What is the primary treatment approach for an adult patient with measles?

Treatment of Measles in Adults

Measles treatment in adults is primarily supportive care with immediate isolation, vitamin A supplementation (200,000 IU orally on days 1 and 2 for complicated cases), and aggressive management of complications, particularly in high-risk populations including pregnant women, immunocompromised patients, and those with respiratory or neurological involvement. 1, 2

Immediate Infection Control Measures

• Isolate the patient immediately in an airborne infection isolation room (negative pressure) for at least 4 days after rash onset, as patients remain contagious from 4 days before through 4 days after rash appearance 1, 2
• All healthcare workers must wear N95 respirators (not surgical masks) when entering the room, regardless of immunity status 1, 2
• Only staff with documented immunity should provide direct care 1
• Immunocompromised patients may shed virus for prolonged periods and require extended isolation 3

Vitamin A Supplementation Protocol

All adults with clinical measles should receive 200,000 IU of vitamin A orally as the standard dose 1

Standard Dosing:

• Day 1: 200,000 IU orally 1
• Day 2: 200,000 IU orally for complicated measles (pneumonia, otitis media, croup, diarrhea with dehydration, or neurological problems) 1, 3

Extended Dosing for Eye Symptoms:

• If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, corneal ulceration), administer a third dose of 200,000 IU at 1-4 weeks after initial doses 1, 3

This is the only evidence-based intervention to reduce measles mortality and should never be overlooked 1, 3

Supportive Care and Complication Management

General Supportive Measures:

• Monitor and correct dehydration with oral rehydration therapy 1
• Assess nutritional status and enroll in feeding programs if indicated 1, 3
• Provide antipyretics for fever (avoid aspirin in younger adults due to Reye syndrome risk) 3

Treatment of Bacterial Superinfections:

• Antibiotics for acute lower respiratory infection and other bacterial complications 1
• Secondary bacterial infections are common and require prompt antibiotic therapy 3, 4

Monitoring for Severe Complications:

• Adults face the highest risk of encephalitis (approximately 1 per 1,000 cases), which typically presents around day 10 post-infection 5, 3, 2
• Watch for seizures, altered mental status, or focal neurological deficits requiring immediate evaluation 3
• 25% of adults with measles require at least 1 day of hospitalization 5, 2

High-Risk Populations Requiring Enhanced Management

Pregnant Women:

• Cannot receive measles vaccine (absolute contraindication) 2
• Face increased risks of spontaneous abortion, premature labor, and low birth weight 5, 2
• Require more frequent hospitalization than non-pregnant adults 2
• Should have received immune globulin (IG) 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure if susceptible 1, 2

Immunocompromised Patients:

• Should have received IG 0.5 mL/kg (maximum 15 mL) if exposed, regardless of vaccination status 1, 2
• May require extended isolation due to prolonged viral shedding 3
• Consider intravenous immunoglobulin for severe cases 6

Healthcare Workers:

• Up to 9.3% of healthcare workers born before 1957 may be susceptible despite presumed immunity 5, 2
• Exposed healthcare workers without immunity must be excluded from work days 5-21 post-exposure 2

Post-Exposure Prophylaxis (If Not Yet Symptomatic)

This section applies only if the patient was recently exposed but not yet symptomatic:

• Administer MMR vaccine within 72 hours of exposure to susceptible adults for maximum protection 2
• If vaccination is contraindicated or >72 hours have passed, give IG 0.25 mL/kg IM (maximum 15 mL) within 6 days of exposure 2
• Do not delay IG administration beyond 6 days, as efficacy is time-dependent 2

Critical Pitfalls to Avoid

• Do not use standard droplet precautions or surgical masks—measles requires airborne precautions with N95 respirators 2
• Do not forget vitamin A supplementation, which is often overlooked but critical for reducing mortality 1, 3
• Do not assume the patient is "out of the woods" at 10 days—encephalitis characteristically presents around this time and requires vigilant monitoring 3
• Do not assume adults born before 1957 are immune, particularly healthcare workers, as up to 9.3% may be susceptible 2
• Do not use aspirin for fever control in younger adults due to Reye syndrome risk 3

Long-Term Surveillance Considerations

• Monitor for subacute sclerosing panencephalitis (SSPE), which occurs in 4-11 per 100,000 measles-infected individuals, though risk is highest in those infected before age 2 3
• Ensure all susceptible contacts received MMR vaccine within 72 hours of exposure or IG within 6 days 3
• Contacts who received IG should receive measles vaccine 3 months later 3