What is the recommended management for an adult diagnosed with measles, considering potential complications and the need for symptom relief?

Management of Adult Measles

Adults diagnosed with measles require immediate airborne isolation with N95 respiratory protection, vitamin A supplementation (200,000 IU orally), supportive care for symptoms, and aggressive treatment of bacterial complications with antibiotics. 1, 2

Immediate Infection Control

• Isolate the patient immediately in an airborne infection isolation room 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, 2
• Immunocompromised patients may shed virus for prolonged periods and require extended isolation beyond the standard 4 days. 2

Vitamin A Supplementation (Critical and Often Overlooked)

All adults with clinical measles should receive 200,000 IU of vitamin A orally, provided they have not received vitamin A in the previous month. 1, 2

Standard Dosing Protocol:

• For uncomplicated measles: Single dose of 200,000 IU orally. 1
• For complicated measles (pneumonia, otitis media, croup, diarrhea with dehydration, or neurological problems): 200,000 IU on day 1 AND day 2. 1, 2

Extended Dosing for Eye Symptoms:

• If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer a third dose of 200,000 IU at 1-4 weeks after the initial doses. 1, 2

Clinical Pearl: Vitamin A supplementation is the only evidence-based intervention proven to reduce measles mortality and is frequently forgotten in adult patients. 2

Supportive Care and Symptom Management

• Monitor and correct dehydration with oral rehydration therapy for diarrhea. 2, 3
• Provide antipyretics for fever, but avoid aspirin in younger adults due to Reye syndrome risk. 2
• Assess nutritional status and enroll in feeding programs if indicated. 1, 2
• Monitor for secondary bacterial infections, which are common and require prompt treatment. 2, 3

Management of Complications

Bacterial superinfections are common and must be treated aggressively:

• Administer antibiotics for acute lower respiratory infection (pneumonia is a leading cause of measles mortality). 1, 2, 3
• Treat otitis media with appropriate antibiotics. 3, 4
• Manage laryngotracheobronchitis (croup) and stomatitis with standard therapies. 3

Neurological complications require vigilant monitoring:

• Acute disseminated encephalomyelitis typically presents around day 10 after rash onset—do not assume the patient has recovered before this critical window. 2, 3
• Subacute sclerosing panencephalitis occurs in 4-11 per 100,000 measles cases and presents months to years later. 2, 3

High-Risk Populations Requiring Enhanced Management

Pregnant Women:

• Face increased risks of spontaneous abortion, premature labor, and low birth weight. 2
• Cannot receive measles vaccine during pregnancy. 2
• Should have received immune globulin (IG) 0.25 mL/kg (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
• Require extended isolation due to prolonged viral shedding. 2

Healthcare Workers:

• Up to 9.3% of healthcare workers born before 1957 may be susceptible despite presumed immunity. 2
• Do not assume immunity based on birth year alone in this population. 2

Post-Exposure Prophylaxis for Contacts

• 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 within 6 days of exposure (0.25 mL/kg IM, maximum 15 mL). 5, 2
• Contacts who received IG should receive measles vaccine 3 months later, after passive antibodies have cleared. 5, 2

Critical Pitfalls to Avoid

• Do not use standard droplet precautions or surgical masks—measles requires airborne precautions with N95 respirators. 1, 2
• Do not forget vitamin A supplementation, which is often overlooked in adult patients but critical for reducing mortality. 1, 2
• Do not assume the patient is "out of the woods" at 10 days—encephalitis characteristically presents around this time and requires vigilant monitoring. 2
• Do not assume adults born before 1957 are immune, particularly healthcare workers, as up to 9.3% may be susceptible. 2
• Do not maintain isolation for less than 4 days after rash onset, even if the patient appears to be improving. 1, 2

Laboratory Confirmation

While clinical diagnosis is often sufficient to initiate management, laboratory confirmation should be pursued:

• Serum measles-specific IgM antibody (most common method). 3, 4, 6
• Detection of measles virus RNA by reverse transcriptase-PCR from throat/nasopharyngeal swabs, urine, or oral fluid. 3, 4
• Four-fold or greater increase in measles-specific IgG between acute and convalescent sera. 4