eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Measles: Treatment & Medication
Updated: Jun 10, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Treatment of measles is essentially supportive.
- Vitamin A supplements have been associated with reduction in morbidity and mortality (by 50%) and are recommended in the following children:8
- Those who live in developing countries or in areas of impoverishment in developed countries
- Children aged 6-24 months who are hospitalized for measles-related complications
- Those with immunodeficiency
- Those with evidence of an ophthalmologic complication due to vitamin A deficiency
- Children with malnutrition
- Children with impaired intestinal absorption
- Those who have recent emigrated from an area with high mortality rates due to measles
- Consider antibiotic or ribavirin (experimental) administration if evidence suggests otitis media or bacterial pneumonia.
- To prevent or modify measles in exposed susceptible individuals, consider administering measles virus (MV) vaccine or human immunoglobulin (Ig). The morbidity rate is high in children younger than 1 year; therefore, Ig is recommended in these patients.
- The Measles virus vaccine is routinely administered as measles-mumps-rubella (MMR) in two doses. For more information, see the 2009 CDC immunization schedule for children aged birth through 18 years.1
- The first dose is given to healthy individuals on or after age 1 year.
- The second dose is given upon school entry, usually at age 4-6 years.
- Ig is given to the following individuals:
- Those with immunocompromise
- Infants aged 6 months to 1 year
- Infants younger than 6 months who are born to mother without measles immunity
- Pregnant women
Consultations
- Consult public health or infectious disease specialists for recommendations and guidelines for diagnostic confirmation of cases and prophylaxis of susceptible contacts.
Diet
- Consider vitamin A supplementation.
Medication
Vitamins
Vitamin A treatment for children with measles in developing countries has been associated with a marked reduction in morbidity and mortality. The World Health Organization (WHO) recommends vitamin A administration to all children with measles in communities where vitamin A deficiency is a recognized problem and where the measles virus (MV)-related mortality rate exceeds 1%. Of note, low serum concentrations of vitamin A are found in children with severe measles in the United States. Thus, consider supplemental vitamin A in patients aged 6 months to 2 years who are hospitalized with measles and its complications (eg, croup, pneumonia, diarrhea). Two doses of vitamin A given 24 hours apart are recommended.
Also recommend vitamin A supplementation for children who have any of the following:
- Immunodeficiency
- Clinical evidence of vitamin A deficiency (eg, ophthalmologic complications)
- Moderate-to-severe malnutrition, including eating disorders
- Impaired intestinal absorption
- Recent emigration from an area with high mortality rates due to measles
Vitamin A (Aquasol A)
Fat-soluble vitamin needed for growth of skin, bones, and male and female reproductive organs.
Adult
Pediatric
<6 months: Not established
6 months to 1 year: 100,000 IU PO as a single dose; repeat dose the next day and at 4 wk for ophthalmologic evidence of vitamin A deficiency
>1 year: 200,000 IU PO as a single dose; repeat dose the next day and at 4 wk for ophthalmologic evidence of vitamin A deficiency
Cholestyramine or neomycin retard absorption
Documented hypersensitivity; large doses may be teratogenic and, thus, contraindicated in pregnancy
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
A 200,000 IU dose may be associated with vomiting and headache; patients with hepatic dysfunction have increased susceptibility to vitamin A toxicity
Antivirals
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 SSPE (IV plus intrathecal high-dose interferon-alfa),9 no controlled trials have been conducted; ribavirin is not approved by the Food and Drug Administration (FDA) for this indication, and such use should be considered experimental.
Ribavirin (Virazole)
For experimental use only. A guanosine analog, the mechanism of action is not fully defined but relates to alteration of cellular nucleotide pools and of viral messenger RNA information.
