Measles Organism-Specific Therapy
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Measles is an acute infection caused by the rubeola virus. It is highly contagious and usually seen in children. The measles virus (MV) belongs to the genus Morbillivirus of the family Paramyxoviridae. [1, 2, 3, 4, 5, 6, 7, 8]
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The clinical diagnosis of measles is based on the classic triad of cough, coryza (watery nasal discharge), and conjunctivitis
Koplik spots, which are white lesions on the buccal mucosa, may be seen 1-2d before the onset of rash
The rash is generalized, erythematous, and maculopapular, appearing 4-7d after symptoms begin and lasting up to 5-7d
Laboratory confirmation can be made with measles IgM antibodies; paired IgG antibody titers (showing > 4-fold increase); viral culture from throat, nasal swab, or urine; or PCR for measles RNA from blood, throat, nasopharynx, or urine
In the United States, measles virus vaccine is usually given along with attenuated rubella and mumps viruses as the measles-mumps-rubella (MMR) vaccine.
The following measles vaccines are available in the United States:
Live measles, mumps, and rubella virus vaccine (M-M-R II)
Live measles, mumps, rubella, and varicella virus vaccine (ProQuad)
Dosing recommendations for M-M-R II and ProQuad:
First dose: 0.5 mL SC initiated at age > 12mo (preferably > 15mo)
Second dose: 0.5 mL at age 4-6y; may be administered before age 4-6y, provided that at least 28d have elapsed since the first dose
Catch-up doses: if not previously vaccinated by age 6y, administer 2 doses of 0.5 mL SC with > 4wk between doses
Safety and effectiveness not established in infants < 6mo
Treatment of measles is essentially supportive care with maintenance of good hydration and replacement of fluids lost through diarrhea or emesis.
The World Health Organization (WHO) recommends that all children diagnosed with measles receive vitamin A supplementation regardless of their country of residence, based on their age, as follows:
Infants < 6mo: vitamin A 50,000 IU/day PO for 2 doses
6-12mo: vitamin A 100,000 IU/day PO for 2 doses
≥ 1y: vitamin A 200,000 IU/day PO for 2 doses
Children with clinical signs of vitamin A deficiency: first 2 doses as appropriate for age, then a third age-specific dose given 2-4wk later
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No specific antiviral therapy is available
MMR vaccine (0.5 mL SC) may prevent or attenuate disease if administered within 72h of exposure to measles-naive individuals
In a susceptible household contact, immune globulin (0.25 mL/kg, or 0.5 mL/kg for patients with HIV, not to exceed 15 mL) instead can be given IM to prevent or modify measles within 6d of exposure
Adequate measles vaccination provides long-lasting immunity and effectively eliminates susceptibility to the measles virus. Other measures of prevention include vitamin A and human immunoglobulin (Ig).
Children who travel or live abroad should be vaccinated at an earlier age than those living in the United States.
Children aged 6-11mo should receive one dose of MMR vaccine; since the immune response to doses given before 12mo of age is variable, these children still need to receive a normal 2-dose series starting at 12mo
Children ≥ 12mo should receive 2 doses of MMR vaccine at least 28d apart
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In addition to standard precautions, airborne precautions are indicated for hospitalized children during the period of communicability 3-5d before the appearance of a rash to 4d after the rash develops in healthy children and for the duration of illness in patients who are immunocompromised
If there is a case of measles, all students and staff who are exposed and do not have evidence of immunity should be excused from school on the fifth to the 21st day after exposure; the same period of being excused from work is expected for susceptible health care workers
Maintaining 2-dose coverage with the MMR vaccine is the most effective way to prevent outbreaks or limit them if they do occur
Taylor GA. Rubeola. Medscape Reference. Updated January 18, 2011. Available at http://emedicine.medscape.com/article/1132710-overview.
CDC. Measles (Rubeola). CDC. Updated May 24, 2011. Available at http://www.cdc.gov/measles/index.html.
Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 May 7. 59:1-12. [Medline].
Measles imported by returning U.S. travelers aged 6-23 months, 2001-2011. MMWR Morb Mortal Wkly Rep. 2011 Apr 8. 60(13):397-400. [Medline].
American Academy of Pediatrics. Pickering, LK. Red Book: Report of the Committee on Infectious Disease. Elk Grove, Ill: AAP; 2009. 444-55.
[Guideline] Centers for Disease Control and Prevention. Immunization Schedules. Updated August 25, 2010. Centers for Disease Control and Prevention (CDC). Available at http://www.cdc.gov/vaccines/recs/schedules/default.htm.
Allam MF. New measles vaccination schedules in the European countries?. J Prev Med Hyg. 2014 Mar. 55 (1):33-4. [Medline].
[Guideline] Strikas RA, Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), ACIP Child/Adolescent Immunization Work Group. Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years–United States, 2015. MMWR Morb Mortal Wkly Rep. 2015 Feb 6. 64 (4):93-4. [Medline].
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.
Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic
Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio
Disclosure: Nothing to disclose.
Measles Organism-Specific Therapy
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