What is the recommended treatment and management for a patient with measles?

Management of Measles

Immediately isolate the patient for at least 4 days after rash onset, implement airborne precautions with N95 respirators, provide supportive care with vitamin A supplementation (200,000 IU for adults and children ≥12 months, 100,000 IU for infants <12 months), and report the case urgently to public health authorities. 1, 2, 3

Immediate Actions: Isolation and Infection Control

Isolation is critical because patients are contagious from 4 days before through 4 days after rash onset. 1, 2

• Place the patient in an airborne-infection isolation room (negative air-pressure) immediately upon arrival 4, 1
• If no isolation room is available, use a private room with the door closed and have the patient wear a medical mask 4, 1
• All healthcare workers entering the room must wear N95 respirators or equivalent respiratory protection, regardless of their immunity status 4, 1
• Only staff with presumptive evidence of immunity should provide direct care when possible 4
• Maintain isolation until at least 4 days after rash onset 1, 2, 3

Mandatory Reporting and Diagnostic Confirmation

Report suspected and confirmed cases immediately to local or state health department—one case constitutes a public health emergency. 4, 2

• Collect blood for measles-specific IgM antibody testing during the first clinical encounter 4, 2
• Do not delay isolation or control measures while awaiting laboratory results 4, 2
• If IgM is negative within the first 72 hours of rash onset, obtain a second specimen at least 72 hours after rash onset, as IgM may not be detectable early 4, 2
• IgM peaks approximately 10 days after rash onset and remains detectable for at least 1 month 4, 2

Essential Treatment: Vitamin A Supplementation

Vitamin A is the only evidence-based intervention proven to reduce measles mortality and must be given to all patients with clinical measles. 2, 3

Standard Dosing Protocol:

• Adults and children ≥12 months: 200,000 IU orally on day 1 2, 3
• Infants <12 months: 100,000 IU orally on day 1 2, 3

Complicated Measles (pneumonia, otitis media, croup, diarrhea with dehydration, neurological problems):

• Give a second dose of vitamin A on day 2 (same dosing as day 1) 2, 3

Eye Symptoms of Vitamin A Deficiency (xerosis, Bitot's spots, keratomalacia, corneal ulceration):

• Give 200,000 IU on day 1,200,000 IU on day 2, and a third dose of 200,000 IU at 1-4 weeks 2, 3

Supportive Care and Complication Management

Treatment is primarily supportive, as there is no specific antiviral therapy for measles. 5

• Monitor for and treat bacterial superinfections (otitis media, pneumonia) with appropriate antibiotics 2, 3, 5
• Provide oral rehydration therapy for diarrhea 2, 3
• Monitor nutritional status and consider feeding programs if indicated 3
• Watch for neurological complications (acute disseminated encephalomyelitis, measles inclusion body encephalitis, subacute sclerosing panencephalitis) 5

Post-Exposure Prophylaxis for Contacts

Evaluate all contacts immediately for evidence of measles immunity and provide post-exposure prophylaxis when indicated. 4

For Susceptible Contacts Without Immunity:

• MMR vaccine within 72 hours of exposure may provide protection 4, 2
• Immune globulin (IG) within 6 days of exposure if vaccine is contraindicated 4

Dosing for Immune Globulin:

• Immunocompromised patients: 0.5 mL/kg (maximum 15 mL) regardless of vaccination status 2, 3
• Pregnant women: 0.25 mL/kg (maximum 15 mL) 2, 3
• Other nonimmunocompromised persons: 0.25 mL/kg (40 mg IgG/kg) 4

Work Exclusion for Healthcare Personnel:

• Healthcare workers without evidence of immunity should receive MMR vaccine and be excluded from work from day 5-21 following exposure 4
• Healthcare workers who develop measles should be excluded from work until ≥4 days following rash onset 4, 1

Outbreak Control Measures

During outbreaks, rapid vaccination without serologic screening is essential to halt disease transmission. 4

• Vaccinate or exclude persons without acceptable evidence of immunity from the outbreak setting 2
• Quarantine susceptible contacts until 21 days after their last exposure 4
• If immune globulin is administered, extend observation period to 28 days after exposure, as IG may prolong the incubation period 4, 1

Common Pitfalls to Avoid

• Do not use regular surgical masks—N95 respirators are required for airborne precautions 1, 3
• Do not forget vitamin A supplementation—this is the only intervention that reduces mortality 2, 3
• Do not end isolation early—maintain for the full 4 days after rash onset 1, 3
• Do not miss the contagious period before rash onset—patients are infectious 4 days before rash appears, making early recognition difficult 1, 3
• Do not allow healthcare workers without proper immunity to provide care 1, 3