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Measles Treatment & Management

  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: Mar 30, 2015
 

Approach Considerations

Treatment of measles is essentially supportive care with maintenance of good hydration and replacement of fluids lost through diarrhea or emesis. Intravenous (IV) rehydration may be necessary if dehydration is severe.

Vitamin A supplementation, especially in children and patients with clinical signs of vitamin A deficiency, should be considered. Postexposure prophylaxis should be considered in unvaccinated contacts; timely tracing of contacts should be a priority.

Patients should receive regular follow-up care with a primary care physician for surveillance of complications arising from the infection (see Complications).

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Supportive Care

Supportive care is normally all that is required for patients with measles. Hospitalization may be indicated for treatment of measles complications (eg, bacterial superinfection, pneumonia, dehydration, croup).

Secondary infections (eg, otitis media or bacterial pneumonia) should be treated with antibiotics; Patients with severe complicating infections (eg, encephalomyelitis) should be admitted for observation and antibiotics, as appropriate to their clinical condition.

Occasionally, IV rehydration is required; patients may be markedly febrile and consequently may become dehydrated. Fever management with standard antipyretics is appropriate.

Airborne precautions are indicated for hospitalized children during the period of communicability (ie, 3-5 day before the appearance of a rash to 4 days after the rash develops in healthy children and for the duration of illness in patients who are immunocompromised). Susceptible health care workers should be excused from work from the fifth to the 21st day after exposure.

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Antiviral Therapy

Measles virus is susceptible to ribavirin in vitro. Although ribavirin (either IV or aerosolized) has been used to treat severely affected and immunocompromised adults with acute measles or subacute sclerosing panencephalitis (SSPE),[31] no controlled trials have been conducted; ribavirin is not approved by the US Food and Drug Administration (FDA) for this indication, and such use should be considered experimental.

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Vitamin A Supplementation

Vitamin A supplements have been associated with reductions of approximately 50% in morbidity and mortality and appear to help prevent eye damage and blindness.

Because vitamin A deficiency is associated with severe disease from measles, The World Health Organization recommends all children diagnosed with measles should receive vitamin A supplementation regardless of their country of residence, based on their age,[8] as follows:

  • Infants younger than 6 months – 50,000 IU/day PO for 2 doses
  • Age 6-11 months - 100,000 IU/day PO for 2 doses
  • Older than 1 year - 200,000 IU/day PO for 2 doses
  • Children with clinical signs of vitamin A deficiency – The first 2 doses as appropriate for age, then a third age-specific dose given 2-4 weeks later
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Postexposure Prophylaxis

Postexposure prophylaxis should be considered in unvaccinated contacts. Prevention or modification of measles in exposed susceptible individuals involves the administration of measles virus vaccine or human immunoglobulin (Ig).

Measles virus vaccine

In the United States, the measles virus vaccine is routinely administered along with the mumps and rubella vaccines as the measles-mumps-rubella (MMR) vaccine. The vaccine is preventive if administered within 3 days of exposure.

Contraindications to the vaccine include immunodeficiency; generalized cancers (eg, leukemia, lymphoma); active, untreated tuberculosis; and therapy with immunosuppressants. HIV infection is only a contraindication in the presence of severe immunosuppression (ie, CD4 counts lower than 15%). The vaccine should be deferred until after delivery in pregnant patients and for at least 5 months in anyone who has received antibody (ie, plasma, whole blood, any immune globulin).[32, 33]

Human immunoglobulin

Human Ig prevents or modifies disease in susceptible contacts if administered within 6 days of exposure. Human Ig is given to the following individuals:

  • Those who are immunocompromised
  • Infants aged 6 months to 1 year (morbidity is high in children younger than 1 year
  • Infants younger than 6 months who are born to mothers without measles immunity
  • Pregnant women

In contacts for whom the vaccine should be deferred (eg, pregnant patients), human Ig 0.25 mL/kg (not to exceed 15 mL) should be administered intramuscularly (IM) immediately after exposure, and the measles vaccine should be given 6 months later. Exposed immunocompromised patients with a contraindication to vaccination should receive human Ig 0.5 mL/kg (not to exceed 15 mL) IM.

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Contributor Information and Disclosures
Author

Selina SP Chen, MD, MPH Assistant Professor of Pediatrics, Department of Internal Medicine, John A Burns School of Medicine, University of Hawaii; Internal Medicine and Pediatric Hospitalist, Kapiolani Medical Center for Women and Children; Internal Medicine Hospitalist, Straub Clinic and Hospital; Electronic Medical Record Physician Liaison and Trainer

Selina SP Chen, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians-American Society of Internal Medicine, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Melissa Burnett, MD Department of Dermatology, Massachusetts General Hospital

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Heather Kesler DeVore, MD Assistant Professor, Clinical Attending Physician, Department of Emergency Medicine, Georgetown University Hospital and Washington Hospital Center

Heather Kesler DeVore, MD is a member of the following medical societies: Emergency Medicine Residents Association and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Stacy Sawtelle, MD Clinical Instructor, Department of Emergency Medicine, University of California, San Francisco, School of Medicine

Disclosure: Nothing to disclose.

Gina A Taylor, MD Clinical Assistant Professor, Attending Dermatologist and Dermatopathologist, State University of New York Downstate Medical Center; Director of Dermatology Service, Attending Dermatologist, Kings County Hospital Center

Gina A Taylor, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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Koplik spots in measles. Photograph courtesy of World Health Organization.
Enanthem of measles (Koplik spots).
Measles conjunctivitis.
Face of boy with measles.
Morbilliform rash.
 
 
 
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