Adult
20-35 mg/kg/d IV for 7 d
Pediatric
Not established
Interacts with thymidine-phosphorylated nucleoside analogs (eg, zidovudine, d4T), decreasing their effects
Documented hypersensitivity
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Closely monitor patients with COPD and asthma for deterioration of respiratory function; associated with a dose-dependent hemolytic anemia
Vaccines
These agents are available in the United States with attenuated rubella and mumps viruses as the MMR vaccine. For information regarding vaccines and immunization schedules, see the CDC Web site. Several measles vaccines are available in the US, as follows:
- Live measles virus vaccine (Attenuvax)
- Live measles mumps, and rubella virus vaccine (M-M-R II)
- Live measles, mumps, rubella, and varicella virus vaccine (ProQuad)
Claims that suggest an association between measles vaccine and pervasive developmental or other neurologic disorders have not been substantiated.3 Vaccines are used for universal immunization of children older than 12 months in the United States or in children at age 9 months in developing countries with high endemicity. In the United States, a second dose can be administered as soon as 2 months later but is generally administered at age 4-6 years. All adults born after 1957 should receive a second dose of MMR unless they are documented as seropositive for measles IgG antibody by enzyme immunoassay (EIA).
If administered within 72 hours of exposure to measles-naive individuals, MMR may prevent or attenuate disease. In a susceptible household contact, consider Ig instead.
In the United States, 48 states and the District of Columbia require a second dose of measles vaccine for school enrollment. Rates of seroconversion average 85% after a single dose at age 9 months (the recommended strategy for routine immunization in developing countries), 95% after a single dose at 12 months, 98% after a single dose at age 15 months, and greater than 99% after 2 doses administered after age 12 months.
The American Academy of Pediatrics suggests an interval of at least 5-6 months after intramuscular Ig (IGIM) is administered before administering the measles vaccine.8
Measles, mumps, and rubella vaccine (M-M-R II)
Used to induce immunity against viruses that cause measles, mumps, and rubella.
Adult
0.5 mL SC in outer aspect of upper arm
Birth date before 1957: Considered to be immune to measles and mumps, no further MMR vaccination required
Birth date during 1957 or later: Should receive >1 dose unless they have a medical contraindication, documentation of >1 dose, history of confirmed measles infection, or laboratory evidence of immunity
Second dose recommended for the following adults: (1) those who have been recently exposed to measles or mumps in an outbreak setting, particularly if in their age group; (2) those who have been previously vaccinated with killed measles vaccine; (3) those who have been vaccinated with an unknown type of measles vaccine during 1963–1967; (4) those who are students in postsecondary educational institutions; (5) those who work in a health care facility; and (6) those who plan to travel internationally
Unreliable rubella vaccination history: Administer 1 dose
Unvaccinated health care workers born before 1957: If no evidence of mumps immunity; administer 1 dose; strongly consider a second dose during an outbreak situation
Pediatric
First dose: 0.5 mL SC initiated at age >12 months (preferably >15 mo)
Second dose: 0.5 mL at age 4-6 y; may be administered before age 4-6 y, provided >4 wk have elapsed since the first dose
Catch up doses: If not previously vaccinated by age 6 years, administer 2 doses of 0.5 mL SC with >4 wk between doses
Drugs that suppress immune system may diminish response to immunization; do not administer concurrently with IGIM (must wait at least 5-6 mo after IGIM)
Documented hypersensitivity to vaccine or components (contains neomycin); cancer affecting bone marrow or lymphatic systems, blood dyscrasias, HIV, or other severe immunosuppressive condition; pregnant women or women who might become pregnant within 4 wk of receiving vaccine; for more information, see CDC Guide to Vaccine Contraindications and Precautions
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Contraception in females is advised for 3 mo following immunization; not indicated for severely immunocompromised patients; determine rubella immunity for women of childbearing years and counsel regarding congenital rubella syndrome
Immunoglobulins
Human Ig prevents or modifies measles in susceptible individuals if administered within 6 days of exposure.
Immune globulin, intramuscular (GamaSTAN S/D)
Transient source of IgG. Indicated for all susceptible contacts of patients with measles who reside in the same household who are pregnant, immunocompromised, or aged 6-12 mo; also indicated for infants less than 6 mo who were born to mothers without measles immunity and also all children and adolescents with HIV infection who are exposed to measles, regardless of measles immunization status, unless they have received IGIV (400 mg/kg as part of routine immunoprophylaxis) within 3 wk of exposure.
