Clinical Insights Around Treating Measles

This is the first installment of a 2-part interview with Stinchfield.

Patricia A Stinchfield, RN, MS, CPNP, past-president of the National Foundation for Infectious Diseases (NFID), has treated measles outbreaks and talks about the transmissibility of the respiratory disease.

“Measles is the greatest combination of the worst things you can think of in viral infections. It's sneaky; it looks like every other infectious disease of a young child—runny nose, cough, fever, until that rash occurs. They're contagious during that time, and that's one of the biggest problems with measles and why it spreads. It's extremely contagious,” Stinchfield said. “If you were to walk into a room of 10 people, none of whom were vaccinated, and someone came in with measles and just breathed—you don't have to have major coughing, just breathing in that airspace—9 of those 10 people will get measles.”

Stinchfield points out there is a large range in the severity of the disease, and she illustrates those serious cases that require hospitalization.

“I've seen children come into the emergency room. They're like rag dolls flopped over their parent’s shoulder. They're crying, but they don't have tears because they're so dehydrated. They have red eyes and photophobia, so the bright lights bother them,” Stinchfield said. “They might have the 3 C's. We call it cough, conjunctivitis, which is that redness in their eyes, and coryza, which is kind of this histamine-mediated, runny nose. They look at first like they have a bad cold, until that rash starts. And the rash starts up on the hairline and it goes down the face and down the trunk, as we have often said, ‘like a bucket of rash poured over your head.’”

Unfortunately, there are not any FDA-approved antivirals to help treat these patients, and ameliorative treatment for measles is the course of action, which includes IVs for hydration, dark rooms to reduce photophobia, and fever-reducing medications like acetaminophen or ibuprofen. And in children, vitamin A supplementation can be used to reduce complications.

Although some in the public may think measles is just a childhood disease that everyone of past generations contracted, Stinchfield points out some statistics to the contrary.

• About 1 in 20 will be hospitalized
• About 1 in 20 will get pneumonia
• About 1 in 1000 will develop encephalitis, which is a brain inflammation, that can lead to blindness, deafness, and permanent neurological problems.

She also points to what she says is “the scariest” complication of measles: subacute sclerosing panencephalitis.

“The virus gets into the nervous system, and this can happen in about 1 in 600 babies, especially those that are less than a year old and get measles. With this virus, over a 7 to 10 year period, it slowly deteriorates their nervous system until they die. It is a fatal outcome of measles. If you're older than a year, it's about 1 in about 1,400 and so this is absolutely not a disease we want to play with,” Stinchfield said.