Measles

Case Definition

Description

General Measures

Medicine Treatment

Referral

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ICD-10 codes: B05.0-4/B05.8-9

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Note: Notifiable medical condition

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CASE DEFINITION

• Fever.

AND

• Red maculopapular (blotchy) rash.

AND

• Cough or coryza (runny nose) or conjunctivitis.

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Inform the local EPI co-ordinator about all cases of suspected measles, (i.e. which fulfil the case definition criteria). Send clotted blood and throat swabs to confirm (or exclude) a diagnosis of measles.

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DESCRIPTION

• A viral infection that is especially dangerous in malnourished children or in children who have other diseases such as TB or HIV/AIDS.
• Initial clinical features, that occur 7–14 days after contact with an infected individual, include:
  • coryza
  • conjunctivitis which may be purulent
  • fever
  • cough
  • diarrhoea
• After 2–3 days of the initial clinical features, a few tiny white spots, like salt grains appear in the mouth (Koplik spots).
• The skin rash appears 1–2 days later, lasting about 5 days and:
  • usually starts behind the ears and on the neck
  • then on the face and body
  • thereafter, on the arms and legs
• Secondary bacterial infection (bronchitis, bronchopneumonia, otitis media) may occur, especially in children with poor nutrition or other concomitant conditions.

GENERAL MEASURES

• Isolate the patient in the clinic to prevent spread.

• In the clinic, use face masks and gloves when examining the patient.
• Counsel the caregiver to isolate the patient in the home (if feasible).
• Reduce exposure of children <12 months of age and pregnant women to the index patient.
• Ensure that the caregiver and other close contacts have been previously immunised.

MEDICINE TREATMENT

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All children <5 years of age with measles should be given an extra dose of vitamin A, unless the last dose was received within a month

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• Vitamin A (retinol), oral, as a single dose.

^{Click on table to enlarge}

• In children <5 years of age, give the 1^st dose immediately. If the child is sent home, the caregiver should be given a 2^nd dose to take home, which should be given the following day.

Administration of a vitamin A capsule

• Cut the narrow end of the capsule with scissors.
• Open the child’s mouth by gently squeezing the cheeks.
• Squeeze the drops from the capsule directly into the back of the child’s mouth. If a child spits up most of the vitamin A liquid immediately, give one more dose.

For fever with distress:

Children

• Paracetamol, oral, 10–15mg/kg/dose 6 hourly when required. See: dosing table

Adults

• Paracetamol, oral, 1g 4- 6 hourly when required.
  • Maximum dose: 15mg/kg/dose.
  • Maximum dose: 4g in 24 hours.                                                             

Children with diarrhoea

• Treat according to Acute diarrhoea in children.

Children with pneumonia (1^st dose before referral)

• Amoxicillin, oral, 45mg/kg/dose. See: Pneumonia in children.

Children with otitis media

• Amoxicillin, oral, 45mg/kg/dose. See: Otitis media, acute.                                

Pneumonia or otitis media with severe penicillin allergy
Z88.0

Children

• Macrolide, e.g.:
  • Azithromycin, oral, 10mg/kg/dose daily for 3 days. See: dosing table.

LoE:IVB⁶

Purulent conjunctivitis

• Chloramphenicol, 1%, ophthalmic ointment 8 hourly into lower conjunctival sac.

REFERRAL

• All adults.
• Children <6 months of age.
• Children who are malnourished or immunocompromised, or who have TB.
• Where serious complications are present. These include:
  • stridor/ croup
  • pneumonia
  • dehydration
  • neurological complications
  • severe mouth and eye complications

Provide emergency treatment, if needed, before referral.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.8 Measles