In the United States, supportive measures for nutrition, hydration and fever control are the mainstay of treatment for measles. Teaching parents when to seek medical attention after diagnosis is important to avoid complications. Rapid medical attention for problems can help avoid serious complications; however, those who are immunocompromised may have a longer course and may even shed the virus for several weeks after the acute illness.
Antipyretics, such as Tylenol, can be given for fever control and comfort; aspirin is not recommended. Because children with measles develop malaise and anorexia, hydration is essential; children may become dehydrated very quickly based on their smaller body mass. Isolation is important as it is highly contagious, and the virus may continue to be shed during the rash phase, which may last up to two weeks. Home management is generally to keep the child in isolation and comfortable. There is currently no cure for measles. Once a child develops measles his body will create a lifetime immunity from it, however getting through the course of symptoms can be uncomfortable for both the child and the parents who care for him.
Cough medicine will not help a measles cough; however, a humidifier or nebulizer may help relieve chest congestion and dryness. Children with measles may not return to school until at least 5 days after the rash appears. Antibiotics may not help against the measles virus but may be prescribed if a secondary bacterial infection develops (eg, pneumonia, or a skin infection from scratching the rash).
For infants in countries where vitamin A deficiency is known to be endemic, the World Health Organization has supported high-dose vitamin A supplementation programs. Children often receive 100,000 IU vitamin A between the ages of 6–11 months and 200,000 IU every 4–6 months between the ages of 12–59 months (Penkert et al., 2019).
In meta-analyses of clinical trials, high-dose vitamin A supplementation was shown to reduce deaths by 12–24%, and in isolated studies, reductions of 35–50% were observed. High-dose vitamin A supplementation reduced morbidities due to infectious diseases, including measles, Plasmodium falciparum, and HIV. High-dose vitamin A supplementation benefits were also observed when antibody responses were measured, including those to vaccination. Some studies have shown improved responses to the measles and tetanus toxoid vaccines following vitamin A supplementation (Penkert et al., 2019).
Worldwide in developing countries without available vaccines, measles has a higher incidence and prevalence and is more severe in malnourished children with fatalities rates as high as 25%.
Measles is not risk-free. Complications can develop and require hospitalization. Hospitals have requested and received CDC recommendations for caring for a child or person with measles.
Post exposure prophylaxis is available with one dose of the MMR and immune globulin (IG) if administered within 72 hours after exposure. If the initial exposure does not result in a full case of measles, it can serve as an additional vaccination and poses no harm.
Measles should be reported within facilities to public health authorities and communicated with key facility staff, including leadership, infection control and epidemiologists. Hospitals should be prepared to place the patient in an isolation room.
When a person presents to a healthcare facility with possible measles, several precautions should be taken to minimize potential exposures before arrival to the facility. Phone triage from a physician's office or a home phone call should alert the staff receiving the patient to take appropriate isolation measures. Facilities should post visual alerts and instructions at entry points. Triage stations should be created to rapidly identify patients with measles and provide a facemask to the patient. Preferably, isolation of the patient prior to entry into the facility is advised according to the Standard and Airborne Precautions standards. In a healthcare setting, all healthcare personnel and anyone entering a room containing a patient with measles, should wear an N95 respirator consistent with airborne infection control precautions.
An airborne infection isolation room (AIIR) with a high efficiency particulate air (HEPA) filter system is preferred, but if not available, the patient should at least be given a private room. An AIIR room must demonstrate at least 6 (if the facility is old) to 12 (for new construction) air changes per hour. Measles can exist in the air for up to 2 hours. Current public air sources have not been built to eliminate the small measles virus.
If patients with measles need to be transported to another facility, they should wear a facemask and notify the receiving facility, so it can make necessary airborne precautions. Airborne precautions should meet current standards, with daily monitoring of air pressure. All healthcare professionals who must enter the AIIR room should use respiratory protection such as an N95 mask. The patient should remain in isolation and AIIR for 4 days after the onset of the rash, or duration of the illness for immunocompromised patients. Limit visitors—especially those without evidence of immunity against measles.
Standard cleaning and disinfection procedures are required for medical waste and there is no additional management needed for waste, according to federal and local rules for regulated medical waste.
Assessment and management of exposure is defined as the time up to 2 hours in a shared air space after the measles patient was present. An example is requiring 2 hours for the necessary time to clean an ambulance after a patient with measles was present. The conservative margin of time is to wait 2 hours with air cycling before a 99% safety status is confirmed.
If there is a large outbreak involving a large number of patients, consult the infection control professionals before a patient is placed, to determine the safety of alternative rooms if an AIIR room is unavailable.
Post-exposure prophylaxis should be offered to people who cannot readily demonstrate immunity against measles; for example, infants under 1 year and pregnant women (Public Health England, 2017). Infants and pregnant women who have not had the vaccine and have been exposed to someone with measles should receive the Human Normal Immunoglobulins (HNIG).
Although the best advance protection against measles still remains two injections of the MMR vaccine, post exposure is better than nothing because the success has been limited. The MMR should be given 72 hours after exposure to infants 12 months or older.
Did You Know. . .
Most other countries have a standard guideline for immunization schedules and post-exposure recommendations. Their recommendations are largely based on the American CDC recommendations and their unique risk for their populations.