Treatment of Measles in Pediatric and Immunocompromised Patients
Immediate Vitamin A Supplementation is Mandatory
All children with clinical measles must receive vitamin A supplementation on day 1, as this is the only evidence-based intervention proven to reduce measles mortality. 1, 2
Standard Vitamin A Dosing Protocol
- Children ≥12 months and adults: 200,000 IU orally on day 1 1, 2
- Children <12 months (including infants under 6 months): 100,000 IU orally on day 1 1, 3
- For complicated measles: Administer a second identical dose on day 2 1, 2, 3
- If eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, corneal ulceration): Give a third dose of 200,000 IU (or 100,000 IU for infants <12 months) 1-4 weeks after the initial doses 2
The vitamin A protocol is safe and toxicity is not a concern with standard dosing, as acute toxicity requires >300,000 IU in adults or >60,000 IU in children within hours/days. 2
Supportive Care and Complication Management
Treatment is primarily supportive, as there is no approved antiviral therapy for measles. 1, 4, 5
Treat Secondary Bacterial Infections Aggressively
- Pneumonia: Use standard antibiotic treatment protocols 1
- Otitis media: Provide appropriate antibiotic therapy 1
- Diarrhea: Administer oral rehydration therapy 1, 2
- Monitor nutritional status and enroll in feeding programs if indicated 1, 2
Common complications include diarrhea (most frequent), otitis media, bronchopneumonia, and encephalitis (approximately 1 per 1,000 cases). 1 Immunocompromised patients, including pediatric solid organ transplant recipients, are at particularly high risk for severe or atypical presentations, including lack of rash, encephalitis, and pneumonitis, with mortality rates up to 33%. 6
Post-Exposure Prophylaxis for High-Risk Patients
Immunocompromised Patients
Administer immune globulin (IG) 0.5 mL/kg body weight (maximum 15 mL) as soon as possible after exposure for immunocompromised persons, regardless of vaccination status. 1, 2
Other High-Risk Groups
- Persons with contraindications to measles vaccination: IG 0.25 mL/kg (maximum 15 mL) 1
- Pregnant women: IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure 2
- Measles vaccine may provide protection if administered within 72 hours of exposure in eligible patients 1
The interval between IG administration and measles vaccination is 6 months for standard doses and up to 11 months for higher doses used in Kawasaki disease. 7
Critical Infection Control Measures
Isolate the patient immediately for at least 4 days after rash onset, as infected individuals remain contagious from 4 days before through 4 days after rash appearance. 2, 5
Healthcare Worker Protection
- All healthcare workers entering the room must wear N95 respirators or equivalent respiratory protection, regardless of immunity status 1, 2
- Only staff with presumptive evidence of immunity should provide care 2
- Exposed workers without immunity must be excluded from work days 5-21 following exposure 1
Use airborne-infection isolation rooms, not just standard isolation with surgical masks. 1, 5 This is a common pitfall that can lead to nosocomial transmission.
Diagnostic Confirmation
Obtain serum measles IgM antibody testing during the first clinical encounter. 1
- If negative within 72 hours of rash onset, obtain another specimen at least 72 hours after rash onset 1
- Alternative diagnostic methods include detection of viral RNA in throat/nasopharyngeal swabs, urine, or oral fluid 4
Do not delay vitamin A administration while waiting for laboratory confirmation, as treatment should begin based on clinical diagnosis. 3
Special Considerations for Infants Under 6 Months
Infants under 6 months face particularly high mortality and complication risks because they are too young for routine measles vaccination and maternal antibodies may have waned. 3