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).
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.
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), [34] 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.
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, [10] as follows:
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Infants younger than 6 months – 50,000 IU/day PO for 2 doses
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Age 6-11 months - 100,000 IU/day PO for 2 doses
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Older than 1 year - 200,000 IU/day PO for 2 doses
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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
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). [35, 36]
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:
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Those who are immunocompromised
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Infants aged 6 months to 1 year (morbidity is high in children younger than 1 year
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Infants younger than 6 months who are born to mothers without measles immunity
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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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Koplik spots in measles. Photograph courtesy of World Health Organization.
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Enanthem of measles (Koplik spots).
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Measles conjunctivitis.
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Face of boy with measles.
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Morbilliform rash.
