What are the potential complications of measles in children, particularly those under 5 years old with weakened immune systems, such as Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) or undergoing chemotherapy?

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Complications of Measles in Children

Overview of Measles Complications

Measles causes serious and potentially fatal complications, particularly in children under 5 years old and immunocompromised individuals, with pneumonia being the leading cause of death and encephalitis occurring in approximately 1 per 1,000 cases. 1

The most critical complications include pneumonia (the most common cause of measles-related death), acute encephalitis (1 per 1,000 cases), diarrhea, otitis media, and the rare but invariably fatal subacute sclerosing panencephalitis (SSPE) that develops years after initial infection. 1, 2

Common Acute Complications

Respiratory Complications

  • Pneumonia is the most common cause of measles-related death in children, occurring frequently enough to warrant early antibiotic treatment for secondary bacterial infections in severe cases. 1, 2
  • Bronchopneumonia develops as a common complication requiring close monitoring for respiratory distress. 1
  • Adult respiratory distress syndrome (ARDS) can occur in severe cases requiring intensive care, with mechanical ventilation needed using the lowest possible inspiratory pressures. 3
  • Spontaneous pneumothorax and empyema can complicate severe pneumonia, particularly in malnourished children. 3

Gastrointestinal and Other Acute Complications

  • Diarrhea is the most common overall complication and should be managed with oral rehydration therapy to prevent dehydration. 1
  • Otitis media (middle ear infection) occurs frequently as a secondary bacterial complication. 1
  • Hypocalcemia, thrombocytopenia, and coagulopathy can develop in severe cases requiring intensive care. 3

Neurological Complications

  • Acute encephalitis occurs in approximately 1 per 1,000 measles cases and represents a leading cause of measles mortality, resulting in permanent brain damage in survivors. 1, 2
  • Encephalopathy can develop during acute illness, particularly in severely ill children requiring intensive care. 3

High-Risk Populations

Children Under 5 Years

  • Infants and young children face significantly higher mortality risk than older children, with death occurring in 1-2 per 1,000 reported U.S. cases but as high as 25% in developing countries. 1, 2
  • Children under 12 months are at particularly high risk for severe complications and death. 1

Immunocompromised Children

HIV-Infected Children

  • HIV-infected children are at increased risk for severe complications if infected with measles, including progressive measles pneumonitis and prolonged infection that may occur without the typical rash. 4, 1
  • Children with severe immunosuppression (defined by specific CD4+ T-lymphocyte counts or percentages) should NOT receive measles vaccination due to risk of vaccine-associated disease. 4
  • HIV-infected children without severe immunosuppression should receive MMR vaccine at 12 months of age, with consideration for a second dose as early as 28 days after the first dose. 4

Children on Chemotherapy

  • Children receiving high-dose corticosteroids (≥20 mg/day prednisone equivalent for >2 weeks) are considered immunosuppressed and at higher risk for severe measles complications. 1
  • Children with leukemias or lymphomas face higher risk of severe and prolonged measles infection. 2

Malnourished Children

  • Malnutrition significantly increases mortality risk from measles, with all children requiring intensive care in one study being malnourished. 3
  • Vitamin A supplementation is recommended for ALL children with clinical measles: 100,000 IU orally for children under 12 months, and 200,000 IU orally for children over 12 months. 1
  • Repeat vitamin A dosing on day 2 for children with complicated measles, and additional dosing 1-4 weeks later for those with vitamin A deficiency eye symptoms. 1

Late Complication: Subacute Sclerosing Panencephalitis (SSPE)

  • SSPE is a rare but invariably fatal late complication that appears years (typically 2-10 years, but can be as short as 4 months) after measles infection in immunologically normal individuals. 1, 2, 5
  • SSPE occurs in approximately 4-11 per 100,000 measles-infected individuals, with the highest risk in children who contract measles at younger ages. 5
  • The disease results from persistent mutant measles virus infection in the CNS, not from active viremia. 5
  • Measles vaccination substantially reduces SSPE occurrence and does NOT increase the risk for SSPE, even among persons who previously had measles disease. 1, 5

Outcomes and Mortality

Case Fatality Rates

  • In the United States, death occurs in 1-2 per 1,000 reported measles cases. 1, 2
  • In developing countries, case fatality rates can reach 25%. 2
  • Before widespread vaccination, measles caused approximately 500 deaths annually in the United States. 2

Long-Term Sequelae

  • Permanent brain damage from encephalitis can occur in survivors. 1
  • Chronic lung disease, hemiplegia, and other permanent disabilities have been documented in children requiring intensive care. 3
  • SSPE develops years after infection and is universally fatal. 1, 2

Critical Management Principles

Supportive Care

  • Oral rehydration therapy for diarrhea to prevent dehydration. 1
  • Vitamin A supplementation for ALL children with measles (dosing as specified above). 1
  • Antibiotics for documented secondary bacterial infections, particularly pneumonia. 1

Intensive Care Considerations

  • Mechanical ventilation should use the lowest possible inspiratory pressures and fraction of inspired oxygen, accepting arterial oxygen pressure less than 60 mm Hg to minimize barotrauma. 3
  • Early antibiotic treatment should be instituted for children requiring intensive care due to high rates of secondary bacteremia. 3

Prevention

  • Vaccination remains the cornerstone of measles prevention, with MMR vaccine recommended at 12-15 months and 4-6 years. 1
  • Post-exposure prophylaxis with MMR vaccine within 72 hours of exposure may provide protection for susceptible contacts. 1
  • Undernutrition is NOT a contraindication for measles vaccination; it should be considered a strong indication for vaccination. 1

References

1
Guideline

Measles Symptoms, Management, and Prevention

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Measles Fatality Risk

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

SSPE Pathogenesis and Risk Factors

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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