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), have them wear a medical mask, and implement strict airborne precautions with N95 respirators for all staff—regardless of immunity status—while simultaneously notifying public health authorities. 1

Immediate Infection Control Measures

Patient Isolation Protocol

• Place the patient in an airborne-infection isolation room (negative air-pressure) as soon as possible upon arrival 1
• If no airborne isolation room is available, use a private room with the door closed and ensure the patient wears a medical mask 1
• The patient should wear a medical mask immediately upon recognition of suspected measles 1, 2
• Maintain isolation until at least 4 days after rash onset, as patients are infectious from 4 days before through 4 days after rash appears 1, 2

Healthcare Worker Protection

• All staff entering the room must use N95 respirators or equivalent respiratory protection, regardless of presumptive immunity status, due to the ~1% vaccine failure rate 1, 3
• Only staff with presumptive evidence of immunity should enter the room when possible 1
• Surgical masks are inadequate—N95 respirators are mandatory for airborne precautions 3, 4

Room Clearance After Exposure

• Allow 30-60 minutes for air exchanges before anyone enters the room after the patient leaves, depending on air exchange rates (30 minutes for ≥12 ACH, 60 minutes for 6 ACH) 3
• If air exchange rate is unknown, wait a minimum of 60 minutes 3

Diagnostic Confirmation

Laboratory Testing

• Obtain serum for measles-specific IgM antibodies—the primary diagnostic test 1, 5
• Collect specimens for viral RNA detection (throat/nasopharyngeal swabs, urine, or oral fluid) as close to rash onset as possible 1
• Contact local or state health department immediately for guidance on specimen collection and shipping 1
• Do not delay control measures while awaiting laboratory confirmation 1

Treatment Approach

Supportive Care

• Treatment is primarily supportive, as no specific antiviral therapy exists for measles 5
• Administer vitamin A supplementation to reduce morbidity and mortality 5
• Monitor for and treat secondary bacterial infections (otitis media, pneumonia) with antibiotics 5
• Provide rehydration for severe diarrhea 5

Special Populations Requiring Aggressive Management

• Pregnant patients, immunocompromised individuals, and unvaccinated persons may require more intensive management 4
• Consider intravenous immunoglobulin or ribavirin in severe cases 4

Post-Exposure Prophylaxis for Contacts

Immediate Contact Assessment

• Identify all persons exposed during the infectious period (4 days before through 4 days after rash onset) 2, 3
• Evaluate all contacts immediately for presumptive evidence of measles immunity 1

Vaccination Strategy

• Administer MMR vaccine within 72 hours of exposure to prevent or modify disease 1
• Even if beyond 72 hours, vaccinate to provide future protection 1
• Healthcare workers without immunity should receive first MMR dose immediately and be excluded from work days 5-21 after exposure 1, 2

Immune Globulin Administration

• Offer intramuscular immune globulin (0.25 mL/kg or 40 mg IgG/kg) within 6 days of exposure for susceptible contacts who cannot be vaccinated 1, 3
• Preferred for infants <12 months who are household contacts 1
• If immune globulin is given, observe for symptoms for 28 days (not 21) as it may prolong the incubation period 1, 2

Exclusion Criteria

• Healthcare workers without immunity who are not vaccinated post-exposure must be excluded from all patient contact from day 5 through day 21 after exposure, even if they received immune globulin 1
• Those with one documented vaccine dose may remain at work but should receive the second dose 1

Public Health Notification

• Contact local or state health department immediately when measles is suspected—one confirmed case is an urgent public health situation 1
• All suspected cases must be investigated promptly due to rapid disease spread potential 1
• Persons unable to provide acceptable evidence of immunity should be vaccinated or excluded from the outbreak setting 1

Common Pitfalls to Avoid

• Do not rely on surgical masks—only N95 respirators provide adequate protection against airborne measles transmission 3, 4
• Do not assume vaccinated healthcare workers are completely protected; all staff require N95 respirators due to ~1% vaccine failure rate 1, 3
• Do not underestimate the pre-rash infectious period—transmission occurs 4 days before rash when diagnosis is not yet apparent 1, 2
• Do not fail to maintain isolation for the full 4 days after rash onset 2
• Do not delay contact tracing, as exposed susceptible individuals have a >90% attack rate and require immediate intervention 3
• Do not continue patient care with healthcare workers lacking measles immunity 6