Adult
15 mL IM; divide dose into several muscle sites to reduce local pain
Pediatric
0.25 mL/kg IM (0.5 mL/kg for patients with HIV); not to exceed a cumulative dose of 15 mL; if dose exceeds 10 mL, divide dose into several muscle sites to reduce local pain
May decrease immune response to live virus vaccines (eg, MMR, Varivax); do not administer measles vaccine within 5-6 mo following IGIM
Documented hypersensitivity; thrombocytopenia or other coagulation disorder preventing IM administration
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
For IM administration only; likely to cause pain and tenderness at injection sites
More on Measles |
| Overview: Measles |
| Differential Diagnoses & Workup: Measles |
 Treatment & Medication: Measles |
| Follow-up: Measles |
| Multimedia: Measles |
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References
[Guideline] Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0 through 18 years---United States, 2009. CDC Recommended Vaccine Schedule. Dec 2008;57(51;52):[Full Text].
Meissner HC, Strebel PM, Orenstein WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics. 2004;114(4):1065-9. [Medline]. [Full Text].
Smeeth L, Cook C, Fombonne E, et al. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet. 2004;11-17;364(9438):963-9. [Medline].
Centers for Disease Control and Prevention. Program in brief: Measles Mortality Reduction and Regional Global Measles Elimination. Available at http://www.cdc.gov/ncird/progbriefs/downloads/global-measles-elim.pdf. Accessed April 14, 2009.
Forni AL, Schluger NW, Roberts RB. Severe measles pneumonitis in adults: evaluation of clinical characteristics and therapy with intravenous. Clin Infect Dis Sep. 1994;19(3):454-62. [Medline].
Garenne M. Sex differences in measles mortality: a world review. Int J Epidemiol. Jun 1994;23(3):632-42. [Medline].
Helfand RF, Heath JL, Anderson LJ, et al. Diagnosis of measles with an IgM capture EIA: the optimal timing of specimen collection after rash onset. J Infect Dis. Jan 1997;175(1):195-9. [Medline].
American Academy of Pediatrics. Measles. In: Pickering LK, ed. Red Book: Report of the Committee on Infectious Disease. Elk Grove, Ill: AAP; 2006:441-52.
Hosoya M, Shigeta S, Mori S, et al. High-dose intravenous ribavirin therapy for subacute sclerosing panencephalitis. Antimicrob Agents Chemother. Mar 2001;45(3):943-5. [Medline].
Centers for Disease Control and Prevention. CDC Guide to Vaccine Contraindicatons and Precautions. Available at http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindications-guide-508.pdf. Accessed April 14, 2009.
Centers for Disease Control and Prevention. Global measles control and regional elimination, 1998-1999. MMWR Morb Mortal Wkly Rep. Dec 17 1999;48(49):1124-30. [Medline].
Centers for Disease Control and Prevention. Measles--United States, 1999. MMWR Morb Mortal Wkly Rep. Jun 30 2000;49(25):557-60. [Medline].
Centers for Disease Control and Prevention. Progress toward global measles control and elimination, 1990-1996. MMWR Morb Mortal Wkly Rep. Sep 26 1997;46(38):893-7. [Medline].
Centers for Disease Control and Prevention. Strategies for reducing global measles mortality. Wkly Epidemiol Rec. Dec 15 2000;75(50):411-6. [Medline].
Gershon AA. Measles virus (rubeola). In: Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Pa: Churchill Livingstone; 1995:1519-26.
Griffin DE, Bellini WJ. Measles virus. In: Fields BN, Knipe DM, Howley PM, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott; 1996.
Griffin, DE. Billeter M, ed. Measles Virus. New York, NY: Springer-Verlag; 1995:117-34.
Perry RT, Mmiro F, Ndugwa C, Semba RD. Measles infection in HIV-infected African infants. Ann N Y Acad Sci. Nov 2000;918:377-80. [Medline].
Shah BR, Laude TA. Measles. In: Atlas of Pediatric Clincal Diagnosis. WB Saunders Co; 2000:59-61.
Further Reading
Keywords
measles, rubeola, Koplik spots, measles virus, MV, rubeola virus, coryza, conjunctivitis, pathognomonic enanthem, Koplik spots, otitis media, bronchopneumonia, acute encephalitis, subacute sclerosing panencephalitis, SSPE, autism, giant cell pneumonia, interstitial pneumonitis, laryngotracheobronchitis, croup, tuberculosis, encephalomyelitis, hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation, DIC, transient hepatitis, generalized lymphadenopathy, mild hepatomegaly, appendicitis, treatment, diagnosis
