend 2 doses of MMR even for those born before 1957 without laboratory evidence of immunity 1
• Do not delay contact prophylaxis—MMR effectiveness decreases significantly if given >72 hours post-exposure 1
• Do not rely solely on surgical masks for airborne precautions if the patient requires re-evaluation in healthcare settings—N95 respirators and airborne isolation rooms are mandatory 1, 2