Measles

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: B05

*Notifiable condition

DESCRIPTION

The following case definition is an epidemiological and not a diagnostic tool:

• Fever and maculopapular rash with any one of the following:
  • cough,
  • coryza/runny nose,
  • conjunctivitis.

Suspect measles in any child fulfilling the case definition.

An acute, highly contagious, viral, childhood exanthem.
Incubation period: 8–14 days from exposure to first symptoms and 14 days between appearance of rash in source and contact.

Complications include:

• pneumonia,
• feeding difficulties,
• laryngotracheobronchitis (croup),
• diarrhoea,
• encephalitis,
• otitis media,
• stomatitis, and
• corneal ulceration.

Subacute sclerosing panencephalitis is a rare long-term complication.

DIAGNOSTIC CRITERIA

Clinical

• Prodromal (catarrhal) phase:
  • duration 3–5 days,
  • fever,
  • runny nose (coryza),
  • cough,
  • conjunctivitis.
• Koplik’s spots, followed 3–5 days later with maculopapular rash.
• The rash begins to fade after 3 days in the order of its appearance leaving temporary darker staining.
• If fever is still present after the third day of the rash, a complication should be suspected.

Investigations

• Serum measles IgM antibodies for confirmation of diagnosis.

GENERAL AND SUPPORTIVE MEASURES

• Notify provincial EPI manager when case is suspected, prior to confirmation.
• Only admit high risk patients:
  • children less than 6 months old,
  • immune compromised/suppressed children,
  • children with severe malnutrition,
  • children with complications.
• Minimal exposure to strong light, if patient is photophobic.
• Isolate the patient in a separate room, if possible away from other children.
• All entering the room to wear mask, gloves and gown.
• Patient is infectious for 4 days after onset of the rash, longer if HIV infected.
• Screen outpatient waiting areas for children with measles.
• If pneumonia with hypoxia, give humidified oxygen by nasal cannula.

MEDICINE TREATMENT

All patients

• Vitamin A, oral, as a single daily dose for 2 days.
  • If < 6 months of age: 50 000 units.
  • If 6–12 months of age: 100 000 units.
  • If > 1 year of age: 200 000 units.

For fever:

• Paracetamol, oral, 10–15 mg/kg/dose, 6 hourly as required until fever subsides.

Pneumonia

Also see: Pneumonia.

Empiric antibiotics for suspected secondary bacterial infection:

To cover S. pneumoniae and Gram negative infection.
Total duration of therapy: 5–7 days.

• Amoxicillin/clavulanic acid, IV, 25 mg/kg/dose 8 hourly.

When child improves, follow with oral therapy to complete 5–7 days treatment:

• Amoxicillin/clavulanic acid, oral, 30 mg/kg/dose 12 hourly.

Penicillin allergy

See: Allergies to penicillins.

In very severe progressive or unresponsive pneumonia consider use of aciclovir for possible herpes infection.

Croup

See: Laryngotracheobronchitis, Acute Viral (Croup).

Diarrhoea

See: Diarrhoea, Acute.

Encephalitis

See: Meningo-encephalitis/Encephalitis, Acute Viral.

Convulsions

See: Status Epilepticus (Convulsive).

Conjunctivitis

• Chloramphenicol ophthalmic ointment 1%, inserted 6 hourly for 5 days.

If corneal clouding/ulceration present, obtain urgent ophthalmologic consultation.

Management of contacts

Immunise children older than 6 months if unvaccinated and less than 72 hours since exposure.

Between 3 and 6 days after exposure and for contacts less than 6 months old:

• Human normal immunoglobulin, IM, 0.25 mL/kg.

If immunodeficient:

• Human normal immunoglobulin, IM, 0.5 mL/kg.

Immunise all children > 6 months of age if an outbreak occurs.

REFERRAL

• Children in need of intensive care unit.
• Children with depressed level of consciousness.
• Children with corneal ulceration/opacity.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 8: Infective/Infectious Diseases,  8.10 Measles