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Measles, Rubeola: Treatment & Medication
Updated: May 18, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Treatment for measles generally consists of only supportive care, with particular attention to maintaining good hydration, especially in the developing world. Recently, however, the WHO has also recommended that vitamin A supplementation be given with measles vaccination in the developing world. The impetus behind this recommendation stems from the fact that a precipitous decrease occurs in vitamin A levels, which may already be low in children who are malnourished, at the onset of the exanthem. By giving a bolus of vitamin A with the vaccine, the WHO hopes to attenuate some of the complications (eg, blindness) associated with vitamin A deficiency. Antibiotics are indicated with diagnosed or suspected secondary bacterial infection but are not empirically indicated.
Infected individuals or those suspected to have infection with the live measles virus should be quarantined until they are no longer contagious to prevent spread of the disease to other nonimmunized individuals.
Consultations
- Dermatologist
- Infectious disease specialist
Diet
Vitamin A supplementation has been recommended in developing nations because of the higher rate of blindness following measles infection in malnourished individuals.
Medication
Preparation
In the United States, the measles vaccine is given in suite with mumps and rubella. Grown in chick fibroblast cell culture, the vaccine contains neomycin, sorbitol, and gelatin. Measles vaccine is both heat sensitive and light sensitive. Once reconstituted, its potency decreases each hour by 50% at 22-25°C, and it is completely inactivated at 37°C. This characteristic of the measles vaccine is important to consider both in the United States and abroad and may be responsible for decreased effectiveness of vaccine programs in developing countries with hot climates, particularly in areas where refrigeration may not be available. The measles vaccine should be stored at 2-8°C (35.6-46.4°F) and protected from light exposure. Once it has been reconstituted, the vaccine should be discarded after 8 hours.
Vaccine-related epidemiology
In the preimmunization era, approximately 130 million cases of measles and 7-8 million measles-related deaths occurred around the world each year (child mortality rate, 7%). However, by 1991, 80% of the world's children were immunized by age 1 year, and an estimated 1 million lives are saved annually with immunization. Despite this marked improvement, the WHO estimated that, in 1994, 45 million cases of measles and 1.19 million measles-related deaths still occurred, primarily in the developing world. Before the advent of the vaccine, measles primarily affected preschool-aged and young school-aged children. In the postvaccine era in industrialized nations, the age of children affected by measles has increased. By 1980, 60% of all cases of measles occurred in children older than 10 years. In developing countries, a different trend has been observed. The age of children infected has decreased, likely because the passive immunity from the mother wanes earlier in these countries.
Vaccine schedule
The difference in the age of children at risk for measles in the developed world versus the developing world has led to unique vaccination schedules aimed at serving the needs of these different communities. Although the best time for vaccination is debated, the following schedules are generally used: 2 doses in industrialized nations at age 12-15 months and age 11-12 years and 3 doses in developing countries starting at age 6-9 months, then at age 15 months, and repeated again upon entry into kindergarten.
One of the major complications with giving the vaccine at such an early age in the developing world is that the child may still have circulating antibodies from the mother. These antibodies can bind vaccine antigen prior to stimulating the child's own immune response and result in primary vaccine failure. Once this passive immunity wanes completely, the child has no protection against infection. This complication led health officials to recommend repeating the injection at age 15 months. Nonetheless, infection can occur within this window.
In industrialized nations, this schedule should be changed in some instances. For example, during outbreaks of measles in the United States or if an infant is traveling to an area where measles is endemic, the child should be vaccinated as young as age 6 months and then the regular schedule for industrialized nations should be followed.
Another indication for the vaccine is postexposure prophylaxis. Some evidence suggests that the vaccine may provide protection in susceptible persons exposed to the virus if the vaccine is given within the first 72 hours of known exposure. The measles vaccine, although live, is not communicable. Therefore, vaccination in all persons in contact with individuals who are immunocompromised is important in preventing the spread of natural disease to these patients.
Vaccine efficacy
Antibody titers following vaccination are lower than those following natural disease. However, 93% of children vaccinated at age 12 months and 98% of those vaccinated at age 15 months develop immunity to measles. Furthermore, more than 99% of children who receive 2 doses of the vaccine at least 1 month apart and after 12 months develop an appropriate response. Protective titers can last as long as 16 years.
Vaccines, viral
The greatest advance against measles in the last 30 years has certainly been in prevention rather than treatment. The measles virus was first isolated in 1954 by Enders and Peebles, and the first live-attenuated vaccine, the Edmonston B strain, became available in the mid-to-late 1960s. The Moraten strain is the attenuated measles virus used in the United States today.
Measles virus vaccine, live attenuated (Attenuvax)
For anyone born in or after 1957 without documentation of live vaccine immunization on or after his or her first birthday.
Adult
0.5 mL SC in outer aspect of upper arm
Pediatric
<15 months: Not established
>15 months: Administer as in adults
Corticosteroids and other drugs that suppress immune system may diminish response to immunization
Documented hypersensitivity (contraindicated in individuals with life-threatening allergic reactions to neomycin and gelatin; patients who are immunocompromised; within 3 mo of cessation of immunosuppressive drugs; thrombocytopenia purpura with previous measles vaccine; tuberculin skin test (PPD results can be falsely negative up to 6 wk following measles vaccination); children who are allergic to eggs (generally considered safe even in individuals with egg allergy [discuss with your physician]); not recommended during or 3 mo prior to pregnancy, although no evidence of harm to fetus or mother has been documented
Pregnancy
X - Contraindicated in pregnancy
Precautions
Contraception in females is advised for 3 mo following immunization; not indicated for patients who are immunocompromised; skin testing of children allergic to eggs prior to vaccination is unreliable
Adverse reactions include fever >39.4°C 5-10 d following vaccine (10%), transient rash (5-15%), thrombocytopenia (occurs in 1 per 30,000-40,000 persons and is usually subclinical but may cause purpuric lesions), and encephalitis/encephalopathy (rare, <1 case per 1 million vaccinations)
Defer vaccination for at least 3 mo following blood or plasma transfusions or the administration of immune globulin; caution in history of cerebral injury, individual or family history of convulsions, or any condition in which stress due to fever should be avoided; should ensure that injection does not enter blood vessel; recent review of available data suggest that subacute sclerosing encephalopathy can be seen with measles infection, but not seen with vaccine
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References
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Further Reading
Keywords
rubeola, morbilli, rubeola measles
