SUPPORTIVE THERAPY
- Patients are provided w/ supportive care
Oxygen Therapy
- May be given in patients w/ resp tract involvement
Hydration & Nutrition
- Oral rehydration is effective in majority of cases
- Administer IV fluids, if necessary
Antipyretics
- May be used to relieve fever
Vitamin A
- Recommended in the following patients w/ measles:
- Hospitalized patients 6 mth-2 yr of age w/ complications
- Patients >6 mth who have not received vitamin A supplementation & who have any of the following risk factors: Vitamin A deficiency, immunodeficient state, impaired intestinal absorption, moderate to severe malnutrition, travel history to areas where high mortality rates are attributed to measles
- May be taken as single dose of 50,000 IU PO for patients <6 mth, 100,000 IU PO for patients 6-11 mth or 200,000 IU PO for ≥1 yr of age
- Dose is repeated the next day & 4 wk later esp in patients w/ ophthalmologic evidence of vitamin A deficiency
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Parental Education
Isolation
- Isolation of household or school contacts solely is not effective in preventing transmission of infection; spread of virus occurs before the onset of symptoms
- Isolation of infected individuals should be done for 4 days after the initial appearance of rashes
Measles Vaccine
- May produce a mild, noncommunicable infection
- Available as monovalent or combined w/ other vaccines (eg mumps, rubella); seroconversion rates same for both monovalent & combined vaccines
- Advisory Committee on Immunization Practices (ACIP) recommends the use of measles-mumps-rubella (MMR) vaccine when any of the individual components is indicated
- 1st dose of MMR vaccine is recommended at 12-15 mth, 2nd dose at 4-6 yr of age or <28 days after the 1st dose
- MMRV may be given as the 2nd dose of measles vaccine at age 12-47 mth
- May also be given as 1st measles vaccine for children aged >4-<14 yr, 2nd dose may be given w/in the same age range
Post-exposure Prophylaxis
- May be protected either by Ig immunization or vaccine administration
- Measles vaccine or MMR vaccine is effective if given w/in 72 hr of exposure
- Ig is administered up to 6 days post-exposure
- Indicated in susceptible contacts of measles patients eg infants <12 mth of age, immunocompromised individuals
- For infants 6-11 mth of age, MMR should be used instead of Ig if given w/in 72 hr post-exposure
1. ANTIVIRALS
- Local inj site reactions, fever, cutaneous reactions
- Use w/ caution in patients w/ gout, renal disturbances, severe gastric ulcers & digitalized patients
1.1 Inosine pranobex (Methisoprinol, Inosiplex)
- <1 yr, <9 kg: 62.5 mg PO 4 hrly
- 1-3 yr, 9-14 kg: 125 mg PO 4 hrly
- 0-7 yr, 14-21 kg: 187.5 mg PO 4 hrly
- >7 yr, >21 kg: 250 mg PO 4 hrly
2. IMMUNOGLOBULIN
- Local inj site reactions, fever, cutaneous reactions
- Administered into the deltoid muscle or into the anterolateral aspect of thigh
- Contraindicated in patients w/ thrombocytopenia & acute febrile illness
2.1 Human immunoglobulin
- Single dose IM
- 0.25 mL/kg
- Immunocompromised: 0.5 mL/kg
3. VACCINES
- CNS effects (fever, seizures, headache, rarely Guillain-barré syndrome); Dermatologic effects (rash, urticaria); GI effects (diarrhea, N/V); Other effects (inj site reactions, joint symptoms, parotitis)
- May cause temporary suppression of tuberculin skin test sensitivity
- Administered into the anterolateral aspect of thigh or arm
- Contraindicated in patients w/ allergic reaction to neomycin, gelatin or any component of the formulation, in patients w/ known anaphylactoid reaction to eggs, w/ blood dyscrasias or malignant neoplasms affecting the bone marrow or lymphatic systems & those w/ immunodeficiency
- Use w/ caution in patients w/ history of postvaccination thrombocytopenia, cerebral injury, seizures
3.1 Vaccine, measles (Measles, live, more attenuated strain vaccine)
- 0.5 mL/dose IM/SC
- Single dose from 6 mth of age followed by revaccination at 12 mth of age as combined vaccine w/ mumps & rubella
- Administered if there’s a risk of exposure to measles
3.2 Live measles, mumps & rubella virus vaccine1 [Measles, mumps, rubella (MMR), live vaccine]
- 0.5 mL/dose IM/SC
- 1st dose: 12 mth of age
- 2nd dose: 4-6 yr of age
- 2nd dose may be administered at least 4 wk since the 1st dose
- If the 2nd dose is not given, the schedule should be completed by 11-12 yr old visit
- 1Combination w/ Varicella vaccine is available. Please refer to mims.com for specific prescribing information.
4. VITAMIN A
- GI effects (vomiting, diarrhea, mouth sore, anorexia, hepatomegaly); Dermatologic effects (skin changes, alopecia, dry hair, bleeding/dry lips, pruritus); CNS effects (inc intracranial pressure, visual disturbances, headache, sedation, confusion); Other effects (fatigue, bone/joint pain, irritability, nocturia)
- Use w/ caution in patients w/ cholestatic jaundice, liver disease fat-malabsorption conditions
4.1 Retinol palmitate
- 6 mth-1 yr: 100,000 IU PO single dose
- >1 yr: 200,000 IU PO single dose
All dosage recommendations are for non-pregnant & non-breastfeeding women, non-elderly adults w/ normal renal & hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed above may not be mentioned in the disease management chart but have been placed here based on indications listed in regional manufacturers’ product information.
Specific prescribing information may be found in the latest MIMS & MIMS.com
Brands available in:
Hong Kong
Indonesia
Malaysia
Philippines
Singapore
Thailand
Vietnam
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