What is the recommended management for a patient suspected of having Rubeola (measles), considering prevention, treatment, and potential complications?

Management of Rubeola (Measles)

Immediate Actions Upon Suspected Case

Immediately isolate the patient with airborne precautions and notify local public health authorities and hospital infection control—this is non-negotiable for preventing transmission of this highly contagious disease. 1

Isolation Requirements

• Implement airborne precautions immediately upon suspicion, before laboratory confirmation 1
• Remove infected healthcare workers from all patient contact and exclude them from the facility until 4 days after rash onset 2
• Maintain isolation for hospitalized patients throughout the infectious period 1

Mandatory Reporting

• Report suspected and confirmed cases immediately to local health departments 2
• Trigger aggressive case finding and intensified surveillance once a case is confirmed 2

Clinical Diagnosis and Laboratory Confirmation

Classic Presentation

• Prodrome: High fever with the "three Cs"—cough, coryza (runny nose), and conjunctivitis 1, 3
• Koplik spots: Pathognomonic white spots on buccal mucosa (when present) 1, 3
• Rash: Erythematous maculopapular rash beginning on face 2-4 days after prodrome, spreading cephalocaudally down the body 1, 3

Laboratory Confirmation (Required)

All suspected cases must be laboratory confirmed—clinical diagnosis alone is unreliable. 2

• Measles-specific IgM antibody (most commonly used method) 2, 3
• Four-fold or greater rise in measles-specific IgG between acute and convalescent sera 3
• Viral isolation or detection of measles virus RNA by RT-PCR 3
• Obtain acute-phase serum as soon as possible, preferably within 7 days of rash onset 2

Treatment Approach

Supportive Care

There is no specific antiviral treatment for measles—management is entirely supportive. 4, 3

• Symptomatic treatment for fever, cough, and malaise 3
• Maintain hydration 4
• Monitor for complications (occur in 10-40% of patients) 3

Vitamin A Supplementation

Administer oral vitamin A to all patients with measles 4

• This reduces morbidity and mortality, particularly in children 4

Antibiotic Therapy

• Only for bacterial superinfections (otitis media, pneumonia) when they occur 3
• Do not use antibiotics prophylactically 3

Complications Requiring Monitoring

Common Complications

• Pneumonia (most common cause of measles-related death) 5, 4
• Otitis media 4
• Diarrhea 4

Serious Complications

• Encephalitis (1 per 1,000 cases) 5, 4
• Blindness 4
• Deafness 4
• Death (1-2 per 1,000 cases in developed countries) 4

Postexposure Prophylaxis for Contacts

Susceptible Healthcare Workers

• Administer MMR vaccine within 72 hours of exposure if no contraindications exist 2
• Remove from patient contact from day 5 through day 21 after exposure, regardless of vaccination status 2
• If not vaccinated after exposure, exclude from day 5 after first exposure through day 21 after last exposure, even if they receive immune globulin 2

Immune Globulin Indications

Based on the 2013 ACIP recommendations 6:

• Infants aged birth to 6 months exposed to measles: administer IGIM 6
• Severely immunocompromised persons without measles immunity: administer IGIV 6
• Pregnant women without evidence of measles immunity who are exposed: administer IGIV 6
• Increased IGIM dosing for immunocompetent persons compared to previous recommendations 6

Special Considerations for Pregnancy

Maternal and Fetal Risks

Measles in pregnancy follows a more complicated course than in non-pregnant adults and significantly increases risk of spontaneous abortion and preterm delivery. 5

• Higher risk of pneumonia and serious complications in pregnant women 5
• Increased risk of spontaneous abortion 5
• Increased risk of preterm delivery 5

Management During Pregnancy

• IGIV for postexposure prophylaxis if exposed and non-immune 6
• Provide supportive care if infection occurs 5
• MMR vaccine is contraindicated during pregnancy (live-attenuated virus) 5

Postpartum Vaccination

Vaccinate all non-immune women immediately postpartum before hospital discharge 5

• Counsel to avoid pregnancy for 3 months after vaccination 5
• Breastfeeding is NOT a contraindication to vaccination 7

Prevention Strategy

Routine Vaccination

Two doses of MMR vaccine are the cornerstone of measles prevention. 6

• First dose: Age 12-15 months 6
• Second dose: Age 4-6 years before school entry 6
• High-risk adults (healthcare workers, students, international travelers): 2 doses 6
• Other adults ≥18 years: 1 dose 6

Critical Pitfall to Avoid

Do not rely on physician-diagnosed disease as evidence of immunity—this is no longer acceptable per 2013 ACIP guidelines. 6 Only laboratory confirmation of disease, documented vaccination, or serologic evidence of immunity are acceptable. 6