Clinical Considerations for Measles: Presentation, Treatment, and Hospitalization

Many younger clinicians may not have seen or treated patients with measles. However, that may be changing in the coming years as immunization rates continue to decline, more outbreaks arise, and the potential for the disease to become endemic and continuously circulating increases, all of which give rise to more opportunities for these medical encounters.

Given the need to better understand what presentation and treatment look like, Lori Handy, MD, MSCE, associate director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, offers insights into the treatment of measles.

In terms of presentation, clinicians might be seeing patients before the telltale rash appears.

“It might look like any other respiratory infection—runny nose, high fever, maybe not drinking quite as well—but what we then find is [that] around day 3 or 4, kids present with a very characteristic rash,” Handy said.

And when the rash does appear, it is very distinctive. Handy says it looks like a “bucket of rash” poured over patients, with it in the hairline and throughout the body.

In terms of care, there are no FDA-approved treatments for measles, and Handy explains that it is about supportive care for patients. Treatment is similar to that of other viral infections, including keeping patients hydrated, using medications to reduce fever, and bed rest. She says the typical American diet provides patients with sufficient vitamin A, so she does not recommend dosing them with it.

When to Hospitalize

Handy says when patients are dehydrated or are having a hard time breathing, these are signs that hospitalization may be warranted.

“If the child has too much diarrhea that they can't keep up with their fluids, or they end up with measles-causing pneumonia, meaning irritation of the lungs that the child is breathing too hard to to be OK at home, that's when we want them to be in the hospital, where our supportive care is in the form of IV [intravenous] fluids or respiratory support—maybe that's oxygen; maybe that's even a breathing tube,” Handy said. “And if we are really dealing with some of the most severe complications, like encephalitis, meaning essentially infection of the brain, then we definitely want them to be in the hospital where we can monitor that child's status and [provide the] support they may need.”

With it being one of the most contagious diseases, she cautions about transmission in hospitals or the doctor’s office.

“Whenever a child is being assessed, whether it's the first pediatrician visit, the emergency [department], or staying in the hospital for treatment, they always need to be in some version of airborne isolation, meaning that the air that they breathe can't come into contact with other people or the hallway because that air itself carries the virus and can infect another person,” Handy said.

Further questions about measles? Check out our FAQ on the topic.