What is the recommended treatment approach for a patient with measles?

Treatment of Measles

Measles treatment is primarily supportive care with mandatory vitamin A supplementation for all children, as there is no specific antiviral therapy available. 1

Vitamin A Supplementation: The Only Evidence-Based Intervention

All children with clinical measles must receive vitamin A supplementation, which is the only proven intervention to reduce measles mortality. 2, 1

Standard Dosing Protocol

• Children ≥12 months and adults: 200,000 IU orally on day 1 2, 1
• Children <12 months (including infants under 6 months): 100,000 IU orally on day 1 2, 3
• Do not administer if vitamin A was given in the previous month 2

Second Dose for Complicated Measles

A second identical dose must be given on day 2 for any patient with complications, including: 2, 1

• Pneumonia
• Otitis media
• Croup
• Diarrhea with moderate or severe dehydration
• Neurological problems

Extended Protocol for Eye Symptoms

If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer: 2

• 200,000 IU (or 100,000 IU for children <12 months) on day 1
• Same dose on day 2
• Same dose 1-4 weeks later

The evidence strongly supports two-dose regimens over single doses. A Cochrane review found that two doses of 200,000 IU reduced mortality by 64% (RR=0.36; 95% CI 0.14 to 0.82), while single doses showed no significant mortality reduction (RR=0.77; 95% CI 0.34 to 1.78). 4 The effect was even more pronounced in children under 2 years, with an 82% mortality reduction. 4

Supportive Care and Complication Management

Infection Control (Critical First Step)

• Isolate immediately for at least 4 days after rash onset (patients are contagious from 4 days before through 4 days after rash appearance) 2, 1
• All healthcare workers must wear N95 respirators, regardless of immunity status 2, 1
• Only immune staff should provide direct care 2

Treatment of Complications

Treat secondary bacterial infections aggressively with appropriate antibiotics: 1

• Standard antibiotic therapy for pneumonia and acute lower respiratory infection 2, 1
• Appropriate antibiotics for otitis media 1
• Oral rehydration therapy for diarrhea 2, 1

Monitor nutritional status and enroll in feeding programs if indicated. 2, 1

Common Pitfalls to Avoid

• Do not delay vitamin A administration waiting for laboratory confirmation—treat based on clinical diagnosis 3
• Do not withhold vitamin A due to toxicity concerns—the standard protocol is safe (acute toxicity requires >300,000 IU in adults or >60,000 IU in children) 2
• Do not use regular surgical masks instead of N95 respirators 2
• Do not stop isolation before 4 days after rash onset 2

Special Populations Requiring Enhanced Management

Immunocompromised Patients

If exposed but not yet symptomatic, these patients should have received immune globulin (IG) 0.5 mL/kg (maximum 15 mL) within 6 days of exposure, regardless of vaccination status. 2 Once symptomatic, provide standard supportive care with vitamin A supplementation. 1

Pregnant Women

If exposed but not yet symptomatic, pregnant women should have received IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure. 2 Once symptomatic, provide supportive care; measles during pregnancy increases risks of premature labor, spontaneous abortion, and low birth weight. 5

Infants Under 6 Months

These infants face particularly high mortality and complication risks because they are too young for routine measles vaccination and maternal antibodies may have waned. 3 Administer 100,000 IU vitamin A with the same two-dose protocol for complicated cases. 3

Diagnostic Confirmation

Obtain laboratory confirmation during the first clinical encounter: 1

• Serum measles IgM antibody testing during the first visit 1
• If negative within 72 hours of rash onset, repeat at least 72 hours after rash onset 1
• Alternative: detection of viral RNA in throat/nasopharyngeal swabs, urine, or oral fluid 6

Post-Exposure Prophylaxis (For Exposed Contacts, Not Active Cases)

MMR vaccine within 72 hours of exposure may provide protection or modify disease severity. 5 However, this does not apply to patients already symptomatic with measles. 5

For susceptible household contacts who cannot receive vaccine (immunocompromised, pregnant, infants <6 months): 5

• Standard dose: IG 0.25 mL/kg (maximum 15 mL) within 6 days of exposure
• Immunocompromised: IG 0.5 mL/kg (maximum 15 mL) within 6 days of exposure